Totem Outdoor School Application "*" indicates required fields Child's First & Last Name* First Last Nickname Date Of Birth MM slash DD slash YYYY Age* Is there another child to register? Yes No Child 2 First & Last Name First Last Child 2 Nickname Child 2 Date Of Birth MM slash DD slash YYYY Child 2 Age Parent 1 Name* First Last Parent 1 Cell*Parent 1 Email Address* Parent 2 Name First Last Parent 2 CellParent 2 Email Address* Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Emergency Name* First Last Emergency Phone Number*Food IntoleranceAllergiesEpi Pen Provided* Yes No Medical ConditionsAny Behavioral ConcernsName of Insurance* Policy Id Number* Driver Pickup Consent Totem Outdoor SchoolCHILD 1 - pick sessionsSpring 2023 - $1000March 2nd-June 16th *no school May 25th/26th 5-10 year olds: Fridays 9:30-3:00pm 4-6 year olds: Thursdays 9:30-3:00pm none Fall 2023 - $900Fridays, September 8th-December 15th, 2023 (14 classes)*No class Nov 24th Yes No Spring 2024 - $1100Fridays, February 23rd-June 14th 2024 (17 classes) Yes No CHILD 2 - pick sessionsSpring 2023 for Child 2 - $1000March 2nd-June 16th *no school May 25th/26th 5-10 year olds: Fridays 9:30-3:00pm 4-6 year olds: Thursdays 9:30-3:00pm none Fall 2023 for Child 2 - $81010% discount Yes No Spring 2024 for Child 2 - $99010% discount Yes No Subtotal $0.00 Totem Outdoor Summer Camps 2023July 11, 12, 13 session QuantityAdd number of children Price: $250.00 Quantity July 18, 19, 20 session QuantityAdd number of children Price: $250.00 Quantity August 1, 2, 3 session QuantityAdd number of children Price: $250.00 Quantity Summer Camp Subtotal $0.00 PaymentPayment Method* Pay Online Pay by check Pay now or monthly?*If you decide to pay monthly online (not available for summer program), you will be taken to the tuition page to set up payments. If you pay the total now, you will be taken to Paypal to make your payment. You do NOT need a Paypal account to pay. Select "Pay with Debit or Credit Card" in next Paypal screen if needed. Pay all now online Pay monthly online Online Processing FeeWe provide online payment to our families as a convenience. If you prefer not to pay the online processing fee please bring your check to the school. Price: $0.00 Total Total to Pay by CheckPlease reach out to Totem Outdoor School after submitting this form if you would like to pay by check monthly (not available for summer programs). $0.00 Total DueYou will be taken to the Tuition Page after you click submit below to make your first monthly payment $0.00 Financial Obligations* I understand the financial obligations to Totem Outdoor School (Totem Preschool LLC). There are no refunds, credits or transfers of payments. Liability Release Statement* This applicant has my permission to participate in activities and events organized by Totem Outdoor School (Totem Preschool LLC). I hereby release from liability and financial obligations directly or indirectly to include teachers, staff and instructors of Totem Outdoor School (Totem Preschool LLC). I understand in a case of an accident or illness, Totem Outdoor School (Totem Preschool LLC) has my permission to secure emergency medical attention. Δ