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Please fill out the following information, sign and initial where indicated. Email completed package to

********  This will be link to fillable PDF  *********



My child has had/ has not had the recommended immunizations.


***Note: It is strongly recommended by health authorities that your child has had all of the recommended immunizations unless there is a medical reason not to do so.


Emergency Contacts

As per your registration form, it should be stated that your child will only be released to an authorized person listed on the Registration Form. A parent’s verbal authorization for pick up must be received before your child will be released to anyone who isn’t listed. If verbal authorization hasn’t been received prior to pick up and we are unable to reach you directly by phone, the child will not be released.

______ Initial

Payment Policy


I agree to paying the monthly tuition fees to Muddy Boot Prints on the 1st of each month, either through post dated cheques, monthly e-transfers or via auto withdrawal. I acknowledge that I will not be reimbursed for any missed days of the program due to my child being sick or unforeseen circumstances.


__________________________ Signature of Parent

____________ Date


Participant Agreement/Waiver


Code of Conduct

Developing an understanding of and responsibility for individual potential and abilities includes accepting responsibility for individual actions. While under the leadership of skilled staff, the activities that your child will engage in as a participant in the Muddy Boot Prints programs involve risk—in choices made by the participant. As a condition of being allowed to participate in the Muddy Boot Prints programs, you warrant the participant is in good physical and mental health. You agree that intentional participant behavior that puts the participant or others at physical or emotional risk will result in immediate dismissal from the program at the discretion of the program’s Director. Expense incurred because of program dismissal will be the responsibility of the participant/parent.


Description of Risks

I am aware that there are inherent risks involved with being a part of this outdoor education program. This includes my child’s use of any equipment. The risks and hazards of outdoor activity may include but are not limited to;

  • Injuries from engaging in self directed risky play and other physical activities
  • Injuries from failing to properly use tools such as hammers
  • The presence of ticks, dogs and other insects

Furthermore, I am aware;

  • That injuries sustained in outdoor activity can be severe
  • That safety is of the utmost importance and all rules are verbally explained and outlined. These rules are designed to enhance the safety of my child and others and are expected to be followed by the child at all times
  • That any work with tools require special instruction and training that will be given from the facilitators and educators of Muddy Boot Prints
  • My child’s risk of injury increases with fatigue



I release Muddy Boot Prints, it’s Directors, Facilitators, Educators, Volunteers, Vancouver Parks Board, and EartHand Gleaners of all responsibility for any injury, loss or damage which my child might sustain while participating in any Muddy Boot Prints program activities.



I acknowledge that I have read and fully understand this agreement, while accepting the risks involved with my child’s participation in these activities with Muddy Boot Prints.


_______________________Signature of Parent


_______________________Printed Name of Child


_______________ Date                              


Photography Consent Form


Muddy Boot Prints Website/Blog/


In an effort to keep registered parents connected to what happens in our program we will be uploading photos and blog entries to our website, The website is a way for registered parents to stay in touch and a way for interested parents to view what our program looks like. This communication is best done with photos and brief explanations of the shown activities. Please indicate if you would be comfortable with images of your child’s face being used as indicated above.


I give my permission for Muddy Boot Prints to use my child’s image on their website and blog as indicated in the above paragraph:



____ No



Muddy Boot Prints will occasionally advertise at different festivals and childcare fairs around Vancouver BC. Pictures of the program will be used for display to show interested families about our programs. Please indicate if you are comfortable with images of your child’s face being used in this manner.


I give my permission to Muddy Boot Prints to use my child’s image as indicated in the above paragraph.


_____  Yes

_____   No


News Media

It is possible that local news media will broadcast or publish articles about Muddy Boot Prints and will request to use images/video footage that include one or more children. Please indicate whether it is okay to use your child’s image in articles/news stories that are in association with Muddy Boot Prints.


I give my permission to Muddy  Boot Prints to use my child’s image as indicated in the above paragraph.

____ Yes

____ No



Name of Parent






Name of Child





Withdrawal Policy


Family’s Request for Withdrawal from Muddy Boots Program


Upon registration, a deposit of one month’s fees is required. This deposit will be held, interest free and put towards your final month of tuition with us be it in June or another date.


During the school year if you would to withdrawal from our program or make changes to your current program (add more or less days), you must offer written notice a full 30 days in advance by the 1st of the month prior to the affected date. (ie: giving notice on January 1st for program changes starting February 1st) Failure to do so will mean that your deposit is forfeited and you will be expected to pay your final month’s tuition whenever that happens to be.


Section A:

The last date to be eligible to withdraw or make changes during the school year and receive a refund is March 1st for leaving April 1st. No deposits will be returned after this deadline.

Section B

If you register in Spring for the Fall term in September, withdrawals or changes made before September for the upcoming new school year will result in your deposit being forfeited.  (Once the school year has begun in September, please refer to section A.


Muddy Boot Prints Request for Withdrawal


Muddy Boot Prints can terminate its services to a family under the following circumstances:

  1. If tuition fees are not paid in full and on time or  appropriate arrangements cannot be agreed upon
  2. If the Director of Muddy Boot Prints is unable to satisfactorily resolve a conflict or concern with a family  
  3. If a family member harasses, threatens or commits a violent or unlawful act toward a staff member, child or other family involved in the program
  4. If a family continually picks up their child late without having made previous suitable arrangements
  5. If, in the assessment of the educators, a child is unable to be safely managed in a group of children within the given adult-to-child ratio. In this case, termination of services will be a measure of last resort.


I have read and understand Muddy Boot Prints withdrawal policy.


__________________________ ___________________________ ___________________

Parent Name       Parent Signature   Date                            


Muddy Boot Prints Field Trip Authorization Form


I, ___________________________________  (Parent’s name)  give Muddy Boot Prints,


permission to take my child, ______________________________ (Child’s name) on short field trips


and other outings as part of the Muddy Boot Prints Programs.  This includes using local transit or


walking trips throughout the neighbourhood.


___________________________________ _______________________

Parent Signature                                              Date


___________________________________ ________________________

Director Signature                                   Date




Please take a quick moment to answer a few more questions about your child. These questions are meant to assist us in getting to know your child better prior to to them joining our program. It is our goal to make the time your child spends with us as comfortable and fun as possible. Knowing some of the finer details really helps us do that.


Does your child have a fear of dogs?


Does your child adapt well to new situations?


Is your child prone to running off on their own? (answering yes to this question won’t stop your child from being accepted into the program we assure you. It merely offers us a heads up in regards to their natural tendencies.)


What is your child’s energy level (1-10)?


Does your child have any specific interests in or concerns about the outdoors?


Describe your family’s connection to the natural world?


Does you child have any experience toileting outdoors?


What is your child’s comfort level around animals?