Ventura Wild Fall Session I
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Registration Form
Class ID
Payment Plan
Class Capacity Status
Participant Information
First Name (child)
Last Name (child)
Preferred Name (Optional)
Birthdate
Pronouns
Please select...
He/Him
She/Her
They/Them
Ze/Hir
Not Listed
Prefer not to Answer
Name of School/Homeschool or N/A
Program Information
Selected Class
Price
$
Waitlist
This class is currently full.
You'll be added to the waitlist and we'll contact you if a space opens. No payment is due now — just submit to hold your place.
Friend/Sibling requests? (We will do our best to place together, but no guarantees)
Will you be requesting charter funds?
Yes
No
Charter Fund Request Details
Attach screenshot or picture of charter fund request.
Date charter funds request was submitted to school.
Please enter any extra details about your charter fund request.
Media Release: Pictures and videos taken of the Ventura Wild programs and participants may be used for publicity and publication. I understand these materials are to educate and inform about the program.
Yes
No
Participant Data
Participant swim ability
Please select...
Swims like a fish
Needs careful supervision
Not a swimmer
Has the participant been stung by a bee/wasp?
Yes
No
If yes, did the participant have an allergic reaction?
Yes
No
Does the participant have any food allergies?
Yes
No
If yes, please describe the allergy (what & severity)
Does the participant have any allergies to insects or plants of any kind?
Yes
No
If yes, please describe the allergy (what & severity)
If your child comes into contact with a known or unknown allergen and anaphylaxis is suspected, do you give permission for our staff to administer 1 chewable children's Benadryl tablet (12.5 mg) per the recommendation of emergency personnel?
Yes
No
Does the participant have any medical conditions which restrict participation in vigorous physical activity?
Yes
No
Does the participant have a history of asthma?
Yes
No
Does the participant have a h
istory of seizures?
Yes
No
Does the participant carry an inhaler, epi-pen, or other emergency medication?
Yes
No
Please provide the particpant's emergency medical plan.
Does the participant take regular medication that we should know about?
Yes
No
Is there a recent surgery or other pertinent medical information?
Yes
No
Does the participant have any physical, sensory, cognitive, or emotional disabilities (including ADD, ADHD, sensory processing, autistic spectrum)?
Yes
No
Please provide details for all 'Yes' responses above.
Please share with us any other physical or emotional ways the participant might need extra support or awareness.
If registering for a Parent/Guardian + Child program, do the participating adult(s) have any medical conditions or allergies we should be aware of? If so, please describe.
Parent/Guardian #1 Information
First Name
Last Name
Relationship to Participant
Email
Email Type
Personal
Work
Mobile Phone
Street Address
City
State (XX)
Zip Code
Does the second adult live at the same address as the Primary Parent/Guardian/Adult?
Same Household
Different Household
Parent/Guardian or Adult #2 Information
First Name
Last Name
Relationship to Participant
Email
Email Type
Personal
Work
Mobile Phone
Parent/Guardian or Adult #2 Information
First Name
Last Name
Relationship to Participant
Email
Email Type
Personal
Work
Mobile Phone
Street Address
City
State (XX)
Zip Code
Caregiver
Enter contact information for another caregiver for the participant (optional).
First Name
Last Name
Relationship to Participant
Email
Email Type
Personal
Work
Mobile Phone
Authorized Pick Ups
Please list all individual(s) authorized to pick up your child from Ventura Wild programs (first and last name and phone number for each)
Additional Notes
Please add any additional notes here.
Ventura Wild Cancellation Policy:
Within 48 hours of registering you can receive the full registration refund minus 10% processing fee. After that, if we can fill the spot, you can receive a full refund minus 10% processing fee. If we cannot fill the spot, we are unable to issue a refund. Within 48 hours of your program starting and after the program has begun, there will be NO refund provided. It is just too hard to fill programs with such short notice. Thank you for considering this before registering.
The 10% processing fee is calculated by the total value of the program.
NOTE:
Though we do have waitlists, people often make other plans and we can’t always fill a spot on short notice. If programs must be cancelled due to program-related reasons, you will receive a prorated refund for all remaining days of program (minus the 10% processing fee).
TO CANCEL:
We have worked very hard to find and train our staff. Late cancellations hugely affect staff confidence in employment, and our budget and sustainability. Thank you for your consideration when making your decision to cancel. To cancel, please send your request via email to
venturawild@venturalandtrust.org
or call the director, Trudy at
805-941-9453
.
Additional Donation
Additional donations will be used to help provide scholarships to those who might otherwise be unable to participate. We thank you for your generosity!
Honeybee Support ($20)
A meaningful gift that helps make nature-based education accessible to a child in need.
Raccoon Fund ($50)
A generous gift that helps offset the cost of a scholarship for a child in need.
Coyote Sponsor ($100)
A generous gift that covers a significant portion of a child's scholarship.
Condor Scholarship ($385 or more)
A transformative gift that provides a full-ride scholarship for a child in need.
Would you like to make an additional donation to Ventura Wild?
Not at this time
Honeybee Support
($20)
Raccoon Fund
($50)
Coyote Sponsor
($100)
Condor Scholarship
($385)
Other
Other Amount
$
Tuition Payment Plan
Selected Class
Price
$
Waitlist
This class is currently full.
You'll be added to the waitlist and we'll contact you if a space opens. No payment is due now — just submit to hold your place.
Charter
You indicated that you have requested charter funds to pay tuition. You will not be charged at this time (unless you have included an extra donation).
How would you like to pay for Ventura Wild tuition?
Pay in Full
How would you like to pay for Ventura Wild tuition?
Pay in Full
Two Payments
How would you like to pay for Ventura Wild tuition?
Pay in Full
Two Payments
Five Payments
Plan2 Amount
Plan5 Amount
PlanFull Amount
Selected Payment Plan
Donation Amount
Tuition Payment Amount
Credit Card Information
Optionally add credit card processing fee?
Yes
No
Processing Fee
Charge Amount
$
Name on Card
Billing Zip Code
Cardholder's Email
Card Number
MM
YY
CVV Code
