APPLICANT INFORMATION
Full Name
First Name
Home Address
Address 2
Street
City
State
Zip
Home Phone
Email
Age
Date of Birth
  Male Female
Grade Completed by June 2005
School
Allergies
Medical Conditions
Can you swim? Yes No
Please select the program and corresponding dates you are interested:
June 26th-July 7th
Breaking the Limits
Session I 		June 26th-July 21st
Community Adventure
Session I 		July 10th-July 21st
Breaking the Limits
Session II 		July 24th-August 18th
Environmental Adventure
Session II
PARENTS OR GUARDIANS
Parent's name
Address (if different from above)
Street
City
State
Zip
Daytime Phone
Evening Phone
Other Parent's or legal guardian's name
Address (if different from above)
Street
City
State
Zip
Daytime Phone
Evening Phone
APPLICANT QUESTION
1. Why do you want to participate in a Broadtree program?
2. Describe an experience you had that was an adventure or was a new experience or challenge. Why was this experience important to you?
3.If you could go on any kind of adventure or trip, where would you go and what would you do?
4. How do you feel about trying new things? Tell me about an experience where you’ve tried something new. How did you react? How did it make you feel?
APPLICATIONS, TUITION AND WAIVERS
APPLICATIONS
Applications for our programs are always excepted but given that there are only fifteen participants per program, the sessions fill up pretty quickly. You may be wait-listed for participation in one of our programs but will be notified upon the receipt of your application. Both the applicant and his/her parent/guardian must sign the application form.
WAIVERS
Participants and parents/guardians will be required to sign the enclosed release forms before our programs begin. Participants will be excluded from the program until the release form is signed. This can be mailed in with this application.
TUITION
Participants must pay $25 to Broadtree in order to reserve their spot  in the program. Payment must be received one week prior to the beginning of the program. Checks can be made out to Broadtree Adventures in Education.
TERMS AND CONDITIONS
Broadtree Team Member Agreement

As a member of a Broadtree team, I recognize that I am a part of a larger community and that my commitment will impact the quality of the experience for everyone else in my team. My signing below, I promise that I will go join the Broadtree program with dedication and an open mind to meeting new people and trying new things. I also agree to following the rules that I and my team establish upon the beginning of the program. I commit to keeping myself and the other team members safe and will not  knowingly do anything to jeopardize the safety of myself or the group.

I commit to not using or carrying with me during the Broadtree program, any alcohol or tobacco products, illegal substances, or weapons of any kind.  I will treat myself and each of my team members with respect and will not judge others unfairly. I agree that disregard for the commitments that I have made here or other behavior harmful to my team could result in my dismissal from the Broadtree program. I have read and agree to all the conditions of this Application for Summer Expedition.
Applicant Name
Parent/Guardian Agreement
I, the parent/guardian of the applicant, understand that teamwork and community are critical to the success of Broadtree’s programs and that any behavior on the part of my child that is harmful to the other participants, or that compromises the safety of the participants, may result in my child’s expulsion from the program, at my expense and without a tuition refund from Broadtree Adventures in Education. I will disclose to Broadtree Adventures in Education, well in advance of the start date, any special behaviors or medical conditions my child may exhibit. I have read, understand, and accept the term s and conditions of this application.
Parent Name