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Heartwood Participant Registration Application
Parent First/Last Name
Parent Phone Number
Participant First/Last Name
Please describe participant's ability to engage in social activities. What are participant's social strengths and limitations? What age peers does participant feel comfortable/uncomfortable interacting with? Please be as specific as possible.
Please describe participants general interests and skills. Please be as specific as possible (i.e. if participant likes music what genres, what instruments, do they play alone in a group, etc.)
Does participant have any learning disabilities that we should be aware of? Does participant have a preferred learning style?
Parent Email
What trip are you applying for?
Choose an option
Participant Preferred Gender and Age
Please describe participant's physical abilities. How often does participant exercise and in what way(s)? What physical activities does participant enjoy/not enjoy? Please be as specific as possible.
Why is participant interested in this experience? What are they looking forward to most? What are they looking forward to least? Are there skills that participant is excited to learn?
Is there anything else that we should know about participant to ensure the best group fit?
If you would like to apply for a scholarship please let us know whether you prefer a payment plan (3 installments over 3 months) or a reduced rate. If you are requesting a reduced rate please let us know how much your family is able to contribute at this time.
Please add me to the Heartwood mailing list to learn about upcoming experiences
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