Call 414.526.5747
Complete this on-line
form to reserve a spot.
What's Your
Adventure Therapy?
Therapeutic Outdoor Programs
© 2010 New Vision Wilderness, LLC  1580 S. 81st St., West Allis, WI 53214  phone 414.526.5747  fax 414.744.6288  info@newvisionwilderness.com
Inspiring Change...By Nature.
Register Here.
Please complete all fields as thoroughly as possible.  This on-line registration helps to ensure your spot on
the next NVW course, and initiates the enrollment process. Once submitted, your registration will be
reviewed by our staff.  You can continue with the enrollment process by downloading the Intake Packet.  
If you are unable to download and print the Intake Packet on-line, please click here to request a packet
be sent to you via mail. A deposit of 30% of the course fee is required.
NVW Offers
Scholarships
(limited availability
to qualifying families)
Youth Serving
Agencies are
eligible for
discount  
rates.
Participant Information
Registration is easy!  Follow these steps:

1. Complete this on-line registration. This
provides our office with basic information, and
reserves your preferred dates. We will review
your submission, and get back to you right away.  
To hold your spot for a 21-day Expedition, a
non-refundable deposit of 30% of the full course
fee is required. Deposits are transferable.

2. Download and complete the Intake Packet. We
can mail a copy too.

3. Mail completed Intake Packet along with
check to New Vision Wilderness.

Payment:

Full payment and the Intake Packet must be
received at least 30 days prior to the beginning
of the course. Make checks payable to New
Vision Wilderness, LLC.  We cannot accept
insurance payments or credit cards at this time.

Cancellation Policy:

Cancellations are subject to charges and fees.
Download our complete Cancellation Policy. In
the event that a course is cancelled due to low
enrollment, your fee will be completely refunded.

Mail to:   

New Vision Wilderness
1580 S. 81st St.
West Allis, WI 53214
Participants Name:
Male
      
 Female
       
Participant Birth Date:
Participant Age:
Participant Grade:
Participant School:
Yes
 No
Can He/She Swim?
Parent/Guardian Information
Parent/Guardian Name:
Relationship:
E-Mail:
Home Phone:
Cell Phone:
Work Phone:
Address:
Important Information:
Emotional/Behavioral History: (issues, concerns, diagnosis,
placements, etc)
Does the participant have any known Allergies? If yes, please list below.
Yes
 No
Medical History: (allergies, asthma, disabilities, limitations )
Medications. Names, times, dosages, reason:
Participants Health Insurance Company and Policy Number:
Additional Comments:
Person Completing Registration:
 Referral Contact. Name/Phone/E-mail:
Client Sizing Info:
 Height:
 Weight:
 Shoe Size:
 Shirt Size:
 Waist Size:
Preferred Course Dates: Check the box of your preferred date/dates for 2010. Dates/Fees are subject to change.
Open Enrollment
Course #
Dates
Gender
# Days
Ages
Fees ($)
OPEN
Open Enrollment
all
30-60 avg.
12-17
call
21-Day Expeditions
Course #
Dates
Gender
# Days
Ages
Fees ($)
046
June 14-July 5
Boys
21
12-17
call
047
July 11-July 3
Boys
21
12-17
call
048
July 12- Aug. 1
Girls
21
12-17
call
049
Aug. 9-29
Boys
21
12-17
call
Course #
Dates
Gender
# Days
Ages
Fees ($)
050
Sept. 13- Oct. 3
Boys
21
12-17
call
051
Sept. 13- Oct. 3
Girls
21
12-17
call
052
Oct. 18- Nov. 7
Boys
21
12-17
call
053
Oct. 18- Nov. 7
Girls
21
12-17
call
054
Nov. 29- Dec. 19
Boys
21
12-17
call
Refresher Programs and 1:1 Trip
Course #
Dates
Gender
# Days
Ages
Fees ($)
055
November 12-15
Boys
4
12-17
call
056
November 12-15
Girls
4
12-17
call
057
TBD
Boys
4
12-17
call
Course #
Dates
Gender
# Days
Ages
Fees ($)
1:1
One on One Trip
all
10 min.
all
call
Thank You.