Complete this on-line
form to reserve a spot.
What's Your
Adventure Therapy?
Therapeutic Outdoor Programs
Inspiring Change...By Nature.
Register Here.
Please complete all fields as thoroughly as possible.  This on-line application helps to ensure your spot on
the preferred NVW course, and initiates the admissions process. Once submitted, your application will be
reviewed by our admissions team.  You can continue with the admissions process by clicking here to
request an admission packet be sent to you via e-mail.
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 application. 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 a spot for a Milestone 21-day Expedition, a
non-refundable deposit of 30% of the full course
fee is required. Deposits are transferable.

If enrolling in QUEST our admissions team will guide
you through the process.

2. Receive the Admission Packet from our office.

3. Fax completed Admission Packet to New Vision
Wilderness.

Payment:

Full payment and the Admission Packet must be
received prior to admission.  We cannot accept
insurance payments. Credit card may be used for
deposit or payment. Make checks or cashier check
for remaining balance payable to New Vision
Wilderness LLC.

Cancellation Policy:

Cancellations are subject to charges and fees.
Contact the NVW office for more information. In
the event that a course is cancelled due to low
enrollment, your fee will be completely refunded.

Mail to:   

New Vision Wilderness
Attn. Admissions
1580 S. 81st St.
Milwaukee, 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:
Post Trip Summary Option: (check one)
Standard Summary
Participants Health Insurance Company and Policy Number:
Advanced Summary (additional fee applies)
Unsure at this time.
Additional Comments:
Person Completing Registration:
 Referral Contact. Name/Phone/E-mail:
Height:
 Weight:
 Shoe Size:
 Shirt Size:
 Waist Size:
Client Sizing Info:
Preferred Course Dates: Check the box of your preferred date/dates for 2011. Dates/Fees are subject to change.
Open Enrollment
Course #
Dates
Gender
# Days
Ages
Fees ($)
QUEST
Open Enrollment
all
30 minimum
12-17
call
MILESTONE:21-Day Expeditions Winter/Spring 2012:
Course #
Dates
Gender
# Days
Ages
Fees ($)
076
February 6-26
Boys
21
12-17
call
077
February 7-27
Girls
21
12-17
call
078
March 12-April 1
Boys
21
12-17
call
079
March 13-April 2
Girls
21
12-17
call
080
 April 16-May 6
 Boys
 21
 12-17
 call
081
April 17-May 7
Girls
21
12-17
call
Refresher Programs and 1:1 Trip
Course #
Dates
Gender
# Days
Ages
Fees ($)
082
January 13-16
Boys/Girls
4
12-17
call
083
tbd
Boys/Girls
4
12-17
call
 
 
 
 
 
 
Course #
Dates
Gender
# Days
Ages
Fees ($)
1:1
One on One Trip
all
10 min.
all
call
Thank You.
© 2012 New Vision Wilderness, LLC  1580 S. 81st St., Milwaukee, WI 53214  admissions (414) 801-9791 office/fax (414) 744.6288  info@newvisionwilderness.com
Call Admissions
414-801-9791