Register for New Vision Wilderness.

Course #

Program

Gender

Dates

# Days

Ages

Fees ($)

020

Wilderness Intervention

Boys

Sept. 26-29

13-17

980

021

Wilderness Expedition

Boys

Oct. 6-26

13-17

5250

022

Wilderness Intervention

Boys

Oct. 24-27

13-17

980

023

Wilderness Intervention

Boys

Nov. 7-10

13-17

980

Course #

Program

Gender

Dates

# Days

Ages

Fees ($)

024

Wilderness Intervention

Boys

Dec.19-22

13-17

980

025

Wilderness Expedition

Boys

Jan. 2-18

13-17

3725

026

Wilderness Intervention

Boys

Jan. 23-26

13-17

1100

027

Wilderness Intervention

Girls

Feb. 20-23

13-17

1100

Course #

Program

Gender

Dates

# Days

Ages

Fees ($)

028

Wilderness Expedition

Boys

March 2-22

13-17

5250

029

Family Wilderness

Co-Ed

April 24-26

all

TBD

030

Rocky Mountain
Expedition
(this trip is to Colorado)

Boys

April 4-13

13-17

2700

1:1

One on One Course

Single

TBD

all

TBD

Participant Information

Parent/Guardian Information

Participants Name:

Parent/Guardian Name:

Male

Female

Relationship:

E-Mail:

Participant Birth Date:

Home Phone:

Participant Age:

Cell Phone:

Participant Grade:

Work Phone:

Participant School:

Address:

Can He/She Swim?

Yes

Important Information:

Emotional/Behavioral History: (issues, concerns, diagnosis,
placements, etc)

Medications. Names, times, dosages, reason:

Participants Health Insurance Company and Policy Number:

Does the participant have any known Allergies? If yes, please list below.

Yes

Medical History: (allergies, asthma, disabilities, limitations )

Referral Contact. Name/Phone/E-mail.

Additional Comments:

Preferred Course Dates: (check the box of your preferred date for 2008/2009) Dates/Fees are subject to change.

Thank You.

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 for 21-Day Expeditions.

Forms Corner...Just download and print.

Intake Packet (pdf)
Packing List-21 Day Summer
P acking List-4/9 Day Summer
Packing List- 4/9 Day Winter