Registration Form / Questioner / Disclaimer

Your Name ______________________________________
What is the date of the workshop you will be
attending__________________
Do you have a physical limitation or allergies (including foods) that I
should be aware of?
Is this your first workshop here?
Please rate your interest on a variety of possible topics. 1-5
(1 is not much, 5 will be the most)
Plants______Birds______Insects_______Art exploration_____
Book making_______Native American Lore______Camaraderie_______
Nature walking_______Learning the chaparral_____
Connection with nature_________Plant technologies________
What is your age bracket 12-25, 26-55, 56-80
What is your contact information (phone, e-mail or address)

______________________
________________________________________________________________________
Are you attending as part of a group of friends?

Please make your check payable to Nina Karavasiles. Send it to
28802 Chihuahua Valley Road, Warner Springs CA 92086.
Amount is $110.00 unless you fall under a special discount arrangement.

Cancelation Policy. There is a $40.00 nonrefundable deposit paid 2
weeks prior to the workshop. The balance of $70.00 is due on the day of the workshop. Please notify me as soon as possible so someone might take you space.

Age restrictions. Due to the difficulty and concentration level necessary for the workshop, children under 12 are not recommended. I am, however happy to do a special workshop for just children under 12 which would be tailored to their needs, level, and taste palate. Contact me directly.

Disclaimer. Please read and initial and date.
As with all outdoor activities in the back country area, there is always a danger of being bitten or stung. Other aspects to be aware of is the 4,000 foot elevation, strong sun, uneven foot paths and possible allergic reactions to new foods.

Nina Karavasiles is not liable for bodily injury or property damage as a result of (but not limited to): physical exertion for which a guest is not prepared; forces of nature; travel by foot or other form of active travel including getting to the site via directions; consumption of alcoholic beverages; civil unrest;terrorism; breakdown of equipment; high altitude; lack of or limited access to medical attention in remote
locations; and the adequacy of medical attention once provided. Always
exercise common sense and caution.

Initials_____________________Date_________________________________