Course Registration Form

Thank you for signing up! Please fill out the form below to complete your registration. Once you hit submit, we’ll be in touch soon with more details. Email info.santacruzpermaculture@gmail.com with questions.

Course Registration Information

Name(Required)

First Last

Preferred Name (If different than above)

In which course are you enrolling?(Required)

Email(Required)

Phone(Required)

Gender Pronoun(s)(Required)

This helps us understand the best way to address you. For example, choose "She/her" if you want us to say "She's celebrating her birthday today." Choose all that apply.

She/Her

He/Him

They/Them

I prefer not to say

Other

Your Age(Required)

City(Required)

(where you live and/or where you will be coming from prior to the course)

Carpooling. Would you like to be in touch with other participants about carpooling?(Required)

Yes

Camping. Will you be staying on site, either in your vehicle or in a tent?(Required)

You can change your mind at any time. We just need to get a general headcount.

Yes - I'm staying in a tent

Yes - I'm staying in my car/truck

No - I'm not staying onsite.

Other

Dietary Preferences.(Required)

We typically have lunchtime potlucks during the course. To make this easier, please list any dietary restrictions or preferences.

Accessibility. Do you require wheelchair access or have any other special needs?(Required)

Yes

If you signed up for one weekend only, which weekend do you plan to attend?(Required)

Refund Policy(Required)

The refund policy is also stated on the course website. Cancellations up to two weeks before the course begins will be refunded, excluding a $150 processing fee. No refunds are given after that date.Participants are welcome to defer their enrollment to the next session of the course.

I have read and agree to the refund policy

Online courses when necessary(Required)

We intend to have all of our sessions onsite and in person. However, due to unforeseen circumstances such as fire, poor air quality, COVID restrictions where an instructor cannot come, or rain, we are prepared to move class online. We always prefer to hold class onsite when possible, but we do host great and engaging online classes when needed.

I understand that class may be moved online when necessary, as explained in the above statement.

How did you hear about us?(Required)

Google (what did you search for, or did you see an ad - please specify below)

Other search engine (which one - please specify below)

Facebook (please specify which group or page below)

Instagram (please specify which group or page below)

Good Times Email

Poster (please specify where below)

Friend / Word of mouth (please specify who below)

Radio (please specify where below)

Conference / Event (please specify where below)

Farmers Market (please specify which location below)

Other (please specify below)

How did you hear about us? (if applicable)

To the best of your recollection, when did you first hear about the course?(Required)

To the best of your recollection, when did you first consider signing up?(Required)

What prompted you to take the next step and sign up?(Required)

What other permaculture courses have you taken, if any?(Required)

Full Permaculture Design Certificate (PDC)

Introduction to Permaculture (2 days or less)

Advanced Permaculture Courses (please specify below)

None

Other..

What's your current job/profession?(Required)

This is for the purpose of building professional connections within our community.

What company/organization do you work for/at?(Required)

What are your main hobbies and/or other organizations you are involved with?(Required)

Anything else you want us to know about you?

Course Participant Liability Waiver & Agreement

I wish to participate in a Santa Cruz Permaculture (“SCP”) course (the “Course”). By signing below, I, the Course Participant (or the Course Participant’s legal guardian, on the Course Participant’s behalf) agree that:

Policies and Safety Rules.
For my safety and that of others, I will comply with SCP’s Course policies and safety rules and its other directions for all Course activities.

Awareness and Assumption of Risk.
I understand that my participation in the Course has inherent risks that may arise from SCP’s operations, my own actions or inactions, or the actions or inactions of SCP, its director, instructors, volunteers, and others present at the Course. These risks may include, but are not limited to, dangers and conditions inherent to Course activities and course property, including bees, insects, poison oak, dust, uneven terrain, allergens, and hand tools. I assume full responsibility for any and all risks of bodily injury, death or property damage caused by or arising directly or indirectly from my presence at Course sites or participation in SCP activities and Courses, regardless of the cause.

Waiver and Release of Claims.
I waive and release any and all claims against the owner or owners of premises on which the Course takes place (collectively, the “Landowner”), SCP, other tenants of Landowner’s premises, and SCP’s, Landowner’s, and other tenants’ directors, employees, volunteers, and affiliates (collectively, the “Released Parties”), for any liability, loss, damages, claims, expenses and attorneys’ fees (collectively, “Liabilities”) resulting from death, or injury to my person or property, caused by or arising directly or indirectly from my presence at the Course, or participation in SCP activities or Courses, regardless of the cause and even if caused by negligence, whether passive or active. I agree not to sue any of the Released Parties on the basis of these waived and released claims. I waive the protections of Section 1542 of the California Civil Code, which provides that a general release does not extend to certain claims not known to me at the time I signed this waiver and release. I understand that SCP would not permit my participation without my agreeing to these waivers and releases.

Medical Care Consent and Waiver.
I authorize SCP to provide to me first aid and, through medical personnel of its choice, medical assistance, transportation, and emergency medical services. This consent does not impose a duty upon SCP to provide such assistance, transportation, or services. In addition, I waive and release any claims against the Released Parties arising out of any first aid, treatment or medical service, including the lack or timing of such, made in connection with my participation in the Course.

Publicity.
I consent to the unrestricted use in any form of any photographs, interviews, film, videotapes, other visual or auditory recordings, in any other medium, including the Internet, of me that the Released Parties or others may create in connection with my participation in the Course. I waive my right to inspect or approve the finished product and acknowledge that I am not entitled to any compensation for creation or use of the finished product.

Indemnification.
I will defend, indemnify, and hold the Released Parties harmless from and against any and all Liabilities, including without limitation, Liabilities arising from any injury, property damage, or death that may be suffered by me or any person in relationship with me or any other third party, which may arise directly or indirectly from my participation in the Course, except and only to the extent the liability is caused by the gross negligence or willful misconduct of the relevant Released Party.

Course Participant Name(Required)

I affirm that I am the course participant named above.(Required)

Yes, I am the course participant.

No, the course participant is under 18 years old, and I am the course participant's parent or legal guardian.

Course Participant or Parent/Guardian Signature(Required)

Please write your name above as your legal signature if you agree to this liability waiver and agreement as described above.

Emergency Information

This information will not be shared with anyone except course instructors, course support team, and in the case of an emergency, medical personnel.

Are you under 18 years old?(Required)

No, I am at least 18 years old.

Yes, I am under 18 years old.

Name of Primary Emergency Contact(Required)

Relationship of Primary Emergency Contact to Course Participant(Required)

Phone Number of Primary Emergency Contact(Required)

Name of Secondary Emergency Contact (Optional)

Relationship of Secondary Emergency Contact to Course Participant

Phone Number of Secondary Emergency Contact

Is there any medical information about yourself that you would like us to know? (Optional)

Examples include severe allergies, asthma, medications you carry with you, or other information that would help save your life in an emergency.

Are you First Aid/CPR certified?(Required)

It's helpful for our team to know who might be able to assist in an emergency medical situation. If you have other medical/emergency certifications or qualifications that would be useful for us to know, please answer Other and describe.

Yes

Other

This field is for validation purposes and should be left unchanged.

Course Registration Information

Course Participant Liability Waiver & Agreement

Emergency Information

SANTA CRUZ PERMACULTURE

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