Personal Information
Name: __________________________________Age: ________
Address: _____________________________________________
City:__________________________ State:_____ Zip:_________
Phone: (home) (work)
Occupation: ___________________________________________
Course name: _________________________________________
Course date: __________________________________________
Previous courses attended: ______________________________
Medical & Emergency information
Contact name:_________________________________________
Phone: (home) (work) ____________
Are you allergic to any food, medicine or insects?
If yes, please explain: ___________________________
Please indicate any medical problem:
___________________________________________________
How did you hear about the school?
___________________________________________________
Please return the application form along with the non-refundable,
non-transferable tuition fee for the class. (Money order
or cashiers check made payable to: Backyard Tourist, Inc)
Confirmation, travel instructions, and equipment list will
be sent upon enrollment.
Signature: _________________________________________
Date: _____________________________________________
All classes in earth-related skills are based on the knowledge
passed down by the Apache Elder and Native American Medicine
man, Stalking Wolf, emphasizing man’s delicate balance
with nature and how we must work together to heal our Earth
and live in harmony.
Backyard Tourist, Inc
12061 Wildcat Canyon Rd.
Lakeside, CA 92040
(619) 443-2399
E-mail: susan.conniry@gcccd.net
|
