Chiron Registration

Please complete this form separately for each boy applying to Chiron. A $200 deposit is required to secure your spot.

Prospective Apprentice's Full Name

My son is applying for:

Two Day Chiron: Tuesdays and Thursdays

One Day Chiron: Wednesday

One Day Chiron: Friday

Birthday

Month

Day

Year

Age as of 9/1/2026

Address

Mothers Full Name

Mother's Phone Number

Mother's Email

Mother's Occupation

Father's Full Name

Father's Phone Number

Father's Email

Father's Occupation

Family's Church Affiliation

Does your son attend school part-time? If so, which school and how many days does he go?

If your son is homeschooled, what curriculum do you use?

Homeschool Groups/Co-ops/Associations that your family belongs to?

Does your son have any allergies or medical conditions of which we should be aware?

How did you learn about Riverside?

What are your four main goals for your son in attending Chiron?

What do you think are your son’s main three gifts? Or skills?

What are the three main activities your son enjoys in his off time?

What aspects of Chiron do you think your son will enjoy most? Friendship, Literature, History, Craftsmanship, Outdoor Adventure

How would you rank your son’s reading level for his age (1 being lowest and 10 highest)

How would you rank your son’s writing level for his age (1 being lowest and 10 highest)

How would you like to see your son’s personality flourish? What virtue do you believe he needs to acquire more than others?

What are your son’s main weaknesses in learning/academics?

Release And Waiver of Liability, Assumption of Risk, and Indemnity Agreement (''Agreement'') for Related Events, Field Trips & Activities (“Activity”)

I represent that I will understand the nature of an Activity and be sure that my son is qualified, in good health, and in proper physical condition to participate in such Activity.

I acknowledge that if I believe conditions are unsafe for my son/daughter, I will immediately discontinue my sons’/daughters' participation in the Activity.

I fully understand that an Activity can involve risks of serious bodily injury, which may be caused by my son/daughter's actions, or others’ actions, those of others participating in the event, the conditions in which the event takes place, or the negligence of the ''releasees'' named below; and that there may be other risks either not known to me or not readily foreseeable at this time.

I fully accept and assume all such risks and all responsibility for losses, costs, and damages I incur as a result of my son participation in the Activity.

I hereby release/discharge/covenant not to sue The Riverside Club for Adventure & Imagination, NFP/its respective administrators/directors/agents/officers/volunteers/employees/other participants/owners or lessors of premises on which the Activity takes place, (each considered one of the ''RELEASEES'' herein) from all liability/claims/demands/losses/damages on my account caused/alleged to be caused in whole/in part by the negligence of the ''releasees''/or otherwise, including negligent rescue ops.

I further agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the releasees from any loss, liability, damage, or cost which any may incur as the result of such claim.

I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

I/we, the above named Parent(s)/Guardian(s), consent to the Riverside General Waiver & Release

I/we consent to photographs and videos of my family taken during Riverside events or programming being used for Riverside promotional purposes, including but not limited to on the website, in print materials, emails, and social media.

Yes

I am interested in receiving the latest news and information on coming events at Riverside

Chiron Deposit

$200

Chiron Registration

Release And Waiver of Liability, Assumption of Risk, and Indemnity Agreement (''Agreement'') for Related Events, Field Trips & Activities (“Activity”)

Event Title

SUN

MON

TUE

WED

THU

FRI

SAT

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