Participant Intake Form

Parent/Guardian Name(s):

First

Last

where weather group

Phone numbers

Email Address:

City / Area:

The Children (names, ages and 5 words to describe them):

What role does nature currently play in your family’s life?

When you imagine your child growing up, what qualities or capacities matter most to you? (examples: confidence, curiosity, resilience, independence, connection, etc.)

What draws you toward something like Moss & Compass right now?

What kind of community are you hoping to find or build for your family?

How do you tend to show up in group settings? (observing, engaging, facilitating, quiet presence, etc.)

Is there anything that would help you or your child feel more supported in a group environment?

How would you describe your child in outdoor or new environments?

What helps your child feel confident and at ease?

Are there any sensitivities, fears, or needs you’d like me to be aware of?

Does your child have any allergies or medical considerations?

Yes
No

If yes, please share details

2 Emergency Contacts (name + phone, other than you):

Understanding Moss & Compass is a parent-attended program. Children remain under the care and supervision of their parent/guardian at all times.

I understand and agree

This program takes place outdoors and includes natural elements such as uneven terrain, weather changes, insects, plants, and physical activity.

I understand and accept these inherent risks

The Founding Cohort is called Soil – where everything begins, a 6-week, relationship-based experience. Consistency supports both your child and the group as a whole.

I intend to attend regularly and engage in the experience

Investment: The full 6-week session is offered on a sliding scale per family of 4, then per person. We operate on a trust-based sliding scale: $222 – Sponsored by community rate; $333 – Supported rate; $444 – True rate; $555 – Community Sponsorship rate

I understand and am prepared to complete payment if admitted

What feels important for me to know about your family that hasn’t been asked here?

Have any ideas you want to share?

Thank you for taking the time to share more about your family. If this feels like a strong mutual fit, you’ll receive next steps and an invitation to join the Founding Soil Collective.

Client Three