Ohio Parks 2024 Application — Worthington Field Studies

Student Name

First Name

Last Name

Student Email Address

Student Phone Number

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent or Guardian Name

First Name

Last Name

Parent or Guardian Email Address

Parent or Guardian Phone Number

(###)

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What is your t-shirt size (student)?

School Student Currently Attends

Student's CURRENT Grade

Please list any science courses you plan to sign up for next year

Do you plan to pursue a college education?

What are your career goals?

Do you feel you are physically able to BICYCLE?

Are you afraid of heights?

If you answered "yes" to having a fear of heights, please use this space to provide information about how severe and how you handle it.

Can you swim?

Do you have a fear of water?

If you answered "yes" to having a fear of water, please use this space to provide information about how severe and how you handle it.

Do you have any allergies?

If you answered "yes" to having allergies, please list them, their severity, and your treatment plan

Do you sleepwalk or have any unusual sleeping habits?

If you answered "yes" to sleepwalking or unusual sleeping habits, please use this space to provide additional information.

Explain in some detail why you wish to participate in this program. Your answer should include why you believe you will benefit from the program.

What contributions do you believe you can make to this field study?

In answering, keep in mind that you will be acting as one member of a closely knit, efficient, social and educational group that will be living and studying together. If you have had any camping experiences, group leadership responsibilities, first aid training, life saving training, swimming abilities, special educational interests or background, be sure to mention those here.

How will you benefit or grow from participating in the trip?

Please use this space to give us any additional information you think would be helpful for us to know about you.