2024 Fir Acres Writing Workshop Online Enrollment Information

Please complete online enrollment no later than May 1, 2024.


Having complete and accurate participant information is essential for us to provide a safe and supportive environment for everyone. Any updates should be communicated to Workshop staff before participant’s arrival. Information will be kept confidential and only shared with Workshop staff and health providers on a need-to-know basis.

This online enrollment must be completed in one sitting and shouldn’t be submitted unless all required materials (required form) have been signed and uploaded. Please only submit this online enrollment form once, and please be sure to complete every section marked with an asterisk* to make sure the form properly submits to us; this may mean simply typing in “N/A” if the section doesn’t apply to you or your young writer. If you answer “yes” to Diabetes, Anaphylaxis, or Asthma, or if you need to submit further Written Medical Documentation, you can find forms and links at the bottom of the main enrollment page.

In order to complete this portion of your online enrollment, you will need the signature page of the “Authorization to Participate” and “Community Code of Conduct” form signed and saved on your computer in order to upload. Please upload your signature page as a PDF file. You can download this form below under “Required Document.”

Thank you so much for filling out this form early!


All fields marked with asterisk (*) are required.

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PARTICIPANT INFORMATION

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Current Grade*
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Sex*
(select one)
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Pronouns
(select all that apply)
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Include street, city, state, ZIP code, and country
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FIR ACRES WRITING WORKSHOP EXPERIENCE PREFERENCES

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Student Participants: please fill out the following information.

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T-shirt Size (unisex, soft fabric shirt)*
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Preferred Creative Writing Genre (you can check more than one)*
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Preferred Creative Writing Elective (you can check more than one)*
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A link to the 2024 Fir Acres Writing Electives can be found on the main Enrollment Information Page. Students work with a new faculty member over two days during the second week; electives offer students the opportunity to learn about topics that faculty have expertise in; electives also offer students an opportunity to work with faculty they may not have worked with during the first week.

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PARENTS / GUARDIANS MUST COMPLETE REMAINING FORM BELOW

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The remainder of this online enrollment, including document that requires a signature, must be completed by a custodial parent/guardian. All updates and changes after submission must be communicated to Workshop staff as soon as possible and ideally before the beginning of the Workshop. Information will be kept confidential and only shared with Workshop staff and health providers on a need-to-know basis. Please complete this online enrollment and upload scans or photos of all required documents no later than May 1, 2024.

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PARENT / GUARDIAN INFORMATION

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Last name, first name
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Last name, first name
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ALTERNATE EMERGENCY CONTACTS

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If we cannot reach parents/guardians in the event of an emergency, whom else may we contact?

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PARTICIPANT HEALTH AND NUTRITION INFORMATION

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Covid Testing and Vaccination

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Is Participant up-to-date on Covid vaccinations / boosters?*
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Custodial Parent/Guardian permits participant to take rapid Covid antigen tests when asked by staff.*
A “yes” response is required for participant enrollment.
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Covid Vaccination

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Lewis & Clark strongly recommends that all community members—students, faculty, and staff—along with guests on our campus, stay fully up-to-date with their COVID-19 vaccinations by receiving all doses recommended for their age group by the CDC. This means that if you’re eligible for a booster, you should get a booster!

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HEALTH AND HEALTH HISTORY INFORMATION

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Health Insurance Information

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Any significant injury or illness will involve transportation to a local urgent care center or emergency room for treatment, and the cost of treatment will be the responsibility of the participant’s parent/guardian. Please email Fir Acres (firacres@lclark.edu) a digital copy of the front and back of your health insurance card. You can do this on the main Enrollment Information page.

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HEALTH HISTORY

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If none, please write in “N/A.”
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Participant has the following health concern(s). Please select all that apply.*
In order to select more than one, your browser may require you to press “command” during selection.
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Does Participant have any health and/or accessibility requirements?*
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If Participant has serious or chronic health and/or accessibility requirements, please fill out the Written Medical Documentation form on the main Enrollment page (at the bottom of the page). This is required for anyone with serious ongoing medical conditions and/or accessibility requirements. Please attach a statement from the Participant’s physician or medical health professional which: (1) describes the condition and the plan to manage it, including medications while at the Workshop; (2) lists behaviors that will indicate to our staff that the Participant needs professional referral; and (3) states that the medical professional foresees no difficulties in your child’s full participation in the Workshop.

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Allergies

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Does Participant have allergies?*
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If Participant has no known allergies, please write “N/A.”
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Anaphylaxis

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Do any allergies cause anaphylaxis in Participant?*
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If your answer to the above is “Yes,” please fill out the Anaphylaxis form on the main Enrollment page (at the bottom of the page). This is required for anyone who answers “Yes.”

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Asthma

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Does Participant have asthma?*
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If your answer to the above is “Yes,” please fill out the Asthma form on the main Enrollment page (at the bottom of the page). This is required for anyone who answers “Yes.”

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Diabetes

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Does Participant have diabetes?*
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If your answer to the above is “Yes,” please fill out the Diabetes form on the main Enrollment page (at the bottom of the page). This is required for anyone who answers “Yes.”

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NUTRITION

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Which diet(s) best describe Participant’s diet?*
Please select all that apply. In order to select more than one, your browser may require you to press “command” during selection.
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If you have nothing further to add, please write “N/A.”
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MENTAL, EMOTIONAL, AND SOCIAL HEALTH

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Has the Participant experienced significant life events that continue to affect their lives (e.g., death of loved one; family changes; natural disasters; community, school, or personal crises, etc.).*
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If this does not apply to your participant, please write in “N/A.”
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During the past year, has the Participant seen a health professional to address social and/or emotional concerns?*
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Do you have any reservations about your Participant fully participating for two weeks at Fir Acres, which includes living in a residential hall with other students, going to daily Workshop sessions, heading off campus for indoor and outdoor field trips, being a part of a writing community, and socializing with others during downtime?*
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Participant has been diagnosed with:*
Please select all that apply. In order to select more than one, your browser may require you to press “command” during selection.
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For any of the above conditions, please fill out the Written Medical Documentation form on the main Enrollment page (at the bottom of the page). This is required for anyone with these diagnoses. Please attach a statement from the Participant’s physician or mental health professional which: (1) describes the condition and the plan to manage it, including medications while at the Workshop; (2) lists behaviors that will indicate to our staff that the Participant needs professional referral; and (3) states that the medical or mental health professional foresees no difficulties in your child’s participation in the Workshop.

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MEDICATIONS

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Please note: students should ONLY bring a TWO-WEEK SUPPLY of any medication(s); please bring medication in original packaging, with detailed dosage instructions. If possible, we ask that students don’t bring large bottles of vitamins or medication(s).

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Oregon law provides that minors under 18 years may not self-administer medications without adult supervision. “Medications” includes both prescription and over-the-counter medications and other substances taken to maintain or improve health, such as vitamins and homeopathic remedies. Participants taking medications for psychiatric reasons should be on the same medication and same dose for at least three months prior to the start of the Workshop. If your child requires routine injections, please contact us.

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If none, please write in “N/A.”
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Over-the-Counter Medications During the Workshop

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Workshop staff have basic first aid/CPR training. Staff have first aid kits and basic over-the-counter medications to be administered in standard dosages when needed for minor illnesses and injuries. Please select all that you authorize your child to receive.

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Workshop staff may administer the following over-the-counter medications to Participant:*
Please select all that you authorize may be given to your child by Workshop staff.
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Name of Parent / Guardian Completing This Form

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REQUIRED: UPLOAD “Authorization of Participation” and “Code of Conduct” signature page

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Signed form is required. Participant must sign the “Community Code of Conduct” portion of the form along with parent / guardian. Download document from link at top of page, sign, and upload PDF.
(50 MB max)
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