Nature Connect 2019-2020 Application
Sign in to Google to save your progress. Learn more
Application Basic Info
Please fill out a separate form for each child.  Thank you!
Child's First Name *
Last Name *
Age & Birthdate *
Gender *
Program *
Required
Parent/Guardian's Name *
Primary Phone Number *
Secondary Phone Number *
Mailing Address *
Email Address *
Questions

These questions will help us all to see if our programs are a good fit for you and your family. Thank you, and we look forward to getting to know you and your family!

**We recommend typing your answers in a Word document, so you don't accidentally lose them.

What is it that you'd love for your child to experience with Nature Connect? *
How often does your child spend time in free play in a natural setting beyond the backyard (woods, beach, fields, etc)? *
Are you comfortable with your child getting muddy and dirty? (please NOTE, your child WILL get dirty and your response to this is important regarding whether they feel okay being involved with the play that happens at Nature Connect) *
Can your child swim? (This is not required)
Clear selection
Does your child have any allergies or health issues? If so, please explain.
Do you have any concerns about your child playing in nature? If so, what are they? *
What do you love about your child and their personality? *
What do you find challenging about your child and their personality? *
Does your child have any siblings? If so, how old are they? *
Is there anything else you'd like us to know? Any questions or concerns? *
How did you find out about Nature Connect programs? *
Where specifically did you find out about Nature Connect? (Please share the name of the person, organization, event, search engine, listserv, etc who referred you, if applicable) *
Financial Aid and Payment Plans
We want our programs to be accessible for every child. Therefore, we offer support in the form of financial aid, scholarship, or payment plans. If you have questions, please email us at contactnatureconnect@gmail.com.
Are you interested in applying for financial aid, scholarship, or payment plan? *
Would it bring you joy to contribute to the Nature Connect Scholarship Fund?
Clear selection
You're almost done!
What is one thing that you are grateful for right now?
Thank you! Please click submit and follow the instructions for your next step.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms