Fall '19 Kids in Nature [ After School Program ] Registration
**IMPORTANT** filling out this form does not guarantee enrollment or registration. It gives the program your information as an applicant who is added to our waitlist, unless we have space in which case we will contact you about your interest in enrolling. Please wait for us to contact you. (Most of our programs fill in Spring when we announce registration opening.)
Email address *
Basic Information
Your Child's Name
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Your Child's Room # *
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Your Name *
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Your Phone Number (Primary Contact): *
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Your Email Address *
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Choose Your Program Days
Please select which day(s) you would like your child to participate by writing in your child's First and Last name under the day/ time you would like to register them for. Please fill out a completely new registration form for each individual child. Note, days are categorized by grade level.
KINDERGARTEN
Kinder Monday 12:25 - 5:00
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Kinder Tuesday 12:25 - 5:00
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Kinder Wednesday 12:10 - 5:00
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Kinder Thursday 12:25 - 5:00
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1ST - 3RD GRADE
Monday 2:25 - 5:00
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Tuesday 2:25 - 5:00
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Wednesday 12:10 - 5:00
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Thursday 2:25 - 5:00
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Friday 2:25 - 5:00
Your answer
4TH - 5TH GRADE
Monday 2:45 - 5:00
Your answer
Tuesday 2:45 - 5:00
Your answer
Wednesday 12:30 - 5:00
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Thursday 2:45 - 5:00
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Medical History and Emergency Contact Info
Emergency Contact { Name and Number } *
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Student History of Illness, Injury or ALLERGY *
Your answer
Medicines or Treatments Typically Used in Our Home
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Other Important Information About My Child:
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It is imperative that your child is ready for the program to insure that they have a good time. If you are able to say yes to the following requirements confidently then they're ready to go!
- Your child is able to carry their own pack for the length of the program

- Child is potty trained and is comfortable with "nature potty" when facilities are not readily accessible.

- Child can be away from their parent for the length of the program.

- Child is capable of listening to instructions, and is willing to be silly and get a little dirty!

- Child will not act violently to their peers, teachers or self.
My child meets the above requirements *
Required
Kids in Nature Waiver
Dear Kids in Nature Parent,

We are delighted you’ve chosen to enroll your child in our Program. We know they will enjoy and benefit from exploring the lovely habitat we all call home. As a parent of a participant we want you to know and understand the common hazards of outdoor exploration before we begin the journey together. Through participation in Kids in Nature your child could be exposed to poison oak, ticks, sun, roads, and the unexpected in nature. Children will also be climbing trees and walking through forests which could result in tripping and falling due to uneven topography in wild landscapes. During the program, the children also cross roads in a carefully supervised group. Though occurrence is incredibly infrequent the forest is also home to many wild creatures and unexpected exposure to these animals could lead to injury or illness.

In the case of an emergency that cannot be treated in the field, it is Program Policy that Emergency Medical Assistance (911) be called which may require an ambulance. Lead Teachers are Wilderness Medicine Certified and equipped with first aid kits and may address any minor injuries such as cuts and scrapes in the field. By signing this waiver you confirm that your child is covered by valid health insurance, and acknowledge the inherent risks involved in participation in this program.

By enrolling your child in our Program you assume such risks yourselves as well as on behalf of your child. Thus, by signing this form you agree that neither Kathryn Jaffe nor Kids in Nature or any of its employees or independent contractors is in any way legally or financially responsible for any injury, death, or illness, mentioned or unmentioned above, sustained by your child through participation in the Program and that you willingly consent to their participation in the Kids in Nature program.

Thank you.
Please sign your name below to agree to the above waiver on behalf of yourself and your child: *
Your answer
Thank you!
Thank you for registering! Let us know if you have any last questions! We look forward to meeting you and your little one....
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A copy of your responses will be emailed to the address you provided.
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