Mindfulness in Nature Youth Program
These classes are sponsored by Web of Connection and will be held at Mountain Song Community School, 2904 West Kiowa Street, Colorado Springs, CO 80904. For questions regarding the classes or filling out this form, contact Ayya at webofconnection.com

Please send in your registration at least two weeks prior to the start of the session which you are signing up for.

Email address *
Which session/dates are you registering for? *
Required
Name and age (s) of child(ren) who will take the class *
Your answer
What outcomes would you like to see for your child as a result of taking this class? *
Your answer
Name of parent(s) or guardians *
Your answer
Email and street address of parent(s) or guardians *
Your answer
Phone number(s) of parent(s) or guardians *
Your answer
Does your child have an allergies? If so, do they carry medicine? *
Your answer
Does your chid have any learning disabilities that might be relevant to his/her experience in this class? *
Your answer
Is there anything else you would like to let me know that could help your child's learning experience?
Your answer
Payment Options ($60 for all five classes) *
You will be notified within a week of sending in your registration to confirm your child's place in the program. Thank you!
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service