Learning Garden July-October Program Schedule
Registration is open for our Green Team scholars and our friends to participate in our summer programming! Call 216.640.0342 or email info@foodstrong.org if you need help with transportation or registration, or if you have any questions.
Student/Participant Name: *
Parent/Guardian Name: *
Parent/Guardian Contact Number: *
Home Address: *
Emergency Contact Name: *
Emergency Contact Number: *
Which date(s) will the participant join us? (check all that apply) *
Does participant have any allergies? If so, list here:
In the event of a medical emergency, I hereby authorize the teacher/program personnel attending to my student to secure medical attention or hospitalization for my child. Participant's Physician's name: *
Physician's Number: *
Dismissal Information *
Do you need assistance with participation of participant? *
Enter any important information here:
I understand that Food Strong does not provide medical insurance for my child, and I am solely responsible for providing such insurance and for payment of any medical treatment expenses for my child that are not covered by insurance. I hereby grant Food Strong and all program partners’ permission to use my child’s likeness in a photograph, video or other digital media in organizational publications, including web-based publications, without payment or other consideration. I have read the information, verifying its accuracy, and agree to the statements made above. *
Please sign full (parent/guardian) name electronically below: *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy