EQA Registration/Consent Waiver: Spring Break Workshops 2024
It's Earth Month! Join Us For Spring Break To Learn About the Numerous Ways You Can Save Your Planet

Join Us from APRIL 23rd- 25th 10:00 Am to 2:00 Pm for 'Science in The Park: Spring break Workshops'.
April 23: Alternative Energy 
April 24: Pollution
April 25: Environmental Activism 
Ages 6-13
Free Admission

Students must bring lunch or snack 
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Email *
Date *
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Child's Name (Last, First, Middle Initial.) *
Child's Date of Birth *
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Age (no younger than 6, no older than 13) *
Child's Grade *
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Address (Street address, City, Zip Code) *
Parent/Guardian's Name *
Parent/Guardian's Telephone Number *
Spring Break Workshops: My child will attend on the following days:  *
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How did you hear about this event?
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Please take a few minutes to list any allergies and medical complications your child may have. If your child does not have any allergies or medical complications, also indicate this below (saying N/A). We want to assure you that all information you provide will be treated as confidential and will be used solely for the purpose of ensuring your child's safety during our workshops.

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TERMS OF REGISTRATION:  As the parent/guardian of the above-referenced child, I hereby register and give my child permission to fully participate in the Spring Break workshops listed above that are offered by the Eastern Queens Alliance Environmental Science Learning Center held on the applicable dates and times. I understand that for outdoor Field Trips and any indoor workshops in the Idlewild Environmental Science Center my child must wear a mask for all sessions, follow all social-distance requirements, and be dressed appropriately for the season. I also understand that during certain seasons my child may need to use insect repellent. I  hereby absolve and hold harmless Eastern Queens Alliance, Inc., its subsidiaries and affiliates, directors, employees and officers from any and all liability for any injuries or unforeseen negative impacts incurred by my child or ward as a result of his/her participation in the full scope of components of the workshops, field trips and online Science-in-the-Park Program offerings.  I understand that this consent and liability waiver shall be legally binding upon me, my child or ward, my heirs, estates or assigns. Parent/Guardian (PLEASE SIGN AND DATE THE FORM.  NOTE: Checking the  "Terms of Registration" box below is considered to be your legal signature and consent.)

Parent/Guardian Signature Below
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MEDIA RELEASE FORM: As the parent/guardian of the above-referenced child, I hereby give my consent to Idlewild Environmental Learning Center to use my image, likeness, and/or voice in any and all forms of media, including but not limited to photographs, audio recordings, videos, and other media recordings for promotional and educational purposes. I understand that Idlewild Environmental Learning Center may use such media recordings in various mediums such as websites, social media platforms, newsletters, brochures, flyers, and other forms of printed or digital media. I hereby release Idlewild Environmental Learning Center, its employees, agents, and representatives from any and all claims, actions, demands, and liabilities that may arise from the use of such media recordings.

I understand that this release is voluntary and that I will not receive any compensation for the use of my name, image, likeness, and/or voice.


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A copy of your responses will be emailed to the address you provided.
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