Land's Sake

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2019 Summer Green Power Registration
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(Family Level Membership and Above)
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Student Information
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First Name
Last Name
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Family Information
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Please include both parents, if applicable
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If parents/guardians are to be traveling during program sessions, contact information for their destination(s) must be provided.
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Health & Safety Information
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If participants may require the administration of prescription or over-the-counter medication while at Land's Sake programs, an authorization to administer medication form must be completed by the parent/guardian.
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Please check all that apply
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Please check all that apply
Please check all that apply
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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We will attempt to contact the primary guardian(s) first unless otherwise instructed.
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Release/Pick Up
Program participants will only be released to parents/guardians or people specified below. People must present a photo ID to be able to pick up participants. If there are specific people your child may NOT be released to, please inform Land's Sake staff in writing in advance. To make additions to this list, parents/guardians may send a signed note.
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Please provide first and last names, specify relationship to child, and provide phone numbers for each person.
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Can walk to the Weston Public Library, can bike home on Tuesdays, etc.
Summer Green Power Policies
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If a family needs to cancel their Green Power registration, they must do so in writing to the Education Manager via education@landssake.org. Refunds will only be given if this cancellation is received by June 1. A $25 administrative fee will be charged for all cancellations. The Education Manager reserves the right to dismiss a participant when in their judgment the participant's behavior interferes with the rights of others, the smooth functioning of the group or activity, or violates the program's principles of conduct. In such cases no refunds will be given. In the event the Green Power program is cancelled due to low enrollment, all families will receive a full refund.
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I understand that while participating in Land’s Sake programs there are inherent risks, including but not limited to: exposure to the elements, biological irritants (i.e. poison ivy), insects, fatigue, sore muscles, moving vehicles, livestock, and heavy objects. Every reasonable effort will be made to manage these risks and emphasize safe working habits. I understand and accept these risks and will hold Land’s Sake, Inc. and the Town of Weston harmless for any and all injuries suffered in the course of a Land's Sake program.
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I give permission for my child to participate in field trips as part of the Green Power Program. I give permission for my child to be transported to and from field trip sites with buses and drivers provided by the Weston Transportation Department.
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The health history I provided is complete to the best of my knowledge. I hereby give permission for Land's Sake staff to provide routine healthcare, administer prescription medication as described, and seek emergency medical treatment. In the case of an emergency, every reasonable effort will be made to contact me. In the event that I cannot be reached, I consent to have the administrators of Land's Sake Summer Programs act on my behalf should an emergency arise, and hereby grant permission to authorize medical attention deemed medically necessary by a physician, nurse, or hospital, for which charges I shall be responsible and agree to pay.
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I authorize Land’s Sake to take and use photographs, slides, and audio/visual recordings of my child / ward as may be needed for documentation and/or public relations purposes. I understand that all such materials will be the sole property of Land’s Sake.
Email Newsletters

Our email newsletters help keep you updated about everything that's happening at Land's Sake. By submitting this form, you agree that the email address you entered will remain on, or be added to, the Land's Sake email newsletter list. You may unsubscribe at any time by clicking on the "unsubscribe" link at the bottom of the emails -- but please know that unsubscribing means that you won't receive any of our email newsletters. If you have previously unsubscribed with the same email address that you entered, we will not be able to re-subscribe that email address.