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Winter Holiday Pop-Ups Little Explorers - December 27, 2022

2022 REGISTRATION FORM

Please complete one form per child.

***Please provide us an email address that you routinely check - it is what we will use for program communication.***

Thank You!

Membership status *

Are you a Fern Hollow Nature Center Member?

Yes, I am a member

No, I am not a member

Not a member? Join today!

CLICK TO PURCHASE A MEMBERSHIP

Member Name *

First Name

Last Name

Participant Information

Please fill out this form for each of your children if you have multiple participating in programs.

Child's Full name *

First Name

Last Name

Is this your child’s first program with us in 2022? *

Child's participation history

Yes

Permission and Waiver Forms / Policies and Procedures

If this is your child's first program at Fern Hollow in 2022, you need to fill out one Fall 2022 Waiver and Permission Form AND one Fall 2022 Policies and Procedures Form per child. Please click on the links below. You may complete the forms after you submit your registration.

Fall 2022 Waiver and Permission Form

Fall 2022 Policies and Procedures

Date of Birth *

Child's Age *

Child's current grade (2022-2023 school year): *

Emergency contact name *

Please provide the full name of who to contact in case of an emergency

Emergency contact phone number *

Please provide the phone number for your emergency contact

Electronic Signature

First & Last Name *

First Name

Last Name

Contact Phone *

Email *

Contact email

Verify Email *

Date *

(mm/dd/yyyy)

Members Only Registration

Winter Holiday Pop-Ups Little Explorers - December 27, 2022 - Member Fee *	Quantity
$30 - Winter Holiday Pop-Ups Little Explorers - Member Fee

Public Registration

Winter Holiday Pop-Ups Little Explorers - December 27, 2022 - Public Fee *	Quantity
$35 - Winter Holiday Pop-Ups Little Explorers - December - Public Fee

Add 3% to my total amount to help cover the payment processing fees