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After-School Classes - Spring 2023
Parent/Guardian Name
*
First Name
Last Name
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Phone Number
*
Email
*
Verify Email
*
Would you like to begin receiving our weekly email newsletter?
Yes
How did you find out about after-school classes at Awbury?
Intro to Wilderness Survival, Mar 14-Apr 25
Quantity
$138
-
Regular rate
0
1
1
$35
-
Scholarship rate (please get approval first)
0
1
1
Natural Wisdom, Mar 15-Apr 26
Quantity
$138
-
Regular rate
0
1
1
$35
-
Scholarship rate (please get approval first)
0
1
1
Science in the Wild class, Mar 7-Apr 25
Quantity
$160
-
Regular rate
0
1
1
$40
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Scholarship rate (please get approval first)
0
1
1
$0
-
Wissahickon Charter students
0
1
1
Outdoor & Wilderness Leadership (OWLS) class, Mar 9-May 4
Quantity
$200
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Regular rate
0
1
1
$50
-
Scholarship rate (please get approval first)
0
1
1
Child's Name
*
First Name
Last Name
Child's Age as of March 2023
*
Child's Pronouns
*
For example: he/him; she/her; they/them
Child's Date of Birth
*
(mm/dd/yyyy)
Child's Physician's Name
*
Child's Physician's Phone Number
*
Health Insurance Provider
*
Health Insurance Policy Number
*
Medications Currently Used
*
Illnesses, Medical Conditions, or Allergies
*
Medical Care Consent
*
I do hereby consent to any medical care and the administration of anesthesia determined by a physician to be necessary for the welfare of my child while said child is under the care of Awbury Arboretum and I am not reasonably available by telephone to give consent. I am the lawful guardian of the child listed and there are no court orders now in effect that would prohibit me from conferring the power to consent upon another person.
Agree
Do not agree
Is there anything special about your child's learning style or physical abilities that you would like to share with us?
Please list who has permission to pick your child up:
*
Emergency Contacts - Phone numbers and relation to child:
*
Photo Release
*
Photographs to be taken of my registered child that have the potential to be used in Awbury exhibits, published in local news outlets and in Awbury publications, or published on Awbury websites or other digital media.
I agree and give photo release permission
I disagree and do not give photo release permission