Land's Sake · 2024 Late Fall Afterschool Registration

Are you a 2024 Land's Sake Member? *

(Family level membership and above)

Yes

Not yet, but I want to be one

No, and not interested

Select your Membership Level for 2024 (valid through 12/31/2024. If purchased after 9/1, valid through 12/31/2025.) *

$125 - Family Membership

$275 - Supporter Membership

$500 - Steward Membership

$1,000 - Sustainer Membership

Participant's Grade, 2024-25 school year *

Kindergarten

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Which session(s) will your child attend?

Please use the check boxes to select the correct price for each program your child will attend.

Tuesday Explorers (8 Tuesday sessions, 10/29-12/17. 2:20 - 4:20pm.)	Quantity
$360 - Member Rate
$400 - Non-Member Rate

Wednesday Sprouts (4 Wednesday sessions: 11/13 and 11/20, 12/11 and 12/18 12:15-2:20pm)	Quantity
$180 - Member Rate
$200 - Non-Member Rate

Thursday Junior Farmers (7 Thursday sessions: 10/31-12/19. No program 11/28. 2:20-4:20pm)	Quantity
$330 - Member Rate
$360 - Non-member rate

November 6 Early Release Farm Program (one session, 11:30 am - 2:20 pm)	Quantity
$50 - Member rate
$70 - Non-Member rate

December 4 Early Release Farm Program (one session, 11:30 am-2:20 pm)	Quantity
$50 - Member Rate
$70 - Non-Member Rate

Student Information

Name *

First Name

Last Name

Birthdate *

Preferred Name *

Gender *

School Attending *

Family Information

Parent/Guardian Name *

First Name

Last Name

Name of additional Parent/Guardian (optional)

First Name

Last Name

Email of Parent/Guardian *

Verify Email *

Secondary Email

Verify Email

Primary Phone Number *

Secondary Phone Number

If parents/guardians are to be traveling during program sessions, contact information for their destination(s) must be provided.

Primary Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Secondary Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Health & Safety Information

Health Insurance Provider *

Subscriber *

Group Policy Number *

Medications *

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.

Allergies *

Dietary Restrictions *

Does the participant have any medical history we should be aware of? *

This will help us be informed, in case of an emergency.

Does the participant require any specific accomodations? *

Has the participant ever been stung by a bee or wasp? *

If yes, please let us know if they had any severe reaction.

Is there anything else you would like us to know about the participant?

Primary Care Physician *

Primary Care Physician's Phone Number *

Dentist/Orthodontist *

Dentist/Orthodontist's Phone Number *

Emergency Contact's Name *

This is someone other than the primary or secondary contact who we will contact only in the case of an emergency. We will attempt to contact the primary guardian(s) first unless otherwise instructed.

Emergency Contact's Phone Number *

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.

My Child May Be Released to the Following People *

Please provide first and last names, specify relationship to child, and provide phone numbers for each person.

Specify Other Means of Pick Up *

For example: Can sign self out and hang out at the farm, can walk alone or with a friend to the Weston Public Library, can bike home on Tuesdays, etc.

Program Policies

Cancellations & Refunds *

If a family needs to cancel their afterschool 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 October 14 AND the spot is able to be filled by somebody else. Refunds will be prorated based on the number of sessions that have occurred, and a $25 administrative fee will be held for all refunds. In the event the Land's Sake afterschool program is cancelled due to low enrollment or in the case that state COVID-19 guidelines prohibit such programs, all families will receive a full refund by request. 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. 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.

I agree to the Cancellations & Refunds Policy

Liability Waiver *

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.

I agree to the Liability Waiver

Medical Attention Authorization *

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 Education 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.

I agree to the Medical Attention Authorization

Media Release *

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.

Authorization Granted

Authorization NOT Granted

Email Newsletters

Our email newsletters keep you updated about happenings at Land's Sake. By submitting this form, you agree that the email address(es) you entered will remain on, or be added to, the Land's Sake email newsletter list. You may unsubscribe at any time.

How did you hear about our programming?

Word-of-mouth (from a friend)

A school or other organization

Google or web search

Social media platform

Land's Sake digital newsletter

Other Land's Sake departments (membership, farmstand, CSA)

Other Land's Sake education programs (open farmyard, after school)

Returning afterschool participant