April/May Environmental Education Registration Form
Please register only one child per form.
Participant's Name:
 A value is required.
Address:
 A value is required.
City, State, Zip
 A value is required.
Phone: (H)
Phone: (W) or (Cell)
Email:
 A value is required.Invalid format.
Date of Birth:
My child wants to be in class with

Please check the sessions in which you would like to enroll.
April 13: Wild in the Parks: slimy, Squirmy and Wearing a Mask
April 15: Salamander Search
April 17: You & Me: Tadpole Tales
April 18: Friday Night OUt: Spring Peeper Hike B
April 26: Trexler Trek: Stalking Salamanders
May 2: Friday Night Out: Tadpoles After Dark
May 6: Plants for Pets
May 11: Wild in the Parks: Let Mom Go Wild in the City
May 13: Odd Edibles
May 20: Growing Giants
May 21: You & Me: Would YOu Eat if Upside Down?
May 30: Trexler Trek: Eye Spy
PARENTAL PERMISSION
Emergency Contact:
(Other than primary caretaker)
Emergency Contact's Phone #:
Physician:
Physician Phone #:
Allergies, special needs, etc.
If NONE, please enter NONE.
A response is required.


Please make a selection.I hereby give permission for my son/daughter to participate in all activites and for my son/daughter to receive emergency medical treatment, if necessary. I also give permission for my child to be photographed during activites, for for Wildlands Conservancy to use my child's photographic image in commercial or non-comercil publiticy for nature programs or facilities.

Questions: Call Maureen Ruhe- 610-965-4397 ext.36

Submit your registration information. You will be directed to our payment form.