Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Please Check Desired Program(s): *

Forest Playschool Sandy (ages 3-6)

After-school Adventures- Millcreek (ages 6-10)

After-school Adventures- Sandy (ages 6-10)

Summer Camp- Millcreek (ages 6-10)

Summer Camp- Sandy (ages 3-10)

Guided Hikes! (ages 5-10)

Day(s) Attending *

Monday

Tuesday

Wednesday

Thursday

Friday (Summers only)

If our program is currently full, would you like to be put on our waitlist?

Yes

No

Parent 1 Name *

First Name

Last Name

Parent 1 Phone *

(###)

###

####

Parent 1 Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent 2 Name

First Name

Last Name

Parent 2 Phone

(###)

###

####

Emergency Contact *

Name & Relationship

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Physician Name

First Name

Last Name

Physician Phone

(###)

###

####

Photo Release *

I hereby grant Grateful Gathering Farms/ Grateful Gathering Forest School permission to use photos of my child in any and all of its publications, including websites, and social media platforms.

No

Yes

Sharing Contact Info

Would you like us to share your information with other families for playdates and/or carpooling?

Yes

No