Welcome to BEan In Nature Survival Saturdays Spring 2019 Registration

Please complete one form per child for Program Registration.

If you have questions or concerns please contact marisa@beaninnature.com

www.beaninnature.com

As soon as you register we go to work preparing for your child administratively. We hold a space in the program and plan our teachers and supplies. For these reasons,

our Registration fee is a non-refundable for semester classes;$50 each child per semester

1 Session First time Trial registration; no REG

or

CATCH THE EARLY BIRD sessions; NO REG THROUGH FEB 15!

Don't forget our Spring Campout!

Spring 2020

April 24-25th; Little Basin State Park

Need more info? Please see link and check box below for more info prior to register children!

Huddart Park, Woodside

with Teacher Diamond

9:30-3:00 pm

1x a month

Dates: Jan 25; Feb 29; March 28; April 4; May 16

EARLY BIRD PRICES THROUGH FEB 15TH

5 sessions $535 NO REG

4 sessions $440 NO REG

3 sessions $330 NO REG

2 sessions $220 NO REG

1 Session (Trial Sign up before FEB 15TH-no reg) $93

AFTER EARLY BIRD PRICES ADD REG

5 sessions $535 ADD reg $50

4 sessions $440 ADD reg $50

3 sessions $330 ADD reg $50

2 sessions $220 ADD reg $50

1 session $125 (Trial any time drop in/no reg required)

Select Program Below

Jan 25; 7 to 15 year olds; Huddart Park, Woodside

Feb 29; 7-14 year olds; Huddart Park, Woodside

March 28; 7-14 year olds; Huddart Park, Woodside

April 4; 7-14 year olds; Huddart Park, Woodside

May 16; 7-14 years old; Huddart Park Woodside

Spring Campout April 24,25,26; please add us to distribution list; Cost is $80 per day per ea child participation; all ages family camp out-

-

How did you hear about our programs? *

Full Name of Friend who referred you

Participant/Student Information

Participant First Name *

Last Name *

Birth Date * +

Female/male *

Age at start of program *

Household / Adult Primary Contact

Relationship to Participant: *

Mother

Father

Guardian

Other Other

Parent/Guardian Name *

Parent/Guardian Last Name *

Primary Phone Contact

Primary Phone *

Primary phone is *

Secondary Phone Contact

Secondary Phone *

Secondary phone is *

Email Address *

Address 1 *

Address 2

City *

Zip *

Emergency Contact #1

Emergency Contact First Name *

Last Name *

Phone Number *

Emergency Contact #2

Emergency Contact First Name *

Last Name *

Phone Number *

People authorized to pick up your child(ren)

Pick up person First Name

Last Name

Phone Number

First Name

Last Name

Phone Number