Program Sign-up-Trumbull Nature & Arts Center

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Participant/ChildName:
Birthdate:
Grade:
Participant/ChildName:
Birthdate:
Grade:
Parent/Guardian Name:
TNAC Membership:
Address:
City:
State:
Zip Code:
Home Telephone:
Work Telephone:
Email Address:
Program Title:
PARTICIPANT�S NAME:
DATE:
TIME:
COST:
Total Payment due:
Message:
Please Complete Parential Permission Below:
Parental Permission Form � This section must be completed by a parent/guardian for all youth program registration. I certify that my child,(insert child name here), is healthy and free of problems that could hinder his/her participation in Trumbull Nature and Art Center Classes. In case of injury, I wish to be contacted as soon as possible at the telephone listed above, or at this emergency number ( Put tel# Here) . If I cannot be reached, please contact , (relationship) at telephone number( ) . In the event of serious illness or injury which would require my child to be sent to a local hospital via ambulance, I understand that I am responsible for all charges either through heath insurance or otherwise. Does your child have any allergies or medical conditions? No Yes, explain Please note that if your child is assisted during the school year, we encourage you to accompany him/her during the program. Thank you for your consideration. Cancellation Policy: The Trumbull Nature & Arts Center�s cancellation policy states that reimbursement in full will be given only to classes that are cancelled by the Nature Center. A credit for classes will be given only with a 24 hour notice of cancellation by individuals registered for the class.

Participant/ChildName:

Birthdate:

Grade:

Participant/ChildName:

Birthdate:

Grade:

Parent/Guardian Name:

TNAC Membership:

Address:

City:

State:

Zip Code:

Home Telephone:

Work Telephone:

Email Address:

Program Title:

PARTICIPANT�S NAME:

DATE:

TIME:

COST:

Total Payment due:

Message:

Please Complete Parential Permission Below:

Parental Permission Form � This section must be completed by a parent/guardian for all youth program registration. I certify that my child,(insert child name here), is healthy and free of problems that could hinder his/her participation in Trumbull Nature and Art Center Classes. In case of injury, I wish to be contacted as soon as possible at the telephone listed above, or at this emergency number ( Put tel# Here) . If I cannot be reached, please contact , (relationship) at telephone number( ) . In the event of serious illness or injury which would require my child to be sent to a local hospital via ambulance, I understand that I am responsible for all charges either through heath insurance or otherwise. Does your child have any allergies or medical conditions? No Yes, explain Please note that if your child is assisted during the school year, we encourage you to accompany him/her during the program. Thank you for your consideration.
Cancellation Policy: The Trumbull Nature & Arts Center�s cancellation policy states that reimbursement in full will be given only to classes that are cancelled by the Nature Center. A credit for classes will be given only with a 24 hour notice of cancellation by individuals registered for the class.