2023 Summer Mud Kitchen Kids & Loose Parts Play Registration

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Hello Muddy Buddies!

Thank you so much for your interest in our "Mud Kitchen Kids and Loose Parts Play" summer enrichment.

🔺UPDATE: WE JUST OPENED UP 2 EXTRA SPOTS IN OUR SOLD OUT SUMMER CLASSES DUE TO OUR RECENT SAND PIT EXPANSION AND EXTRA VOLUNTEER

👀 PLEASE READ ALL THE DETAILED INFORMATION BELOW

🔺 Our early 10am - 12pm class

🔺 Our afternoon 1- 3pm class

Class Details:

◘ Ages 4 - 7

◘ Class is a drop off (feel free to hang around if your child needs support transitioning)

◘ Class needs a minimum of 6 children to initiate

◘ "Mud Kitchen Kids and Loose Parts Play" enrichment is NOT considered physician referred, occupational therapy - this is an enrichment class

◘ If you are registering multiple children, please fill out multiple forms.

◘ Children must be potty trained ( we have a portable potty on site in a private tent)

◘ Enrichment classes meet rain or shine (we have overhead shade/protection).

◘ Once payment has been received, there are no refunds.

◘ There are no refunds for missed sessions due to limited schedule to create make-ups.

◘ If a class must be canceled for an unforeseen event, a make up class will be provided on Sat. July 1st

◘ Once this form is completed, we will email a link to secure payment in order of received applications

◘ If class fills, we will put you on a waitlist and keep you updated as things shift.

◘ Previous participating Mud Kitchen families are given priority registration

☀️ Our summer session will be every Friday in the month of June

◘ June 2, 9, 16, 23, and 30th.

◘ Each class is a 2 hour session

We have two classes to choose from

❶ Morning Class A: 10:00am - 12:00pm

❷ Afternoon Class B: 1:00pm - 3:00 pm

Tuition Total = $230

If you have any questions, concerns, or curiosities please email Daniele at: boiseoutdoorot@gmail.com

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電子郵件 *

Please add me to your summer waitlist *

I'd like to be added to your summer wait list

Which class are you registering your child ? *

Morning Class A: Friday 10:00 am - 12:00 pm

Afternoon Class B: Friday 1:00 pm - 3:00 pm

必填

Due to the nature and dynamic of this group being "child-led" adult participation is capped to our lead occupational therapist and intern students. Child must be able to attend group independently without caretaker. *

Yes, I understand and agree. My child can attend enrichment group independently.

Child's name *

Child's Age *

Child's D.O.B *

Child's grade *

Gender

Primary caregiver's first and last name *

Primary caregivers contact # *

Emergency contact and phone number *

Please list caregivers granted permission to pick child up from enrichment. *

Due to teacher student ratio, children must be fully potty trained. Mud Kitchen Kids provides a pop up potty in a privacy tent. Is your child able to complete toileting tasks independently?
*

Please note any medical diagnosis, delays or history of seizures. If none, please note n/a. *

Please list allergies and intervention if necessary. If none, please note n/a. *

Please note any medications your child is currently taking. If none, please note n/a. *

What brings your child joy? *

What are your child's strengths? *

What are your child's challenges? *

Has your child / does your child utilize the support of an 1:1 aide? *

Do you anticipate any behavioral needs and/or challenges?

Does your child have a history of elopement (fleeing, running off/away from caregivers)? If so, due to teacher ratio and the open environment, this group session would not be a best fit. A 1:1 OT session would better support needed safety. *

Please list any additional information and/or history you think would be helpful for Boise Outdoor OT to know about your child.

I understand the following challenges need one-to-one support and will not be a best fit for the open environment, teacher ratio, and group dynamic.

• aggression toward teachers, others or self
• destruction of environment
• fleeing the area / running away outside play perimeter
• repeated verbal disrespect towards others or teachers

• extreme fear of bugs or the outdoors

Staff has the right to terminate participation at any time should these or other challenging behaviors occur. Refunds will not be issues in these circumstances.

I understand and agree

必填

I understand that "Mud Kitchen Kids and Loose Parts Play" enrichment is an enrichment class; it is NOT physician referred occupational therapy services. But If your child has specific goals we would love to help support these during our groups. *

I understand and agree

必填

Once you complete your google form we will be in touch in regards to if class is filled, follow up paper work and payment. *

SHOW FACE: I hereby grant full permission to Boise Outdoor OT to take and use photographs for social media related to the mission of sharing how "Mud Kitchen Kids and Loose Parts Play" enrichment developmentally supports children.

FACE WILL REMAIN PRIVATE: I hereby grant permission to Boise Outdoor OT to take and use photographs WITHOUT MY CHILD'S FACE IN VIEW for social media related to the mission of sharing how "Mud Kitchen Kids and Loose Parts Play" enrichment developmentally supports children. (Examples: hands hammering nails, lower body balanced on rocks, back of body writing on chalkboard, or face blurred out unable to identify).

I FULLY DECLINE to give permission for any photos to be take of my child.

Once you complete your google form we will be in touch in regards follow up in-take paper work and payment - or if class has been filled.
*

I understand

How did you hear about "Mud Kitchen Kids and Loose Parts Play" enrichment?

Anything you'd like to add? Any questions?

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