Member Registration Contract
You will be contacted to make a payment after you complete this contract. This is a legally binding form.
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Email *
Primary Parent Name *
Primary Parent Phone *
Please provide both home and cell phone numbers.
Family Address *
Please provide actual and mailing adresses
Did you attend an open house in 2021?
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Parent or Helper Contact Info *
Please provide all email addresses that may be associated with the adults who bring or pick up your children. List name then email and cell phone number.
Please list all children enrolled, their age, grade level, and DOB. *
Please provide an emergency contact name and cell phone number. *
We process payments by ACH. Please indicate if you will pay in full or in monthly installments. *
Please complete and return this ACH payment plan form: https://docs.google.com/document/d/1_u6zwwuBfpA0qVWD6uDFtfqatAfYdN0SKkDTz74rEDc/edit?usp=sharing       You may need to cut and paste this link in your web browser.
You must agree that you have read the full terms of this contract. This registration contract is legally binding. The full terms of the contract are here: https://docs.google.com/document/d/1kL48Bhb931tQr9yRKk_k_qHaxt1sZd2Y_ZKUB6KYV3k/edit?usp=sharing *
You may need to cut and past the link in your browser.
Required
Walnut Grove Coop respects member allergies. By enrolling in Walnut Grove Coop, you agree to respect these restrictions. If your family has any severe allergy that may require medical intervention, you agree to report those allergens to staff. *
Required
Please report any allergens that your family may need to avoid. Please note that dietary restrictions are not considered "allergens" but will be respected though not prohibited.
Please check all programs for which you are registering. If you are registering more than one child, please note the child's name in the "other field." *
Required
Please check all programs for which you are registering. If you are registering more than one child, please note the child's name in the "other field."
Please check all programs for which you are registering. If you are registering more than one child, please note the child's name in the "other field."
A copy of your responses will be emailed to the address you provided.
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