Little Willows, Caregiver & Me Registration
This class is for 1-5 year olds and their caregivers. Please select 1 or all of the program blocks you would like to attend.  
A one-time registration fee of $20 must be paid when registering to hold your child's spot *if you are not paying in full at this time.*
Tuition must be paid in full before classes begin.
PayPal link for registration will appear once your form is submitted.

4 week block-$60            additional sibling-$50              
Drop in class-$22 (only if there is space to attend, must still register)

If paying for ALL THE BLOCKS: $400 - (Discount of $10 off each block)
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Email *
Enrollment History- (each child will have to pay 1st time enrollment fee to hold their spot regardless if they are in the same family) *
Is this a sibling or member of a participating family? *
Childs First Name *
Child's Last Name *
Age *
Date of Birth *
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Gender *
Ethnicity *
Choose your program for 2022/2023: (these are 4 week block programs or you can choose drop in) Mondays 10am-11am: Morsches Park, Columbia City, IN Giving Gardens of Indiana (summer only) *
Parent/Guardians  Name First & Last Names *
Primary Phone Number *
Secondary Phone Number *
Mailing Address *
Emergency Contact Name *
Emergency Contact Phone Number *
Does your child have any allergies or health concerns? If so, what are they? *
Does your child see, or have they seen, a therapist of any kind (i.e. physical, emotional, cranial, orthopedic, etc.)? If so, what were the reasons for this and how does this affect your child at the current time? We have this question because Little Willows, Caregiver & me is a very small program. Challenges in children's lives become very visible rather quickly in such a small group. Without any information we are limited to how well we can be of support to the child and to the rest of the group. We have experienced hardships from not being informed of such matters. We appreciate your cooperation and willingness in regards to this. Your answer will be kept confidential. *
Do you have any concerns about your child playing in nature? If so, what are they? *
Are you comfortable with your child getting muddy and dirty? (Please NOTE, your child WILL get dirty and your response to this is important regarding whether they feel okay being involved with the play that happens at Nature School.) *
How often does your child spend time in free play in a natural setting beyond the backyard (woods, beach, field, etc.)? *
What do you wish for you and your child to gain from being in Little Willows, Caregiver & Me program? *
What do you love about your child and his/her personality? *
Does your child have any siblings? If so, how old are they? *
What is something you would like us to know or think we should know about your child? *
Is there anything else you'd like us to know? Any questions or concerns? *
How did you find out about Little Willows, Caregiver & Me program? *
Would it bring you joy to contribute to the Wild Willow Nature Preschool Scholarship Fund? This funds supports a family who wants their child(s) to attend, but cannot afford tuition.
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