Spring Break Camp Registration


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Application Basic Info
Please fill out a separate form for each child.  Thank you!
Child's First Name *
Last Name *
Age & Birthdate *
Program *
Parent/Guardian's Name *
Primary Phone Number *
Secondary Phone Number *
Email Address *
Questions

These questions will help us all to see if our programs are a good fit for you and your family. Thank you, and we look forward to getting to know you and your family!

**We recommend typing your answers in a Word document, so you don't accidentally lose them.

What is it that you'd love for your child to experience with Nature Connect? *
How often does your child spend time in free play in a natural setting beyond the backyard (woods, beach, fields, etc)? *
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 Connect) *
Do you have any concerns about your child playing in nature? If so, what are they? *
Does your child have any siblings? If so, how old are they? *
Is there anything else you'd like us to know? Any questions or concerns? *
How did you find out about Nature Connect programs? *
Where specifically did you find out about Nature Connect? (Please share the name of the person, organization, event, search engine, listserv, etc who referred you, if applicable) *
Would it bring you joy to contribute to the Nature Connect Scholarship Fund?
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Thank you! Please click submit and then make your deposit by following the link on the next page.
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