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The Shoals Center Application/Registration Form
If you have previously completed this form and have no changes in information, you will not be required to answer every question. Thank you for supporting The Shoals Center!
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* Indicates required question
Email
*
Your email
Participant's name
*
Your answer
Participant's gender/pronouns
Your answer
Participant's current age
Your answer
Participant's date of birth
MM
/
DD
/
YYYY
Does participant toilet independently? (Recognizes need to eliminate and can manage clothing without assistance?)
Your answer
Does participant have any known allergies? If so, what are they?
*
Your answer
Please list any sensitivities here.
Your answer
What is participant's history with school/group involvement?
Your answer
Do you anticipate any difficult drop-offs? If so, would you like to schedule a phone chat to discuss strategy?
Your answer
For what program are you applying/registering?
Please specify any dates in the next section.
Summer Camp
Traveling Tuesdays
Wild Wednesdays
Waders Drop-In
Teacher Workday
Please specify dates and times (if applicable.)
Your answer
Would you be comfortable with your child traveling on field trips via the city bus system?
*
Yes
No
Maybe
May the participant consume foods not listed in allergies and sensitivies provided by The Shoals Center or other families? (Foods containing artificial colors, flavors, and preservatives will never be served.)
*
Yes
No
Other:
Do you consent to the participant's photos being used for promotional purposes, without the use of name?
*
Yes
No
Would you (or a representative) be interested, willing, and available to contribute time to the program in any of the following ways?
After hours service (maintenance, cleaning, administrative work)
Working with participants during operating hours
Other:
If you are willing to contribute time, please describe what you could offer.
Your answer
How did you find out about The Shoals Center?
Your answer
Please share a few thoughts about why you think The Shoals Center would be a good fit for your family.
Your answer
What concerns might you have about participation at The Shoals Center?
Your answer
Caregiver's name
*
Your answer
Email
*
Your answer
Address
Your answer
Phone
*
Your answer
Second contact person and phone number
Your answer
Please click here to make payment via Venmo.
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I am paying through the web portal.
I have made other payment arrangements.
Please click here to make payment via web portal.
*
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I paid via Venmo or PayPal.
I have made other payment arrangements.
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