FUNdamental Minds April 2024 FUNday Field Trip Registration Form

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Please complete one form for each child attending.

$75/event ($60 sibling). Registration includes field trip cost and transportation, lunch, & academic activities.

Brandon Address: 1721 S. Kings Ave.

Zephyrhills Address: 35008 SR-54

Phone Number: (813) 409-3110

Email: director@fundamentalminds.com

Email *

What is your name?
*

What is your phone number?
*

What is your child's name?
*

What age group is your child in?
*

5-7

8-10

11-13

Which location will your child attend?
*

Brandon

Zephyrhills

Which event(s) will your child attend? *

Week 1 - Library (New River or Bloomingdale) (4/5)

Week 2 - Field Day (at Zephyrhills Campus) (4/12)

Week 3 - Julian B. Lane Splash Park (4/19)

Week 4 - STEM Day (in house) (3/29)

Required

Is your child fully potty trained, needing no bathroom support?
*

Yes

Does your child have any medical concerns or allergies we need to be made aware of? Please explain or write N/A.
*

Has your child been diagnosed with an emotional, physical, mental, or educational disability? If so, please state the diagnosis and any applicable supports needed for your child. If not, please write N/A.
*

Does your child require additional 1 on 1 support from an adult/aide in academic/social environments? Please describe below or write N/A if not applicable.

Are there any academic/behavioral concerns that we should be aware of (for example: resistance to writing, failure to follow directions when given, physical acts of aggression toward self or others)? Please describe below or write N/A if not applicable.
*

Do you qualify for any of the following discounts? (Proof of eligibility required)
*

Sibling (must be registered for the same field trip event)

Military

First Responder

School Employee

None of the above

Required

I understand that my child will be transported to/from the field trip location and a field trip form must be signed for each event. If I choose to provide my own transportation and attend the event with my child(ren), I will be responsible for the costs of travel and the cost of any parent entry. *

Yes

I understand that payment is due upon successful registration and refunds will not be provided for any absences. *

Yes

Required

A copy of your responses will be emailed to the address you provided.

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