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Nature Connect Trial Day Application
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Application Basic Info
Please fill out a separate form for each child. Thank you!
Child's First Name
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Your answer
Last Name
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Your answer
Age & Birthdate
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Your answer
Program:
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Monday Forest Families, 9-10:45am (0-5 year olds with adult family member or friend)
Tuesday Homeschool, 9:30am-2pm (6-12 year olds, drop-off or with adult)
After School Wednesdays (3:15-5:15, drop-off)
Date would you like your child to attend?
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MM
/
DD
/
YYYY
Parent/Guardian's Name
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Your answer
Primary Phone Number
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Your answer
Secondary Phone Number
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Your answer
Email Address
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Your answer
Mailing Address
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Your answer
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?
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Your answer
How often does your child spend time in free play in a natural setting beyond the backyard (woods, beach, fields, etc)?
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Your answer
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)
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Your answer
Do you have any concerns about your child playing in nature? If so, what are they?
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Your answer
What do you love about your child and their personality?
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Your answer
What do you find challenging about your child and their personality?
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Your answer
Does your child have any siblings? If so, how old are they?
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Your answer
Is there anything else you'd like us to know? Any questions or concerns?
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Your answer
How did you find out about Nature Connect programs?
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Word of Mouth
Facebook
Search Engine
Other:
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)
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Your answer
Would it bring you joy to contribute to the Nature Connect Scholarship Fund?
Yes, I'd love to contribute
Yes, but I'd rather not right now
No, thank you
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What is one thing that you are grateful for right now?
Your answer
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