2017-2018 FOrest preschool Program APPLICATION

ages 3-6


Child's Name *
Child's Name
Parent 1 Name *
Parent 1 Name
Home address *
Home address
Phone number *
Phone number
Parent 2 Name
Parent 2 Name
Home address
Home address
Phone number
Phone number
Child's Physician *
Child's Physician
Physician's Phone Number *
Physician's Phone Number
Days per week *
I would like to enroll my child in the following class or classes for 2017-2018 school year (check your choices):
Liability Waiver *
Liability Waiver: I understand that South Mountain Nature School operates classes entirely outdoors and that there are risks which naturally occur whenever children are playing outside. I also understand that SMNS classes take place in a county park and that there are hazards over and underfoot that are beyond the control of Mary Clair Sonneman and South Mountain Nature School. I release Mary Clair Sonneman, South Mountain Nature School and it’s teachers and Board of Directors from any liability for injuries that might occur as a result of my child attending South Mountain Nature School. My child is in good physical health and I will provide appropriate clothing for the weather.
Media Release *
Consent to Photograph: I do hereby consent and agree that South Mountain Nature School, LLC has the right to take photographs and video clips of my child and to use these on the Educator's websites and promotional materials without compensation. Your child's name and identity will not be revealed.
Today's Date *
Today's Date