Environmental Education Registration Form
Please register only one child per form.

Participant's Name:
A value is required.
Address:
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City, State, Zip
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Phone: (H)
Phone: (W) or (Cell)
Email:
A value is required.Invalid format.
Date of Birth:
My child wants to be in class with

Please check the sessions in which you would like to enroll your child. Every week will be different, so your child will have a new experience each time he or she attends

SESSION A :
9:00 - 11:00 AM
1- June 9 - 13
2- June 16-20
3- June 23-27
5- July 7-11
7-July 21-25
10-August 11-15
12-August 25-29

Fee:
Members: $65
Non-Members: $75
Individual or You & Me Team

 

Go Wild! For You and Me:
YM1 YM2 YM5 YM12

Go Wild! For 4 Year-Olds - Choose Session A or B only
F1 F2 F3 F5 F7 F10 F12

Go Wild! For 5-7 Year-Olds - Choose Session A or B only
FS1 FS2 FS3 FS5 FS7 FS10 FS12

Go Wild! For 8-10 Year-Olds - Choose Sessions A, B, C, or D only
ET2 ET3 ET5 ET7 ET10 ET12

Specialty Camps
OAYM- July 14-18 - 3-4 year-olds
Choose Session A or B only.
OA4 July 14-18 - 4 year-olds
OA5-7 July 14-18 - 5-7 year-olds
OA8-10 July 14-18 - 8-10 year-olds
OA11-13 July 14-18 - 11-13 year-olds
Water Camps
YMWC - 3-4 year-olds & adult teams - July 28-August 1
FWC - 4 year-olds - July 28-August 1
FWC2 - 4 year-olds August 18-22
Lazy, Crazy Camps
LCYM - 3-4 year-olds & adult teams - August 4-8.
Session A or B
LCF - August 4-8 - 4 year-olds
LCFS - August 4-8 - 5-7 year-olds
LCET - August 4-8 - 8-10 year olds

TOTAL # FOR SESSION A:

HOLIDAY CAMPS:SESSON A : 9:00-11:00AM
June 30 - July 3

Fee:
Members: $48
Non-Members: $56

Holiday Camps
YMHC - Adult/Child teams Session A only
FHC - 4 year-olds Session A
FSHC - 5-7 year-olds Session A
TOTAL # HC-SESSION A

HOLIDAY CAMPS:
SESSION B:
June 30 - July 3
9:00 AM - 12:00 PM

Fee:
Members: $72
Non-Members: $80

Holiday Camps
FSHC - 5-7 year-olds Session B
ETHC - 8-10 year-olds Session B only
TOTAL # HC-SESSION B

SESSION B:
9:00 AM - 12:00 PM
1- June 9 - 13
2- June 16-20
3- June 23-27
5- July 7-11
7-July 21-25
10-August 11-15
12-August 25-29

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Go Wild! For Kids & Pals
KP7 KP11

Go Wild! For 4 Year-Olds - Choose Session A or B only
F1 F2 F3 F5 F7 F10 F12

Go Wild! For 5-7 Year-Olds - Choose Session A or B only
FS1 FS2 FS3 FS5 FS7 FS10 FS12

Go Wild! For 8-10 Year-Olds - Choose Sessions A, B, C, or D only
ET2 ET3 ET5 ET7 ET10 ET12

Go Wild! For 11-13 Year-Olds - Choose B, C, or D or only.
LT2 LT3 LT7 LT10 LT12

Specialty Camps
Choose Session A or B only.
OA4 - 4 year-olds July 14-18
OA5-7 - 5-7 year-old July 14-18
OA8-10 - 8-10 year-olds July 14-18
OA11-13 - 11-13 year-olds July 14-18 Field studies suitable for older partipants.
Water Camps
FSWC - 5-7 year-olds July 28-August 1
ETWC 8-10 year-olds July 28-August 1
LTWC 11-13 year olds July 28-August 1
KPWC2 Kids& Pals - August 18-22 - 3 - 12 year-olds & adult teams
KSWC2 5-7 year olds. August 18-22
ETWC2 8-10 year olds - August 18-22
LTWC2 11-13 year olds - August 18-22
Lazy, Crazy Camps
Session A or B
LCF - August 4-8 - 4 year-olds
LCFS - August 4-8 - 5-7 year-olds
LCET - August 4-8 - 8-10 year olds

TOTAL # SESSION B:
SESSION C:
8:30 AM - 5:30 PM
1- June 9 - 13
2- June 16-20
3- June 23-27
5- July 7-11
7-July 21-25
10-August 11-15
12-August 25-29

Go Wild! For 8-10 Year-Olds - Choose Sessions A, B, C, or D only
ET2 ET3 ET5 ET7 ET10 ET12

Go Wild! For 11-13 Year-Olds - Choose Sessions B, C, or D only
LT2 LT3 LT7 LT10 LT12

 

TOTAL #SESSION C:
SESSION D:
12:30 - 5:30 PM

1- June 9 - 13
2- June 16-20
3- June 23-27
5- July 7-11
7-July 21-25
10-August 11-15
12-August 25-29

Go Wild! For 8-10 Year-Olds - Choose Sessions A, B, C, or D only
ET2 ET3 ET5 ET7 ET10 ET12

Go Wild! For 11-13 Year-Olds - Choose Sessions B, C, or D only
LT2 LT3 LT7 LT10 LT12

 

TOTAL # SESSION D:
Adventure Camps
12-16 year olds

Appalachian Adventure - M-8:30 AM -5:30 PM & Tues.8:30 AM - Thurs. 5:30 PM
LTHC - June 30 - July 3

Canoe Camp - 8:30 AM - 5:30 PM Mon. to Wed., Thurs. 12:00 PM - 12:00 PM Fri.
CC5 - July 7-12

Out & About Camp - Monday-Friday 8:30 AM - 5:30 PM
OUT9 - July 4-8

PARENTAL PERMISSION
Emergency Contact:
(Other than primary caretaker)
Emergency Contact's Phone #:
Physician:
Physician Phone #:
Allergies, special needs, etc.
If NONE, please enter NONE.
A response is required
.


Please make a selection.I hereby give permission for my son/daughter to participate in all activites and for my son/daughter to receive emergency medical treatment, if necessary. I also give permission for my child to be photographed during activites, for for Wildlands Conservancy to use my child's photographic image in commercial or non-comercil publiticy for nature programs or facilities.

Questions: Call Maureen Ruhe- 610-965-4397 ext.36

Submit your registration information. You will be directed to our payment form.