Registration

Nature In Mind Registration Form 2019 - 2020

Spring Session (May - June, after school 6-12 yrs)
Winter 2 Sessions (Mar- April, toddlers)
Spring Session (May-June, after school, 6-12)

Child Information Online Form

* Indicates required field

Child’s full name: *

First

Last

Birthdate (YYYY/MM/DD) *

YYYY/MM/DD

Spring Session May - June *

Butterflies, Monday 4:15-5:45 pm Bees: Thursday 4:15-5:45 pm

Date and Location
Butterflies
Monday, May 4
Lion's Park
Monday, May 11
Lion's Park
** No class on May 18, Victoria Day
Monday, May 25
Lion's Park
Monday, June 1
Lois E Hole Provincial Park
Monday, June 8
Lois E Hole Provincial Park
Monday, June 15
Lois E Hole Provincial Park

Date and Location
Bees
Thursday, May 7
Lion's Park
Thursday, May 14
Lion's Park
Thursday, May 21
Lion's Park
Thursday, May 28
Lion's Park
Thursday, June 4
Lois E Hole Provincial Park
Thursday, June 11
Lois E Hole Provincial Park
Thursday, June 18
Lois E Hole Provincial Park

Fee: Tuesday session includes 6 classes. Thursday session includes 7 classes.
Age 6-9 Age 10-12
1 child $90 1 child $105
2 children $155 2 children $178
3 children $230 3 children $268

Program Payment Options:

Cheque: please make it payable to Anne Logan
Email transfer
Cash

Weather Conditions
If the weather is at -15° C or below, the program will be canceled for the day. An alternative make up date will be discussed with the group if possible. If it is not possible to find an alternate date, the class will be refunded.

Parent/ Guardian name *

Address *

Line 1

City *

Postal Code *

Email *

Cell Phone Number *

Work Phone Number *

Emergency Contact Information

Emergency Contact's Name and relationship to your child *

Phone Number *

Work Number *

I have up to date Standard First Aid. In the event of an emergency I will determine the nature and extent of the emergency. I will ensure that all children are safe. I will assess the injury and call 9-1-1 if necessary. I will use first aid to help the injured child. Finally, I will complete an Accident Report form.

Medical Information

Allergies

List all allergies and their severity *

Any Medical concerns I should be aware of? *

Any behavioral needs I should be aware of? *

Additional health related information *

Permission to Photograph
I give Nature In Mind permission to take photographs of my child or an adult participant during program activities. I am aware that these photos may be used for promotional purposes, including but not limited to Facebook, Instagram, website and print.

Permission to Photograph *

I allow my child to be photographed I will not allow my child to be photographed

Parent Signature *

Date (dd/mm/yy) *

Waiver *

I, the adult participant in Nature in Mind programs named below (the "Participant") and guardian (the "Guardian"), of minor participant(s) named below (the "Children") understand that by checking off and entering my name on this document I expressly agree to all the terms and conditions set forth in this agreement (the "Release"). I understand that participation in activities can expose the named participant to risk and possible injuries. I understand that there is a qualified certified First Aider on site and grant permission for them to treat the above named participant in the event of an injury. I, as Parent and Guardian, accept and assume any and all risks of injury up to and including death, to myself and my Child/ren, or any property damage, whether caused by the negligence of Nature in Mind or otherwise. I, as Parent and Guardian, expressly waive and release any and all claims, now known or hereafter known, against Nature in Mind, and its officers, directors, employees, volunteers, successors and assigns (collectively, the "Releasees"), on account of injury, death, or property damage arising out of or attributable to participation in Nature in Mind Programs, whether arising out of the negligence of Nature in Mind, of any or the Releasees, or otherwise. I, as Participant and Guardian, covemant not to makr or bring any such claim against the Nature in Mind or any other of the Releasees and forever release and discharge Nature in Mind and all other of the Releasees from liability under such claims. I, understand that as a Guardian, I must exercise extra care, responsibility, and supervision of myself and my Child/ren during Nature in Mind Programs. I understand that if my child is too sick to go outdoors they should not attend the program. Where possible, I acknowledge that I have read and fully understand this agreement and accept the risks involved with the aboved named participant's engagement in these activities with Nature in MInd program.

Waiver Signature

Name on waiver *

First

Last

Signature *

Date (dd/mm/yy) *

Preparing for Nature in Mind: Clothing and Equipment
Learning can only happen when we are comfortable, so please ensure your child is set up for success.
As we are traveling each day, food is not provided. Please pack enough food for your child and a drink to meet their needs.

Spring and Fall

See Summer List, and:

Bag lunch, please no nuts.
Warmer Sweater
Jacket Gloves
Base Layers
Extra Boots

Winter

Bag lunch, something hot to drink, please no nuts.
2 Winter Hats,
Fleece Balaclava and/or Neck Warmer
2 Pairs of Warm, Waterproof Mitts
1 Warm, Waterproof Snowsuit
1 set of Warm, Waterproof Boots (with removable liner)
3 Base Layers: Thermal Shirt and Pants, Middle Layer, Wool/Fleece Sweater (cotton not ideal for winter weather)
2 Pairs Warm Wool Socks
Extra Clothing!

Summer

Bag lunch, please no nuts.
Rain Gear (Waterproof Boots, Pants, Jacket)
Running Shoes,
Sun Hat
Lightweight Clothing
Water Shoes (sandals, crocks)
Bathing Suit
Sunscreen
Sunglasses

All seasons

Small Backpack,
Healthy Food, please no nuts.
Water Bottle
Change of Clothes(especially socks!)

Layers is the name of the game and especially in winter we want to choose clothing that wicks moisture, dries fast, insulates our bodies and is waterproof and breathable.

The 3 Basic Layers: The base layer – the layer next to your skin. Avoid cotton – synthetic and merino wool fabrics work best. They dry quickly. When it’s really cold, it’s common to wear 2 base layers: a lightweight or middle weight layer, then a thicker heavyweight layer. The middle layer – keeps you warm! Fleece or microfleece shirts/pants, and jacket (a goose down jacket or similar).

The outer layer – the ―shell. This is your water- and windproof layer and is breathable. Think Gore-Tex, or other polyurethane-coated fabrics with vents (core/underarm) that help release heat. Remember snow pants as well! There is no need to go with expensive gear – check out the local thrift shops too!

Children will stay indoors or attend an indoor field trip when the weather conditions are:

Tornado watch / warning – spotting of green sky and funnel clouds
An outside temperature of -20 ºCelsius and or temperature with a wind chill to make it -20 ºCelsius
Heavy rain or snowfall
High and or wind gusting over 29 km per hour

Getting to Know Your Child

What are your child’s favorite activities? *

Does your child enjoy spending time outdoors? If yes, what do they like to do? *

How would you describe your child’s personality? *

Are there any challenges that your child experiences and requires support for? (sensory issues, emotional, separation anxiety, other) *

What skills or knowledge do you hope your child will gain by attending the Nature in Mind program? *

What are your child’s strengths? *

Thank you for sharing this information with me. If you have any questions or concerns please feel free to connect with me after class in person, by email or by phone to collaborate about your child’s learning and growth. I look forward to getting to know your child and exploring the outdoors with them.

How did you learn about Nature In Mind’s program?

How did you learn about us ? Choose Any *

Website Newspaper Friend or Family Facebook/Social Media Other

If you selected "other", please let us know where *

Once you have registered for the program, payment is due within 72 hours of receiving the confirmation email. This email will be sent to you within 2-3 business days of receiving your registration.

Please submit payment of fees via
e-transfer to info@natureinmind.ca (please make the password “natureprogram” or by cheque to secure your spot.
Cheques can be made out to Anne Logan

Submit

Child Information Online Form

* Indicates required field

Child’s full name: *

First

Last

Birthdate (YYYY/MM/DD) *

Younger sibling name *

Birthdate of sibling *

Winter Program Sessions *

Tuesday: Chickadees 10-11:30 am Thursday: Blue Jays 10-11:30 am

DATES
Chickadees

Tuesday, March 10
Lion's Park
Tuesday, March 17
Lion's Park
Tuesday, March 24
Lion's Park
Tuesday, March 31
Lion's Park
Tuesday, April 7
Lois E Hole Provincial Park
Tuesday, April 14
Lois E Hole Provincial Park
Tuesday, April 21
Lois E Hole Provincial Park

Dates
Blue Jays

Thursday, March 12
Lion's Park
Thursday, March 19
Lion's Park
Thursday, March 26
Lion's Park
Thursday, April 2
Lion's Park
Thursday, April 9
Lois E Hole Provincial Park
Thursday, April 16
Lois E Hole Provincial Park
Thursday, April 23
Lois E Hole Provincial Park

Fee: Each session includes 7 classes.
Children under 2 are free when registering with a sibling between 3-5.
1 child $105
2 children $180
3 children $270

Program Payment Options:

Cheque: please make it payable to Anne Logan
Email transfer
Cash

Parent/ Legal Guardian Information

Parent / Guardian *

Address *

City *

Province *

Postal Code *

Email *

Cell Phone Number *

Relationship to child *

Emergency Contact Information

Emergency Contact's Name and relationship to your child *

Phone Number *

Work Number *

Medical Information

Allergies

List all allergies and their severity *

Any Medical Concerns I should be aware of? *

Any behavioral needs I should be aware of? *

Additional health related information *

Permission to Photograph *

I allow my child to be photographed I will not allow my child to be photographed

Parent Signature *

Date (dd/mm/yy) *

Waiver *

I, the adult participant in Nature in Mind programs named below (the “Participant”) and guardian (the “Guardian”), of minor participant(s) named below (the “Children”) understand that by checking off and entering my name on this document I expressly agree to all the terms and conditions set forth in this agreement (the “Release”). I understand that participation in activities can expose the named participant to risk and possible injuries. I understand that there is a qualified certified First Aider on site and grant permission for them to treat the above named participant in the event of an injury. I, as Parent and Guardian, acknowledge that I am and my Child/ren are voluntarily participating in Nature in MInd Programs offered by Nature in Mind I, as Parent and Guardian , accept and assume any and all risks of injury up to and including death, to myself and my Child/ren, or any property damage, whether caused by the negligence of Nature in Mind or otherwise. I, as Participant and Guardian, expressly waive and release any and all claims, now known or hereafter known, against Nature in Mind, and its officers, directors, employees, volunteers, successors and assigns (collectively, the "Releasees"), on account of injury, death, or property damage arising out of or attributable to participation in Nature in Mind Programs, whether arising out of the negligence of Nature in Mind, of any of the Releasees, or otherwise. I, as Participant and Guardian, covenant not to make or bring any such claim against the Nature in Mind or any other of the Releasees and forever release and discharge Nature in Mind and all other of the Releasees from liability under such claims. I, understand that as Guardian, I must exercise extra care, responsibility, and supervision of myself and my Child/ren during Nature in Mind Programs. I understand that if my child is too sick to go outdoors they should not attend the program. Where possible, I acknowledge that I have read and fully understand this agreement and accept the risks involved with the aboved named participant's engagement in these activities at Nature in Mind program.

Waiver Signature

Name on waiver *

First

Last

Signature *

Date (dd/mm/yy) *

Preparing for Nature in Mind: Clothing and Equipment
Learning can only happen when we are comfortable, so please ensure your child is set up for success.

Spring and Fall

See Summer List, and:

Warmer Sweater
Jacket Gloves
Base Layers
Extra Boots

Winter

Winter Hat
Fleece Balaclava and/or Neck Warmer
2 Pairs of Warm, Waterproof Mitts
1 Warm, Waterproof Snowsuit
1 set of Warm, Waterproof Boots (with removable liner)
2-3 Base Layers: Thermal Shirt and Pants, Middle Layer, Wool/Fleece Sweater (cotton not ideal for winter weather)
2 Pairs Warm Wool Socks
Extra Clothing!

Summer

Rain Gear (Waterproof Boots, Pants, Jacket)
Running Shoes,
Sun Hat
Lightweight Clothing
Water Shoes (sandals, crocks)
Bathing Suit
Sunscreen
Sunglasses

All seasons

Small Backpack,
Food for a snack,
Water Bottle/ Thermos of a hot drink for winter
Change of Clothes(especially socks!)

Layers is the name of the game and especially in winter we want to choose clothing that wicks moisture, dries fast, insulates our bodies and is waterproof and breathable.

The 3 Basic Layers: The base layer – the layer next to your skin. Avoid cotton – synthetic and merino wool fabrics work best. They dry quickly. When it’s really cold, it’s common to wear 2 base layers: a lightweight or middle weight layer, then a thicker heavyweight layer. The middle layer – keeps you warm! Fleece or microfleece shirts/pants, and jacket (a goose down jacket or similar).

The outer layer – This is your water- and windproof layer and is breathable. Think Gore-Tex, or other polyurethane-coated fabrics with vents (core/underarm) that help release heat. Remember snow pants as well! There is no need to go with expensive gear – check out the local thrift shops too!

Getting to Know Your Child

Child’s full name *

What are your child’s favorite activities? *

Does your child enjoy spending time outdoors? If yes, what do they like to do? *

How would you describe your child’s personality? *

Are there any challenges that your child experiences and requires support for? (sensory issues, emotional, separation anxiety, other) *

What skills or knowledge do you hope your child will gain by attending the Nature in Mind program? *

Does your child have any challenges that they are learning to deal with? *

What are your child’s strengths? *

What are your wishes for this program? *

How did you learn about Nature In Mind’s program?

How did you learn about us? Choose Any *

Website Newspaper Friend or Family Facebook/Social Media Other

If you selected "other", please let us know where *

Once you have registered for the program, payment is due by the first class. This email will be sent to you within 2-3 business days of receiving your registration.

Please submit payment of fees via
e-transfer to info@natureinmind.ca (please make the password “natureprogram” or by cheque to secure your spot.
Cheques can be made out to Anne Logan

Submit

Child Information Online Form

* Indicates required field

Child’s full name: *

First

Last

Birthdate (YYYY/MM/DD) *

YYYY/MM/DD

Spring (May-June) SESSIONS *

Butterflies - Mon 10-11:30 am Bees - Thur 10-11:30 am

Dates
Butterflies
Monday, May 4
Lion's Park
Monday, May 11
Lions' Park
**No class on May 18, Victoria Day
Monday, May 25
Lion's Park
Monday, June 1
Lois E Hole Provincial Park
Monday, June 8
Lois E Hole Provincial Park
Monday, June 15
Lois E Hole Provincial Park

Dates
Bees
Thursday, May 7
Lion's Park
Thursday, May 14
Lion's Park
Thursday, May 21
Lion's Park
**No class Thursday May 29 as I'll be at the Toddler Town International Children's Festival
Thursday, June 4
Lois E Hole Provincial Park
Thursday, June 11
Lois E Hole Provincial Park
Thursday, June 18
Lois E Hole Provincial Park

Fee: Each session includes 6 classes.
Children under 2 are free.
1 child $90
2 children $ 155
3 children $230

Program Payment Options:

Cheque: please make it payable to Anne Logan
Email transfer
Cash

Parent/ Legal Guardian Information

Parent 1 / Guardian *

Address *

city *

province *

postal code *

Email *

Cell Phone Number *

Work Phone Number *

Emergency Contact Information

Emergency Contact's Name and relationship to your child *

Phone Number *

Work Number *

Medical Information

Allergies

List all allergies and their severity *

Any medical concerns I should be aware of? *

Any behavioral needs I should be aware of? *

Additional health related information *

Permission to Photograph *

I allow my child to be photographed I do not allow my child to be photographed

Parent Signature *

Date (dd/mm/yy) *

Waiver *

I , the adult participant in Nature in Mind programs named below (the "Participant") and guardian (the "Guardian"), of minor participants(s) named below (the "Children") understand that by checking off and entering my name on this document I expressly agree to all the terms and conditions set forth in this agreement (the "Release"). I understand that participation in activities can expose the named participant to risk and possible injuries. I understand that there is a qualified certified First Aider on site and grant permission for them to treat the above named participant in the event of an injury. I, as Parent and Guardian, acknowledge that I am and my Child/ren are voluntarily participating in Nature in Mind Programs offered by Nature in Mind. I, as Parent and Guardian, accept and assume any and all risks of injury up to and including death, to myself and my Child/ren, or any property damage, whether caused by the negligence of Nature in Mind or otherwise. I, as Participant and Guardian, expressly waive and release any and all claims, now known or hereafter known, against Nature in Mind, and its officers, directors, employees, volunteers, successors and assigns (collectively, the "Releasees"), on account of injury, of or attributable to participation in Nature in Mind Programs, whether arising out of the negligence of Nature in Mind, of any of the Releasees, or otherwise. I, as Participant and Guaridan, covenant not to make or bring any such claim against the nature in Mind or any other of the Releasees and forever release and discharge Nature in Mind and all other of the Relasees from liability under such claims. I, understand that as Guardian, I must exercise extra care, responsibility, and supervision of myself and my Child/ren during Nature in Mind Programs. I understand that if my child is too sick to be outdoors they should not attend the program. Where possible, I acknowledge that I have read and fully understand this agreement and accept the risks involved with the aboved named participant's engagement in these activities at Nature in Mind Program.

Waiver Signature

Name on waiver *

First

Last

Signature *

Date (dd/mm/yy) *

Preparing for Nature in Mind: Clothing and Equipment
Learning can only happen when we are comfortable, so please ensure your child is set up for success.

Spring and Fall

See Summer List, and:

Warmer Sweater
Jacket Gloves
Base Layers
Extra Boots

Winter

1 Winter Hat
Fleece Balaclava and/or Neck Warmer
2 Pairs of Warm, Waterproof Mitts
1 Warm, Waterproof Snowsuit
1 set of Warm, Waterproof Boots (with removable liner)
2-3 Base Layers: Thermal Shirt and Pants, Middle Layer, Wool/Fleece Sweater (cotton not ideal for winter weather)
2 Pairs Warm Wool Socks
Extra Clothing!

Summer

Rain Gear (Waterproof Boots, Pants, Jacket)
Running Shoes,
Sun Hat
Lightweight Clothing
Water Shoes (sandals, crocks)
Bathing Suit
Sunscreen
Sunglasses

All seasons

Small Backpack,
Food for a snack
Water Bottle/ Thermos of a hot drink for cold days
Change of Clothes(especially socks!)

Layers is the name of the game and especially in winter we want to choose clothing that wicks moisture, dries fast, insulates our bodies and is waterproof and breathable.

The 3 Basic Layers: The base layer – the layer next to your skin. Avoid cotton – synthetic and merino wool fabrics work best. They dry quickly. When it’s really cold, it’s common to wear 2 base layers: a lightweight or middle weight layer, then a thicker heavyweight layer. The middle layer – keeps you warm! Fleece or micro-fleece shirts/pants, and jacket (a goose down jacket or similar).

The outer layer – the ―shell. This is your water- and windproof layer and is breathable. Think Gore-Tex, or other polyurethane-coated fabrics with vents (core/underarm) that help release heat. Remember snow pants as well! There is no need to go with expensive gear – check out the local thrift shops too!

Children will stay indoors or attend an indoor field trip when the weather conditions are:

Tornado watch / warning – spotting of green sky and funnel clouds
An outside temperature of -23 º Celsius and or temperature with a wind chill to make it -23 º Celsius
Heavy rain or snowfall
High and or wind gusting over 29 km per hour

Getting to Know Your Child

What are your child’s favorite activities? *

Does your child enjoy spending time outdoors? If yes, what do they like to do? *

How would you describe your child’s personality? *

Are there any challenges that your child experiences and requires support for? (sensory issues, emotional, separation anxiety, other) *

Do you have any concerns about your child attending an outdoor program? *

Does your child have any challenges that they are learning to deal with? *

What are your child’s strengths? *

What are your wishes for this program? *

How did you learn about Nature In Mind’s program?

How did you learn about us? Choose Any *

Website Newspaper Friend or Family Facebook/Social Media Other

If you selected "other", please let us know where *

Submit

“Teaching children about the natural world should be seen
as one of the most important events in their lives.” ‬

Thomas Berry

Nature In Mind Registration Form 2019 - 2020

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