Registration

Nature In Mind Registration Form 2019 - 2020

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Fall Sessions
Winter Sessions
2020 Sessions

Child Information Online Form

* Indicates required field

Child’s full name: *

First

Last

Birthdate (YYYY/MM/DD) *

YYYY/MM/DD

Fall Sessions *

Muskrats - Mon & Wed 9:00-12:00pm Squirrels - Tues & Thurs 9:00-12:00 pm Coyotes - Friday only 9:00-12:00 pm

DATES
Muskrats: Sept. 16 – Oct. 30
No class on Oct. 14
Squirrels: Sept. 17 – Oct. 31
Coyotes: Sept. 20 – Oct. 27

# OF CLASSES
M/ W 13
T/ T 13
F 7

FEE
Muskrats
$455
Squirrels
$490
Coyotes
$210

Each 3 hour class is $35.00
Muskrats: Sept. fee: $175, Oct. fee $280, Total $455
Squirrels: Sept. fee $140, Oct. fee $350, Total $490
Coyotes: Sept. fee $70, Oct. fee $140, Total $210

Payment Options:
Monthly post-dated cheques due by first day of class.
E-transfer: full program payment or monthly payments at the start of the month

info@natureinmind.ca
Refund Policy

A registration deposit of $75 is non-refundable (part of the first month's payment for the program).
30 days notice is required to withdraw from the program after the program commences.

If you do not provide notice, you will be required to pay for one more month of class fees.

If your child is unable to finish the program: you will be refunded the fee for remaining classes minus 2 weeks.

Parent/ Legal Guardian Information

Parent 1 / Guardian *

Parent 2/ Guardian *

Address *

Line 1

City *

Province *

Postal Code *

Email *

Cell Phone Number *

Work Phone Number *

Relationship to child *

Parent 2 Address *

Parent 2 city *

Parent 2 province *

Parent 2 postal code *

Parent 2 Email *

Parent 2 Cell Phone Number *

Parent 2 Work Phone Number *

Parent 2 Relationship to child *

Emergency Contact Information

Emergency Contact's Name and relationship to your child *

Phone Number *

Work Number *

I have up to date Standard First Aid. I will always carry my cell phone and the list of parents’ phone numbers and information about allergies or medications. 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. Next I will contact their parents. I will then complete an Accident Report form.

Illness Policy Prevention
Illness prevention is key and we want to keep our community as healthy as can be, so if any of the following cases occur, I ask that parents/guardians keep their child at home and only allow them back at Nature in Mind at minimum 24 hours after their last symptom has subsided
(this is true for myself and my family as well):

Cold accompanied by a runny nose and coughing
Any communicable disease
High fever during the previous 24 hours
Diarrhea and or vomiting during previous 24 hours
A new unexplained rash

Alternative chaperone for child pick-up
If you are not available to pick up your child at the end of class, you can designate an alternative chaperone to pick up your child.
All designated chaperones must be 18 years of age or older and will required photo ID in order for the child to be released into their care.

Others who may pick up your child at the end of class:

Name of others who may pick up your child *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

For last-minute (day-of-class) chaperone additions:
A verbal authorization by phone from the child’s legal guardian (as listed on this registration form) will be permitted to add a designated chaperone in the event that chaperones listed above are not available for child pick-up.

Late Policy
If you arrive 10 minutes late you will be charged $10. For every 5 minutes after, you will be charged $5.00. Please notify me if you are running late.
10 minutes late $10
15 minutes late $15
20 minutes late $20
25 minutes late $25

Medical Information

Doctor's Name *

First

Last

Doctor’s Office Phone *

Alberta Health Care # *

Allergies

List all allergies and their severity *

Medications *

Medical Problems *

Behavioral needs *

Additional health related information *

Medication: If your child requires medication during the program, you are responsible for teaching me when and how to give the medication. We will complete a medication record form.

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) *

Statutory Holidays and Breaks
The following is a list of designated days that the Nature in Mind program will not be open.

Labour Day,  Sept. 9, 2019
Thanksgiving Oct. 14, 2019
Remembrance Day, Nov. 11, 2019
Christmas holidays  Dec. 16 – Jan. 10, 2020
Family Day,  Feb. 17, 2020
Spring Break, March 23- March 27, 2020
Good Friday,  April 10, 2020
Easter Monday, April 13, 2020
Victoria Day,  May 18, 2020

Nature-In-Mind Waiver
Please mark all of the boxes to show that you understand and comply with the following statements:

Waiver *

I understand that by checking off and signing this document I hereby release Nature in Mind from any and all liability associated with the program my child is attending. 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 recognize that Nature In Mind reserves the right to move the program indoors due to unsafe weather conditions or other unforeseen circumstances. 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. When possible, Nature in Mind will attempt to reschedule, but this may not always be possible. I will not hold Nature In Mind liable for loss of fees or programs. All tools and materials will be provided by Nature In Mind. Participants are discouraged from bringing additional items to sessions as they may be lost or stolen. I will not hold Nature In Mind responsible for any lost or stolen items. I understand that it is my responsibility to ensure that the named participant is dressed properly for weather conditions as this is a program largely based outside in natural settings. I understand that the participant may not be admitted to a session if they are not clothed properly for the conditions and I will not hold Nature In Mind responsible. While participating in the Nature In Mind program, I understand that the named participant will be required to listen and follow the guidance of the Nature In Mind teacher. In the event that: the participant’s behaviour is felt to be unsafe or unmanageable, if an illness or injury should arise in which a doctor's diagnosis is required, other unsafe conditions develop that require participant’s removal from the program, I authorize Nature In Mind to dismiss my child early, in which case I will assume responsibility for transporting my child from the program at a time specified. I understand that if my child is too sick to go outdoors they should not attend the program. 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.

Waiver Signature

Name on waiver *

First

Last

Signature *

Date (dd/mm/yy) *

General Field Trip Permission and Transportation Form

This form gives the Nature in Mind permission to go to the following destinations
For all other field trips, you will be notified in advance and asked to sign a separate specific field trip form.
Safety rules are reviewed with children prior to each field trip.
In case of an emergency, I give consent for any emergency medical treatment as may be deemed necessary by staff.

Parent name *

hereby give Nature in Mind permission to take

Child name *

to the various sites throughout the session.

St Albert

Grey Nuns White Spruce Forest
Lacombe Lake
Riel Recreation Park
Sturgeon River & Pathway
Muriel Martin mini-forest
Lois E Hole Park, John E. Poole platforms
City Parks: Ronald Harvey Elementary & Liberton, Lions Park
Heritage Lakes
Tree Fort by Ecole Marie Poburan School
River Lot 56
Woodlands Play park
Parish Community Garden beside St Albert Catholic Church

Morinville
Cardiff Park

Spruce Grove
Happy Acres U-Pick

Edmonton
Beaumaris Lake
Hawrelak Park

Devon
Clifford E. Lee Sanctuary

Winter Indoor Places
for days when it is below -20 ºC

Anne's House
John Janzen Nature Center
Alberta Provincial museum
St Albert Library
VASA - Visual Arts Studio

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

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) *

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

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? *

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) *

YYYY/MM/DD

WINTER SESSIONS *

Rabbits - Mon & Weds 9:00-12:00 pm Moose - Tues & Thurs 9:00-12:00 pm Deer - Friday only 9:00-12:00 pm

DATES
Nov. 4 - Dec. 18 No class on Nov. 11
Nov. 5 - Dec. 19
Nov. 1 - Dec. 20

# OF CLASSES
Rabbits 13
Moose 14
Deer 8

FEE
Rabbits $455
Moose $490
Deer $280

Each 3 hour class is $35.00
Rabbits: Nov. fees $245, Dec. fees $210, total $455
Moose: Nov. fees $280, Dec. fees $210, total $490
Deer: Nov fees $175, Dec. fees $105, total $280

Payment Options:

Monthly post-dated cheques due by first day of class.
Full payment for session
E-transfer monthly payments on the first of each month (to info@natureinmind.ca, password natureprogram)

Refund Policy
If you decide to withdraw from the program, 30 days notice is required.
If you do not provide notice, you will be required to pay for one more month of class fees.
The registration deposit of $75 is non-refundable. If your child is unable to finish the session and you require a refund, you will be refunded the remaining classes minus 2 weeks.

Parent/ Legal Guardian Information

Parent 1 / Guardian *

Address *

City *

Province *

Postal Code *

Email *

Cell Phone Number *

Work Phone Number *

Relationship to child *

Parent 2/ Guardian *

Parent 2 Address *

Parent 2 City *

province *

Postal code *

Parent 2 Email *

Parent 2 Cell phone number *

P 2 work phone number *

Parent 2 relationship to child *

Emergency Contact Information

Emergency Contact's Name and relationship to your child *

Phone Number *

Work Number *

Cold accompanied by a runny nose and coughing
Any communicable disease
High fever during the previous 24 hours
Diarrhea and or vomiting during previous 24 hours
A new unexplained rash

Others who may pick up your child at the end of class:

Name of others who may pick up your child *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Medical Information

Doctor's Name *

First

Last

Doctor’s Office Phone *

Alberta Health Care # *

Allergies

List all allergies and their severity *

Medications *

Medical Problems *

Behavioral needs *

Additional health related information *

Medication: If your child requires medication during the program, you are responsible for teaching me when and how to give the medication. We will complete a medication record form.

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 *

Waiver Signature

Name on waiver *

First

Last

Signature *

Date (dd/mm/yy) *

General Field Trip Permission and Transportation Form

Parent name *

hereby give Nature in Mind permission to take

Child name *

to the various sites throughout the session.

St Albert

Grey Nuns White Spruce Forest
Lacombe Lake
Riel Recreation Park
Sturgeon River & Pathway
Muriel Martin mini-forest
Lois E Hole Park, John E. Poole platforms
City Parks: Ronald Harvey Elementary & Liberton, Lions Park
Heritage Lakes
Tree Fort by Ecole Marie Poburan School
River Lot 56
Woodlands Play park
Parish Community Garden beside St Albert Catholic Church

Morinville
Cardiff Park

Spruce Grove
Happy Acres U-Pick

Edmonton
Beaumaris Lake
Hawrelak Park

Devon
Clifford E. Lee Sanctuary

Winter Indoor Places
for days when it is below -20 ºC

Anne's House
John Janzen Nature Center
Alberta Provincial museum
St Albert Library

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

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

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,
Water Bottle
Change of Clothes(especially socks!)

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

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) *

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

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 *

Submit

Child Information Online Form

* Indicates required field

Child’s full name: *

First

Last

Birthdate (YYYY/MM/DD) *

YYYY/MM/DD

Winter 2020 SESSIONS *

Foxes - Mons & Weds 9:00-12:00 pm Lynxes - Tues & Thurs 9:00-12:00 pm Wolves - Friday only 9:00-12:00 pm

DATES
Jan. 13- Feb. 26 No class on Feb. 17
Jan. 14 - Feb. 27
Jan. 17 - Feb. 28

# OF CLASSES
14
14
7

FEE
Foxes $490
Lynxes $490
Wolves $245

Each 3 hour class is $35.00
Foxes: Jan. fee $210, Feb. fee $280, Total $490
Lynxes: Jan. fee $210, Feb. fee $280, Total $490
Wolves: Jan. fee $105, Feb. fee $140, Total $245

Payment Options:

Monthly post-dated cheques due by first day of class.
Full payment for session
E-transfer monthly payments on the first of each month (to info@natureinmind.ca, password natureprogram)

Parent/ Legal Guardian Information

Parent 1 / Guardian *

Address *

city *

province *

postal code *

Parent 2/ Guardian *

Address *

City *

Province *

Postal Code *

Email *

Cell Phone Number *

Work Phone Number *

Relationship to child *

Email *

Cell Phone Number *

Work Phone Number *

Relationship to Child *

Emergency Contact Information

Emergency Contact's Name and relationship to your child *

Phone Number *

Work Number *

Cold accompanied by a runny nose and coughing
Any communicable disease
High fever during the previous 24 hours
Diarrhea and or vomiting during previous 24 hours
A new unexplained rash

Others who may pick up your child at the end of class:

Name of others who may pick up your child *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Medical Information

Doctor's Name *

First

Last

Doctor’s Office Phone *

Alberta Health Care # *

Allergies

List all allergies and their severity *

Medications *

Medical Problems *

Behavioral needs *

Additional health related information *

Medication: If your child requires medication during the program, you are responsible for teaching me when and how to give the medication. We will complete a medication record form.

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 *

Waiver Signature

Name on waiver *

First

Last

Signature *

Date (dd/mm/yy) *

General Field Trip Permission and Transportation Form

Parent name *

hereby give Nature in Mind permission to take

Child name *

to the various sites throughout the session.

St Albert

Grey Nuns White Spruce Forest
Lacombe Lake
Riel Recreation Park
Sturgeon River & Pathway
Muriel Martin mini-forest
Lois E Hole Park, John E. Poole platforms
City Parks: Ronald Harvey Elementary & Liberton, Lions Park
Heritage Lakes
Tree Fort by Ecole Marie Poburan School
River Lot 56
Woodlands Play park
Parish Community Garden beside St Albert Catholic Church

Morinville
Cardiff Park

Spruce Grove
Happy Acres U-Pick

Edmonton
Beaumaris Lake
Hawrelak Park

Devon
Clifford E. Lee Sanctuary

Winter Indoor Places
for days when it is below -20 ºC

Anne's House
John Janzen Nature Center
Alberta Provincial museum
St Albert Library

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

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

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,
Water Bottle
Change of Clothes(especially socks!)

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

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) *

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

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 *

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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