RM_Stats

Nature Detectives Enrollment

Username^*

Name of School or Organization

Class Start Date & Time

Child First Name

Child Last Name

Child Grade

Special interests & talents

First Name Parent or Guardian

Last name Parent or Guardian

Primary Email^*

Primary phone number

Secondary phone number

Parent Questions or Comments

Medical Liability

I release Janice Kelley from any liability in the event of accident or injury. I agree to release all personnel for any liability in connection with this activity and assume financial responsibility for all expenses of such care.

Images

I authorize any images and video captured during this event may be used to create promotional material and publications. Any rights of compensation or ownership to these images are waived by the students, their parents and/or guardians.

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