MOTHER NATURE'S CLASSROOM
2007 REGISTRATION FORM
Instructions:
 1) Print this form. 2) Fill in the information requested.
3) Sign the form. 4) Mail this form along with payment to the address below.
Note: This form cannot be submitted online.

Please use one form per student enrolled.


Child's Name:___________________________________________

Date of Birth:_________________________M:_______ F:________

Address:________________________________________________

City:__________________________ State:____ Zip:____________

Telephone: (day)_________________ (cell)____________________

Email: __________________________________________________

Medical Information/Allergies:_______________________________

**Special Needs:__________________________________________

Name of Parent or Guardian: _____________________________

Parent or Guardian Signature:____________________________

Open to children ages 5 to 6. Classes are each 2 1/2 hours.

5 - class sessions: $93.75 members/ $125 nonmembers

4-class sessions: $75 Flanders' members, $100 nonmembers

3-class sessions: $56.25 members / $75 nonmembers

2-class sessions: $37.50 members / $50 nonmembers

Check program date(s) & circle AM or PM.

September (3 Thursday classes): ____ AM / PM

October (4 Thursday classes): ___ AM / PM

November (4 Thursday classes): ___ AM / PM

December (3 Thursday classes): ___ AM / PM

Circle one: Current Member / Nonmember

Optional Family Membership: $50/year _________

TOTAL ENCLOSED:________

Please mail this form (one per student) and payment by check to:
Flanders Nature Center & Land Trust
P.O. Box 702, Woodbury, CT 06798

Office is located at the corner of Flanders & Church Hill Roads in Woodbury.

Space is limited. Registration and advance payment by mail or in person is required.