Discovery Programs Registration Form

Send registration with deposit/payment to:

Roaring Brook Nature Center
70 Gracey Road, Canton, CT 06019

Child's Name: ________________________________________ Grade in Sept:_________ Age _________
 

Class Name: _________________________________________
Dates: _______________
(Circle)
AM  or  PM

Class Name: _________________________________________
Dates: _______________

AM  or  PM

Class Name: _________________________________________
Dates: _______________

AM  or  PM

Class Name: _________________________________________
Dates: _______________

AM  or  PM


Parent's Name (please print) :_________________________________________  

Parent's Signature:___________________________________________________


Address:___________________________________________________________


Day Phone: ______________________Evening Phone:_____________________

Email:_____________________________________________________________

Are you a member of RBNC/The Childrens Museum? ____Yes ____No

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