Summer Discovery Programs Registration Form

Send registration with payment to:

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


Child's Name
:________________________________________Age:_____ Grade in Sept:____

Address:
_____________________________________________________________________
 

Class Name
:_________________________________________Dates:____________________

Class Name
:_________________________________________Dates:____________________

Class Name
:_________________________________________Dates:____________________

Class Name
:_________________________________________Dates:____________________
(indicate AM or PM if appropriate)
 

Parent's Name:________________________________________________________   

Parent's Signature:_____________________________________________________

Parent Work/Day Phone: ___________________Home Phone:__________________

Email
:_____________________________________________________
Are you a member of Roaring Brook Nature Center/The Children's Museum? ____Yes ____No
 

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