Registration - Parent Child Program - Wild Roots Forest School

Songbirds Parent Child Program Registration - Wild Roots Santa Barbara

Welcome to Songbirds!

Please fill out the form below to register. You will receive a confirmation and orientation note by email.

SONGBIRDS
Location ~ at Lake Los Carneros in Goleta
Toddlers ~ sturdy walkers up to 3 years

Spring Class: Nine consecutive Thursdays
April 12 - June 7, 2018
9:30-11:30am
cost ~ $250

Payment information
Payment is due to secure your space for the Spring Class, and can be made through Google Wallet to wildroots.sb@gmail.com, or by check made out to "Wild Roots" and mailed to 3730 Avon Lane, Santa Barbara, CA 93105, with memo: Songbirds.

Cancellation Policy
Prior to March 12, 2018: Payments are partially refundable, less a $50 cancellation fee.
March 12 - April 5, 2018: If a participant is available to take the space from a waiting list, payment will be partially refunded, less a $50 cancellation fee.  If a replacement participant is not available, payment is fully non-refundable, and is partially transferrable (50% of the fee paid may be credited to a future class within the 12 months following the cancelled class).
After April 5, 2018: Payment is fully non-refundable, and is partially transferrable (50% of the fee paid may be credited to a future class within the 12 months following the cancelled class).
*If a Songbirds class is cancelled by Wild Roots, all payments made will be fully refunded.*

Contact
You are welcome to contact Juniper with questions at juniperdwight@gmail.com.

* Indicates required field

Child's Full Name *

Child's Date of Birth *

Child's Gender *

Male Female

Parent/Guardian Name *

First

Last

Cell Phone Number *

Other Phone Number *

Email *

Repeat Email (so we know it's correct) *

City / Town *

Alternate Parent/Guardian Name *

First

Last

Email *

Phone Number *

EMERGENCY CONTACT INFORMATION. Please provide 2 or 3 emergency contacts. (Full Name, Relationship to you, Phone Numbers w/area codes, if cell phone or land line) *

CHILD: Please list any allergies your child has (Foods, Environmental, Medications, Insects) as well as frequency, duration and treatments *

PARENT/S: Please list any allergies the parent/s attending the program has (Foods, Environmental, Medications, Insects) as well as frequency, duration and treatments *

Please tell us who lives in the house with you? Adults? Siblings? Friends? Other children, etc? *

How many hours of visual media (TV, computer,videos) does your child experiences? Please include whether number is a daily or weekly basis. *

Please describe the type of visual media. *

Do you have any concerns you want to share with us? *

Please click the SUBMIT button below.

Submit