Little Rangers Pop up 8/8

Little Rangers Summertime in the Bluegrass 8/8/22

For children ages 4-6. Let's get outside and learn about nature!
Location: Lexington city park- exact location will be emailed out upon registration

Date/Time: Monday, August 8th 2-3pm

Cost: $20 per student

All students should have a guardian with them for the duration of the class.
Student Information
Child's Name *

First Name Last Name
Age *
Gender *

Male Female
T-shirt size
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Siblings:
If you are signing up siblings together for the same session, please enter Sibs5 for the promo code at checkout on both registration forms in order to recieve 5% off. Please list sibling if applicable:
Sibling's Name
Parent/Guardian Information
Parent/ Guardian Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
E-mail *
example@example.com
If we have a time-sensitive question/ emergency, what's the best number to text you at? *
All important communications will happen via email, but if we need to ask you a time-sensitive question or have an emergency that forces us to evacuate the park (inclement weather, injury, etc.) we will send you a text.
List people who will possibly accompany your child for class (besides parent/guardian on this form)
Emergency Contact Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
E-mail
example@example.com
Child Information
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is your child prescribed an inhaler? If yes, please explain any instructions.
What do you want your child to gain from this class?
Is there any other information that you would like to share with us about your child?
Ex: Any medical, learning, behavioral, or emotional challenges that may affect their ability to participate in this program? How does your child interact with other children, adults?
How did you hear about Rugged Research? *

Facebook Instagram Word of Mouth Youtube Web/Google search Advertisement
Confirmation

BY AGREEING AND ENTERING MY NAME BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Name of Parent/Guardian: *

First Name Last Name
Date *

Month Day Year
Date

My Products

Little Rangers Pop up $ 20.00

August 8th, 22

Enter coupon

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please verify that you are human *
Should be Empty:

Little Rangers Summertime in the Bluegrass 8/8/22