Fall 23 Homeschool (Larimer)

Fall 2023 Homeschool Program: Larimer County
Note about Payment Plans

If you are interested in a payment plan, email us at Contact@RuggedResearch.org prior to submitting your child's registration form.
Child Information
Child's Name*

Child First NameChild Last Name
Age*
Note - We have a Little Rangers program for children 3-6 years old.
Gender*

MaleFemale
Does your child have any medical conditions?*
Please include inhaler use, allergies, ADHD, ASD, etc. Anything you'd share with a school nurse or teacher.
Is there a particular learning style that best suits your child?
Please describe your child's experience with hiking and the wilderness, if any.
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? We ask so that we can be accommodating and adjust our teaching style to fit your child's needs. All information provided is confidential to instructors.
What topics is your student most interested in?

FishMammalsPlants, Trees, FlowersBirdsGeologyDinosaurs, FossilsReptiles and AmphibiansInsectsOcean LifeHikingEcological Interactions
Parent/Guardian Information
Parent/ Guardian Contact's Name*

Parent First NameParent Last Name
Relationship*
Phone Number*

Area CodePhone Number
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 from our satellite phone that has reception everywhere.
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
List people who are allowed to pick up your child (besides parent/guardian on this form)
Emergency Contact Information
Parent/Guardian Contact's Name*

Emergency Contact First NameEmergency Contact Last Name
Relationship*
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
How did you hear about Rugged Research?*

FriendFacebookInstagramYoutubeWeb/Google searchMacaroni KidsAdvertisement
Program Selection & Payment
Which program would you like to enroll in? (Select BOTH for the full 8 week course!)

Payment

(8 weeks) Close Encounters with Nature Course *Best Deal*$499.00

This Naturalist led course meets every Tuesday for 4 hours, for 8 weeks.

(4 weeks) Close Encounters with Nature Course$275.00

This Naturalist led course meets every Tuesday for 4 hours, (you choose 1st or 2nd 4 weeks above).

Quantity

Enter coupon

Subtotal $0.00Tax $0.00Total $0.00

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

If you are enrolling siblings in the same course, please (1) enter the siblings name below AND (2) enter Sib5 in the Promo Code box above for a 5% sibling discount.
Signature
Confirmation Statement

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:*

Parent First NameParent Last Name
Date of Signature*

MonthDayYear
Date
Please verify that you are human*
Please close page after submission to prevent double submissions and payments. Thank you!
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Fall 2023 Homeschool Program: Larimer County

Note about Payment Plans