Registration Request
Completing this form reserves an available spot for your child (or, if the class is full, places your child on the waiting list.) This form is 1 page. There's no registration fee and no money due upfront. Participants are billed at the end of each month we meet, and fees are prorated to adjust for cancellations and absences. Jenni will follow up via email soon after you submit this form - please check your spam/junk folder for an email from nourishedoaks@gmail.com if you don't see a response in 24 hours.
Nourished Oaks
www.nourishedoaks.com
General Information
Parent/Guardian's Name
*
First Name
Last Name
Parent/Guardian's Relationship to child
*
Parent/Guardian Email Address
*
Parent/Guardian Phone Number
*
Please enter a valid phone number.
May we text your phone number?
*
Current Address
Parent/Guardian Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you interested in being a volunteer?
*
yes
no
not now but maybe in the future
If yes, in what areas are you interested?
set up
clean up
occasionally preparing class materials at home
teaching assistant
Student Information
Homeschool Enrichment is for ages 6-12. Nature Explorers is for ages 5-12. Note: If you want to register more than one child, please complete and submit this form for the first child and then on the confirmation page you can click the button to begin the form again. The general information entered this first time should then prefill for you and you will only need to enter the information specific to the additional child.
Child's Name
*
First Name
Last Name
Child's Preferred Name
*
Child's Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
Child's Gender
*
Please Select
Male
Female
Tell us about your child
Please complete the questions that apply to your child. Any fields that don't apply may be left blank.
Which season(s) do you want your child to attend?
*
Fall 2024 (starts September 3, 2024)
Which program(s) do you want your child to attend?
Homeschool Enrichment (Tues 1-5pm) *1 spot available
Homeschool Enrichment Half-Day (Tues 1-3pm) *1 spot available
Tuesday Nature Explorers (Tues 3-5pm)
Thursday Nature Explorers (Thurs 3-5pm)
LEGO club (4th Friday of the month 3-4:30pm)
Art club (2nd Friday of the month 3-4:30pm)
(Please go ahead and register even if a group is wait-listed. Plans often change last-minute and families on the waiting lists will be contacted in the order in which their applications were submitted.)
Briefly describe your child's experience(s) learning and/or playing with a group of peers, if any (e.g. Have they attended homeschool co-op, extracurricular classes, playgroups? Will this be their first experience with group learning?)
*
What about your child makes you proud?
What are your child's gifts and strengths?
If your child has a disability, please share a little bit about your child's story and area of disability.
Does your child have any specific passions, strong interests, or activities that excite them or bring them joy?
What activities and people does your child enjoy?
What are your child's favorite ways to play?
How would you describe the style your child tends to learn best? (e.g. listening, reading, seeing pictures, hands-on, with movement, etc...)
What books or audiobooks has your child enjoyed recently? (These can be books your child explored independently or with you)
Describe areas of life your child finds particularly difficult, if any.
In what way(s) does your child most comfortably communicate? (e.g. speech, AAC, ASL, etc....)
What are your primary goals for your child this semester? And/or what do you hope this environment/group will do for your child?
Does your child have any sensory preferences or aversions? If yes, please Describe.
Is there anything notable about your child's relationship to music? (e.g. Does your child really benefit from and/or enjoy background music? Dance breaks? Or, is your child sensitive to or easily overstimulated by music?)
Does your child have any physical differences that would be helpful for me to understand?
Does your child use any mobility aids?
Is your child able to walk or otherwise travel a short, mostly level "hike" of less than 1/2 mile?
What tends to cause your child to feel frustrated or overwhelmed?
Please describe any challenges your child tends to struggle with in group settings and/or when feeling frustrated, overstimulated, or overwhelmed
What coping tools and skills does your child benefit most from having available?
What classroom accommodations most benefit your child in a traditional classroom?
If your child struggles with transitions, what usually helps make transitions more tolerable for them?
Does your child have any food or other allergies?
*
Does your child have dietary restrictions? If so, what foods should be avoided?
*
What are your child's favorite/"safe" foods?
Is there anything else should we know about your child?
Will this child be attending with a parent, attendant, or other adult caregiver?
*
yes
no
I'd like to discuss
Do you have any questions for us?
Emergency Contact 1
EC 1 Name
*
First Name
Last Name
EC 1 Phone Number
*
-
Area Code
Phone Number
Emergency Contact 2
EC 2 Name
First Name
Last Name
EC 2 Phone Number
-
Area Code
Phone Number
Pick Up Permission
Who can pick up your child? Your child will only be released to individuals listed here unless other plans are specifically communicated.
*
Please separate multiple names with commas
Physician and Medical Information
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.
*
Physician Name (or Practice Name)
*
Physician Phone Number
*
-
Area Code
Phone Number
Preferred Hospital
*
Insurance/Health Coverage (Company)
If you want to register more than one child, please complete and submit this form for the first child and then on the confirmation page you can click a button to begin the form again. The general information entered this first time should then prefill for you and you will only need to enter the information specific to the additional child.
Submit
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