HOWL Nature Company After School Program Registration
Please fill out this form to register for our youth programs. You will be sent a medical waiver and invoiced upon receipt.
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Full Name
*
First Name
Last Name
Primary Contact's Email Address- This is where your invoice will be sent.
*
example@example.com
Parent/Guardian Alternate Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please check which after school program your child will be attending:
*
Gaylord Community Gardens- Thursdays from 3:15-4:45
Other information we should know about your child- Allergies, medical needs, etc.
Sliding Scale Selection and Payment Type
Please check the amount you want to contribute for your tuition. A $5 registration fee will be added to your total.
$50
$60
$80* (*$20 donation to Scholarship Fund)
The County Bus will be available to transport your child for a fee of $3 per ride. You will need to pick up your child at the Community Garden when the program is done. The total for the month is an additional $15. Would you like to use this service?
Yes
No
If YES to bus transport, what school does your child attend? Please also share their teacher's name and grade. Thank you!
Payments
We do accept online payments, but must ask for you to help pay the fees included for this service. Please check your preferred payment type. It will be reflected on your invoice from Wave.
Payment method
Credit Card (2.9% + $0.60)
American Express (3.4% + $0.60)
ACH (1%)
Check (Mailed - no fee)
Discount Zone and Donations
Sibling Discount- If you have multiple children attending HOWL, you will receive a 10% discount. Please list their names below. Please note, we still need a registration form for each child.
Donation to Scholarship Fund- HOWL's emergence from recent hibernation means our scholarship fund is very low. We would love to build this up for youth programs. If able to donate, please put amount below and it will be added to your invoice. HOWL is a 501(c) 3 organization. All donations are tax deductible.
Thank you for your support!
Are you interested in our scholarship program?
Yes
No
Where did you learn about HOWL Nature Company?
Social Media- FB or IG
Friend or Family Member
Community Event
Poster or Flier
Other
Additional Notes or Requests
Submit Registration
Should be Empty: