Wild Rose Farm, 'Community Days' Program Registration 2024-2025

Wild Rose Farm

'Community Days' Program 2024-2025

Thursdays 1:00 - 3:00 p.m.

Fridays 9:00 a.m. - 1:00 p.m

Fridays 1:30 - 3:00 p.m.

snack & crafting materials included

Autumn 2024: September 12 - December 12 (no program, 11/28)

Winter 2025: January 9 - February 27

Spring 2025: March 13 - June 12 (Thursdays) & June 6 (Fridays) (no program 4/21-4/24)

*Please NOTE that we take into consideration that families may schedule different holiday days/weeks, throughout the year. We will work with you, with advanced notice, to credit your balance due for these absences. We require a minimum number of participants to hold each program and, in the event of low enrollment, we will do our best to inform you 2 weeks prior to the program start date.

Registration & Program Payment

Registration Thursday 'Community Days', 1:00 - 3:00 p.m.

$25.00

Registration Friday Community Days', 9:00 a.m. - 1:00 p.m.

$40.00

Registration Friday 'Community Days', 1:30 - 3:00 p.m.

$25.00

Total

$0.00

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

INVOICING: We email Invoices, for the balance due, via QuickBooks to the primary email address listed on this Registration Form. Unless otherwise agreed upon the payment for the first Invoice payment will be due 15 days after the first day of the program, and the balance will be due 15 days prior to the end of the program.

Please check all that apply to your current circumstances. We will apply a multiple day discount, if applicable, to your balance due. If requested we will contact you to coordinate a payment plan and/or financial support, and answer any further questions.

Single invoice

Please invoice me, for the total balance due, in one invoice.

Payment Schedule

Please contact regarding setting up a payment schedule.

Financial Support

Please contact me to coordinate financial support.

Multiple Program discount

Please deduct a 5% discount with a Registration that includes both Thursday Programs

Is there anything else that would be helpful to ensure participant Registration?

Child's Name*

First NameLast Name

Birthdate*

Child's current Grade in School (if applicable)

Parent or Adult Caregiver*

First NameLast Name

Relationship to child*

Emergency Contact:*

YesNo

Primary Phone Number*

MobileLandline

*

Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code

Additional Parent or Adult Caregiver (optional)

First NameLast Name

Email*

example@example.com

Emergency Contact:

YesNo

Relationship to child

Primary Phone Number

MobileLandline

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Does your child follow any dietary guidelines or have any food preferences?*

if yes, please provide notes belowno

Dietary notes

Is your child currently taking any regular medications, including carrying an inhaler or an Epi-pen?*

if yes, please provide notes belowno

Medical notes

Is there anything else you would like to share with us about your child? Please note how you would like to be contacted. Thanks!