Early Ecology

"Children are born with a sense of wonder and an affinity for Nature.  Properly cultivated, these values can mature into ecological literacy, and eventually into sustainable patterns of living."

-Zenobia Barlow

Emergency Contact Form

Please fill in as many fields as possible. Even if you are a returning student and you think we have your info, please fill out each field again as completely as possible as this will serve as final form for the 2018-2019 school year. Thank you!


Please include first and last name.
Please let us know in which class your child is enrolled for the 2018-2019 school year.
Child's birthdate
Child's birthdate
If no allergies, please write 'None'
Has your child ever had a reaction to a bee sting? *
If yes, please provide more detail in the "Anything else you'd like us to know" box below.
Has your child ever had a seizure? *
If yes, please provide more detail in the "Anything else you'd like us to know" box below.
Parent / Guardian 1 *
Parent / Guardian 1
Mobile phone number *
Mobile phone number
Home or Work Phone
Home or Work Phone
Parent / Guardian 2
Parent / Guardian 2
Mobile phone number
Mobile phone number
Home or work phone
Home or work phone
Emergency Contact / Other person authorized to pick up your child *
Emergency Contact / Other person authorized to pick up your child
Mobile phone of emergency contact 1 *
Mobile phone of emergency contact 1
Emergency contact 2 / Person other than parents autorized to pick up child
Emergency contact 2 / Person other than parents autorized to pick up child
Mobile phone of emergency contact 2
Mobile phone of emergency contact 2
Please post the name of your child
Parent Signature: (Please type your name)
Date of Signature *
Date of Signature
Assumption of Risk *
Assumption of Risk
PLEASE READ CAREFULLY & ACKNOWLEDGE THAT YOU UNDERSTAND BY SIGNING BELOW. I understand that outdoor activities, such as those at a nature-based program, naturally contain risk. In consideration of the benefits to be derived from participation in such activities, I choose for my child to participate. To the maximum extent permitted by law, I hereby assume any and all of the risks attendant with my child’s participation in this program. I agree to hold harmless and release Joanna Ferraro, Darci Andresen, and associated teachers from all claims arising out of any accident, illness, injury, damage, or other loss or harm to/or incurred or suffered by my child or to his or her property, in connection with or incidental to an Early Ecology Program, activity or trip. Please state name of your child
Posting your name will serve as your signature.
Date of signature *
Date of signature
I understand that portions of the program may be recorded or photographed for the purpose of documentation and promotion of this program and that they may use them for these purposes only. Any photos used on the website or in any other public digital forum (excluding the private Facebook group) will be cleared in advance.

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