Registration Form for Friends of
Environmental Club 2009-2010
Name ______________________________________________________
Phone _________________ Cell
# _______________ E-mail _____________
Address _____ญญญ_____________________________________________________
City _______ State _____________ Zip code ___________________
Grade _______ School
________________ Teacher __________________
Emergency Contact ___________________________ Phone
________________
Do you have any Allergies or
special needs we need to know about?
___________________________________________________________________
Have you been a club member
before? yes ______ no ______
Why do you want to
participate in the Elementary Environmental Club?
___________________________________________________________________
___________________________________________________________________
Please read and initial the
following statements:
__________ I understand there is no fee for
attending the Environmental Club
from 3:30-4:30 pm.
__________ I have read and understand the
guidelines and
discipline procedures and will follow them while
attending the
Environmental Club.
__________ I understand that I as an Environmental
Club member will be picked up at 4:30 pm.
I give permission for my
son/daughter's photograph or video image to be used in connection with the Elementary
Environmental Club. I give permission
for my son/daughter to participate in the Environmental Club.
Parent/Guardian Signature:
_______________________________Date__________