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EMNC Program Registration Form
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| Endless Mountains Nature Center P.O. Box 536, Tunkhannock, PA 18657 * 570-836-3835 To register for programs: 1. Print this page. 2. Complete form, including Emergency Medical Release, if applicable. 3. Calculate registration fee. 4. Make check payable to "Endless Mountains Nature Center." 5. Mail form and check to EMNC. Name:_______________________________________________________________________________ Phone:______________________________________________________________________________ Address:____________________________________________________________________________ City, State, Zip:___________________________________________________________________ Email:______________________________________________________________________________ Program Title:______________________________________________________________________ Program Date:___________________________ Number of Adults:_____ Number of Children:_____ Fee for program:________ Program Title:______________________________________________________________________ Program Date:___________________________ Number of Adults:_____ Number of Children:_____ Fee for program:________ |
Emergency Medical Release for Unaccompanied Minors I, the undersigned, hereby give permission for my child, _____________________________, to participate in the above activities of the Endless Mountains Nature Center and assume all risks and hazards incidental to the program(s). I also hold harmless Endless Mountains Nature Center, its staff, and appointed assistants. I fully consent to emergency medical care to be rendered by licensed medical personnel should my child require it and I cannot be contacted. I consent to emergency transportation, if necessary. __________________________________________ Parent/Legal Guardian Signature ________________ Date |