Parker Learning Gardens

Seeds of Success Discount Program - Registration

**How It Works: (Admin Approval Only)**

**The prices below are 50% off of the full season prices, these prices are for approved applicants only.**

FOR REGISTRATION ISSUES CALL OR TEXT our staff at 541-579-8788. For questions regarding any of our seasonal programming, email sasha@parkerlearninggardens.org

Please feel free to read our [Youth Protection Policy](https://docs.google.com/document/d/1lwx_T_LaySFOJ49sqXITqWARHtBNTDppGIz8Ow7yoDA/edit?usp=sharing) .

How many students enrolling? $110.00 How many students enrolling?

Program- $110 each *

Mom & Me Garden Club: 0-4 year olds

Children's Garden Club: 5-11 year olds

Youth Discovery Program: 13-17 year olds- Tuesdays

Youth Discovery Program: 13- 17 year olds- Thursday

Sprouts Garden Camp

Total Cost

Parent/Legal Guardian Name *

Parent/Legal Guardian Phone (1st called in emergency) *

Parent/Legal Guardian Email *

Student #1 First & Last name *

Student #1 age *

Student #1 Food Allergies: *

Student #2 First & Last name:

Student #2 age

Student #2 Food Allergies:

Student #3 First & Last name:

Student #3 age

Student #3 Food Allergies:

Emergency Contact #1 (non-parent): Name / Number

Emergency Contact #2 (non-parent): Name/Number

Anything else you'd like to tell us about your kiddo(s)?

How did you hear about our Seed of Success Discount Program?

LIABILITY WAIVER: By typing my initials on this form, I hereby release and discharge the owner(s) of land used with Parker Learning Gardens and its employees and directors from any bodily harm or damage or loss of whatever kind arising from, or in any manner or form connected with the Parker Learning Gardens' programs. INITIALS BELOW FOR LIABILITY WAIVER AGREEMENT FOR PARENT AND ANY MINOR CHILDREN (MUST BE LEGAL GUARDIAN OF CHILDREN). PLEASE PRINT CHILDREN'S FIRST AND LAST NAME ABOVE. *

Everything above I have answered honestly, and I am the legal guardian of the children listed above. (Please Initial) *

Would you like to join our Parent Advisory Council? This entails mostly one email a month or so with a brief questionaire to help us continue to improve our programming and connect with families and the needs of our community. It may include invitations to VIP events and or meetings.

MEDIA RELEASE-For consideration which I acknowledge, I irrevocably grant to Parker Learning Gardens (PLG) and PLG's assigns, licensees and successors the right to use my image, voice, and name in all forms and media including composite or modified representations for all purposes, including advertising, trade or any commercial purpose throughout the world and in perpetuity. I waive the right to inspect or approve versions of my image used for publication or the written copy that may be used in connection with the images. I release PLG and PLG's assigns, licensees and successors from any claims that may arise regarding the use of my image and/or voice including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright. PLG is permitted, although not obligated, to include my name as a credit in connection with the image or recording. PLG is not obligated to utilize any of the rights granted in this Agreement. I have read and understood this agreement and I am over the age of 18. This Agreement expresses the complete understanding of the parties. INITIALS BELOW FOR MEDIA RELEASE FOR PARENT AND ANY MINOR CHILDREN

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Seeds of Success Discount Program - Registration

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Seeds of Success Discount Program - Registration

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