Green Power, Farm & Forest Explorers and Junior Apprentice Registration

Thank you for your interest in our educational programs. Please fill out the form below to register your child for Green Power or the Farm and Forest Explorers program!

Name of student: *

Program requested: *

Date of birth: *

Grade completed by June 2009: *

Address (street, city, state, zip): *

Phone number: *

Name of parents/guardians: *

Parent/Guardian daytime phone number: *

Parent/Guardian email address: *

Medical

Physician name: *

Physican phone number: *

Provider: *

Policy Number: *

Physical/medical conditions?: *

In case of emergency contact name/phone number: *

Terms: *

Yes, I accept the following terms: While working at Land's Sake there are inherent risks from heat, insects, fatigue, sore muscles, moving vehicles, and heavy objects. Every reasonable effort will be made to emphasize safe working habits. I understand and accept these risks and will hold Land's Sake, Inc. and the Town of Weston harmless for any and all injuries suffered in the course of the Green Power and Junior Apprenticeship programs.

Preferred method of payment: *

by credit card

by check

How did you hear about this program: *

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Green Power, Farm & Forest Explorers and Junior Apprentice Registration