Online Program Registration

Contact Name *

Contact Name

Asterisks indicate required registration information. You may use this form to register for up to 5 programs at a time. If you are just registering for 1 program, leave fields that are not marked by asterisks blank and skip to "Total Cost for all programs above" section and below. Please note some of our programs are free http://www.naturevision.org/free-programs-for-schools/ You must click "Submit" upon completion of this form, or we will not receive your registration.

First Name

Last Name

Full School Name/Organization Name *

Full School Address *

County *

Billing Address

Fill out only if different than school address.

Teacher Email Address *

Daytime Phone *

1) Program Name *

Program Date Desired *

Please see our calendar of available dates.

Program Time Desired *

Teacher Name *

Grade Level *

Number in Class/Group *

30 students or fewer.

Room Number/Field Site Desired *

Enter room number or field site location desired.

2) Program Name

Program Date Desired

Program Time Desired

Teacher Name

Grade Level

Number in Class/Group

Room Number/Field Site Desired

3) Program Name

Program Date Desired

Program Time Desired

Teacher Name

Grade Level

Number in Class/Group

Room Number/Field Site Desired

4) Program Name

Program Date Desired

Program Time Desired

Teacher Name

Grade Level

Number in Class/Group

Room Number/Field Site Desired

5) Program Name

Program Date Desired

Program Time Desired

Teacher Name

Grade Level

Number in Class/Group

Room Number/Field Site Desired

Total Cost for all programs above *

$100 for one program; $110 for one summer or library program $200 for two programs; $220 for two summer or library programs $300 for three programs; $330 for three summer or library programs $400 for four programs; $440 for four summer or library programs $500 for five programs; $550 for five summer or library programs Please note that some of our programs are free. If you saw a flier or email that specified certain programs are sponsored for your school, you do not need to worry about payment when you register: http://naturevision.org/free-programs-for-schools

Information about your class:

More than 30 students

High percent ELL

Other (please list under additional notes)

Any additional notes for us?

Additional Information for Teachers: 30 students maximum. A teacher or responsible adult must be present for the program at all times. If you do not wish to pay online now, we will invoice you later. Field trip site closest to you will be chosen unless otherwise specified. Please schedule 2-4 classroom or field programs per date selected for your school. This allows us to send available staff and supplies in the most efficient way possible.

LIMITATION OF LIABILITY AND INDEMNITY *

TYPING YOUR NAME BELOW SERVES AS YOUR DIGITAL SIGNATURE. THE ABOVE NAMED SCHOOL AGREES TO RELEASE AND HOLD NATURE VISION, ITS OWNERS, EMPLOYEES, VOLUNTEERS AND DIRECTORS HARMLESS TO THE EXTENT PERMITTED BY LAW, FROM AND AGAINST ALL CLAIMS, DEMANDS, SUITS, PENALTIES, LOSSES, DAMAGES, JUDGMENTS AND COSTS OF ANY KIND ARISING OUT OF OR IN ANY WAY RESULTING FROM THE ACTIVITIES OF STUDENTS, TEACHERS, VOLUNTEERS, PARENTS OR OTHER DISTRICT OR SCHOOL PARTICIPANTS IN NATURE VISION ACTIVITIES, INCLUDING TRANSPORTATION TO AND FROM NATURE VISION ACTIVITIES. THE ABOVE NAMED SCHOOL RELEASES AND AGREES TO INDEMNIFY NATURE VISION, ITS OWNERS, EMPLOYEES, VOLUNTEERS AND DIRECTORS FOR ALL LOSSES, DAMAGES, JUDGMENTS, COSTS AND EXPENSES OF ANY KIND ARISING OUT OF OR IN ANY WAY RESULTING FROM THE ACTIVITIES OF STUDENTS, TEACHERS, VOLUNTEERS, PARENTS OR OTHER DISTRICT OR SCHOOL PARTICIPANT IN NATURE VISION PROGRAMS, INCLUDING SETTLEMENT PAYMENTS, COURT JUDGMENTS AND REASONABLE LEGAL DEFENSE FEES.

Date *

Date

YYYY

Payment Options *

Choose Free Program (Sponsored) http://naturevision.org/free-programs-for-schools ; or scroll down to choose Invoice. You will receive a confirmation once we have received your registration. If you choose "Invoice" you will be billed later. You must click "Submit" upon completion of this form, or we will not receive your registration.

Program Sponsor Name (if applicable)

Please list the sponsor of your program if possible. For example, Cascade Water Alliance, Saving Water Partnership, etc.