Garden Explorers Summer 2024 Registration - The Old Stone House in Brooklyn

Student Name*

First Last

School (as of Fall 2024)*

Grade (as of Fall 2024)*

Select grade from dropdown.

Date of Birth*

I am registering for the following session(s):*

Select All
Session 4: 8/12-16
Session 5: 8/19-23
Session 6: 8/26-30

All sessions take place Monday through Friday, 9 am to 3 pm.

My child has the following activity or medical restrictions. Please elaborate so that we may better meet your child's needs.

Parent Name*

First Last

Parent Cell #*

Email*

Address*

Street Address City State ZIP Code

Emergency Contact*

First Last

Please provide a contact OTHER than the parent listed above.

Relationship to student*

Emergency Cell #*

Please tell us how you learned of this OSH program:

Please feel free to share any other comments you may have.

Release and Waiver of Liability

While participating in activities at the Old Stone House each student is assumed to be voluntarily performing activities for which he/she assumes all risk, consequences, and potential liability. The undersigned hereby releases and holds harmless the Old Stone House and its agent or agents from any and all claims arising or resulting directly or indirectly from participation in the program. I authorize the Old Stone House to take necessary action in case of emergency if I am unable to be reached. In addition, I authorize the Old Stone House to use photographs or recorded video in which my child appears, as well as art my child produces, in promotional literature, ads, displays, website or any format representing the activities.*

I agree to Waiver

I am interested in financial aid

Yes

An application will be emailed to you.

You will receive an email confirmation upon successful registration. Please contact us at education@theoldstonehouse.org if you do not.

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Garden Explorers Summer 2024

Release and Waiver of Liability

You will receive an email confirmation upon successful registration. Please contact us at education@theoldstonehouse.org if you do not.

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