Homeschool Registration

All events are located at: Chintimini Wildlife Center Education Yurt, 311 NW Lewisburg Rd, Corvallis. See map and directions.

 
Contact Ronda at programs@chintiminiwildlife.org for information.
 
Register and Pay Online

* required fields

Child's Name 1*: Child's Age 1*:
Child's Name 2: Child's Age 2:
Child's Name 3: Child's Age 3:
Child's Name 4: Child's Age 4:
Parent/Guardian Name*:
Address 1*:
Address 2:
City*:
State/Province*:
ZIP/postal code*:
E-mail address*:
Work Phone
(with area code)*:
Home Phone
(with area code)*:
Cell Phone
(with area code)*:
Emergency Contact & Phone*:
2018 Homeschool
How did you hear about our program?* email from Chintimini    social media / Facebook
online search engine    heard from a friend
Other:
Wet and Wild, 9am - 11am class
May 28th
(Same class is run twice in one day:
one in morning; one in afternoon)
$10 per child per 2-hour class
May 28, 9am - 11am - Ages 5 to 12
Name(s) of children attending Wet and Wild homeschool:
Wet and Wild, 1pm - 3pm class
May 28th
(Same class is run twice in one day:
one in morning; one in afternoon)
$10 per child per 2-hour class
May 28, 1pm - 3pm - Ages 5 to 12
Name(s) of children attending Wet and Wild homeschool:
Total Fees
$0.00
Write down this amount!
Payment Method
Submit this form. Follow instructions for either method.*
Paypal    By check
Allergies/Medical Information/Additional Information (on campers)*:
Authorized By (Represents your signature)*:
I give CWC permission to include my child in photographs that may be used in brochures, newsletters and other media. Yes    No

By submitting this application, I hereby certify that I am the legal parent or guardian of the child. I understand and assume the risks of participation in this program. For myself, my heirs, and assigns, I agree to waive, release, and forever discharge any claim for injury or damage, and hold harmless Chintimini Wildlife Center (CWC), its officers, agents, volunteers, and employees against any claim, loss, liability, or expense, including attorney's fees, resulting directly/indirectly from participation. I also give CWC permission to use photographs of participant(s) in marketing and media brochures, newsletters, and website.

Pay online by credit card through PayPal after you Submit this form (or you can mail us a personal check).