After School Registration

To complete your registration please send payment to P.O. Box 90293 Portland, Oregon 97290

Please email lauren@ecologyoutdoors.org with any questions.

Your students name *
Your students name
What program are you registering for? *
What grade is your student in? *
Your name *
Your name
Phone *
Phone
If you'd like someone else to be contacted in case of emergency, please provide their name and phone number:
Who is your student's teacher? *
Who is your student's teacher?
We ask for their name and email so we can ensure your student gets from the classroom to our program safely.
Do we have permission to preform basic first aid on your student? *
Do we have permission to preform basic first aid on your student?
Do we have permission to take pictures of your student for use in social media and marketing? *

Your registration will be complete once we receive payment at P.O. Box 90293 Portland, Oregon 97290. Thank you!