Youth Education Class Registration Form

youth-edCitizens for Conservation is located at 459 West Highway 22 (between Kelsey and Rte. 59), Barrington, IL. Look for the white farmhouse with the silo across from Good Shepherd Hospital. Phone 847-382-7283. Remember to dress for the weather.

Which class are you registering for?

What is the date and time of the class?
Date:
Time:

Your Name:

Your Street Address:

City:
State:
Zip Code:

Your Email (required):

Primary Phone Number (will be used in case of emergency):

Would you like to be informed of future classes?

Any special instructions, questions, or comments:

Your Children:

Name and Age of Child(ren) (required):

Secondary Phone Number (for emergencies):

Number of children attending:
Number of adults attending:

Will you allow CFC to take photos of your child(ren), if applicable? Photos may be used on our website, for media submissions, and for marketing purposes.

Liability Waiver
The person filling out this form, a parent or guardian of the above-entered child(ren), hereby assumes all responsibility for injuries which may result from normal activities for the above program(s) for which child(ren) is/are hereby enrolled and hereby releases Citizens for Conservation of any such responsibility.

Check here to indicate your acceptance of the above terms (required to register).

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