Youth-Ed Class Registration Form Citizens 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! Please send payment checks for classes to: Citizens for Conservation 459 West IL Rte. 22 Barrington, IL 60010 Please write your child’s name and the class on the memo line. Please fill out the form below with parent or guardian information. Which class are you registering for (required)? What is the date and time of the class? Date (required): Time: Your Name (required): Street Address (required): City (required): State: Zip Code: Email (required): Primary Phone Number (required, will be used in case of emergency): Secondary Phone Number: Would you like to be informed of future classes (required)? SelectYesNo Any special instructions, questions, or comments: Number of children attending: Names of children attending: Number of adults attending: Names of adults attending (if applicable): Will you allow CFC to take photos of you and your child(ren), if applicable? Photos may be used on our website, for media submissions, and for marketing purposes. SelectYesNo Liability Waiver I hereby release Citizens for Conservation from any responsibility for injury to me, my child(ren), family members or guests that may occur during the class for which I am registering.If you are bringing children: 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 for any such responsibility. Check here to indicate your acceptance of the above terms (required to register).