Jr Naturalist Registration Please complete this information to register for monthly Jr. Naturalist workshops. Student Name(Required) Parent or Guardian Name(Required) Are you interested in being a parent volunteer for these workshops? Yes No Phone(Required)Email(Required) Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Student Birth Date(Required) MM slash DD slash YYYY Students must be 8-12 years old by the time of the workshop. Workshops May 21, 3:30-5:00pm Intertidal Zones, Kopachuck State Park June 25, 9:00-10:30am Plants, Plankton, and Algae, DeMolay Nature Preserve Choice July 30, 12:30-2:00pm Animal Adaptations, Sunrise Beach Park August 13, 12:30-3:00 Intertidal Food Webs, Penrose Point State Park September 24, 10:30-12:00 Watershed Ahead, Kopachuck State Park October 22, 10:00-11:30 Forest through the Trees, McCormick Forest Park November 19, 10:00-11:30 Super Salmon, Donkey Creek Park Please select which workshops you are interested in attending. The fee for each workshop is $25 and attendance is limited to 12 students per instructor. Product Name Price: $25.00 Quantity: Please ensure the number of workshops matched the number of check boxes above Total Scholarships Yes, my student needs a scholarship No, a scholarship is not needed. Please select if you are applying for a scholarship. We never want cost to stand in the way of student learning. Photo Waiver I agree to allow photography of my childI, parent or guardian of the child named above, hereby consent that the photographs and/or motion picture or videotape for which I/my child posed, and/or audio recordings made of my/his/her voice may be used by Harbor WildWatch its assignees or successors, in whatever way they desire, including television and electronic media. Furthermore, I hereby consent that such photographs, films, recordings, plates and tapes are the property of Harbor WildWatch, and they shall have the right to duplicate, reproduce, and make other uses of such photographs, films, recordings, files, plates, and tapes as they may desire free and clear of any claim whatsoever on my part.Liability Waiver(Required) I agree to the liability WaiverBy signing this agreement/liability waiver, I agree to indemnify and hold the landowners, Harbor WildWatch, its staff, contractors, other volunteers, and any other third party for whom is involved, harmless from and against any liability, claim, injury, or costs arising from or resulting from this program. Furthermore, I acknowledge that there are potential hazards associated with Harbor WildWatch activities and I agree that I/my child will exercise common sense and follow all safety precautions to avoid accident and injury.Is there anything else we should know about your student?How did you find out about this program? Facebook Instagram TikTok Email Website Flyer Word of Mouth Credit CardCard Details Cardholder Name
