Adventurers Afterschool Nature Club
Ages 5 – 7
Mondays 4:00 - 6:00 and/or Wednesdays 3:30 - 5:30
September 9 - May 26
would you like to PAY IN FULL NOW?




would you like to be on our PAYMENT PLAN?
Choose A Frequency
You will be charged your first installment payment today.
Remaining installments will be charged monthly beginning in July,
regardless of the date listed on the receipt that you receive for today's payment.

(5% transaction fee applies to payment plan)
Would you like to Round Up?
Round Up to make a donation and help Learning Outside impact more children!
Total: $0.00
Future Commitment: $0.00
Please select the days you would like your child to attend:
Registrant Information
A complete and accurate registration provides safety for your child. It is the information we rely on in an emergency.
(At start of session)
(write “home schooled” if applicable)
Parent/Guardian #1/Payer Information
This is the address where your credit card or bank statements are mailed.
A receipt will be e-mailed to this address.
Parent/Guardian #2 Information
Emergency Information
EMERGENCY contact person (if parent/guardian cannot be reached)
BACKUP CONTACT PERSON (in case primary contact cannot be reached):
Medical Contact Information
Health Information
(food, drugs, insects, plants, etc. or N/A)
(If none, enter N/A)
Does your child, or has your child ever, worked with a Therapist, Early Childhood Specialist or other support person? (Ex: Occupational Therapist, Phsyical Therapist, Speech/Language Therapist, Play Therapist, Family Therapist, Psychologist)
(If not, enter N/A)
Has the participant been hospitalized and/or had any surgeries in the last year?
Does the participant have any chronic medical conditions that require him/her to be under the care of a doctor? (Epilepsy, Asthma, Diabetes, Heart Condition etc.?)
Check here if you are submitting a NC Immunization Exemption Form.
Does your child have any social challenges, communication challenges, physical limitations, handicaps, fears or other conditions that Learning Outside staff should be aware of?
Other Important Information
(Please note, your child WILL get dirty and your response to this is important to whether they feel ok with being involved in the play that happens at Learning Outside.)
Release Statement
I hereby attest that all of the information provided above is correct and complete.

In event of injury or illness, I give the Learning Outside Staff and emergency/professional medical personnel permission to provide medical treatment for the participant listed above.
I have read the above and give permission.
Hold Harmless Agreement
Learning Outside offers outdoor learning programs on Triangle Land Conservancy’s Irvin Nature Preserve, 269 acres of pasture, forest and wetlands preserved in perpetuity by the Triangle Land Conservancy in Orange County. Program activities include art, science and other learning activities for both children and adults.

Activities in this program may include, but are not limited to: gardening, farm chores, interaction with goats, chickens and other farm animals as well as cats and/or dogs, drawing, painting, printmaking, other arts and crafts activities, nature crafts, singing, song writing, storytelling, dance, creative drama, puppet making, nature exploration, shelter building from natural materials, fire building, cooking, animal tracking, running games and other strenuous physical activity, archery, walking along the farm driveway to the pond, pond exploration and wading in the pond, hikes in the woods and to the creek, creek exploration and wading in the creek, work with woodworking hand tools and more.

Risks inherent in these activities include, but are not limited to:
  • Exposure to biting insects, ticks, poison ivy, and poisonous snakes
  • Exposure to diseases carried by ticks and other biting insects
  • Walking, hiking, running and playing in hot or otherwise inclement weather
  • Falls from climbing or slipping on pond banks, tree stumps, branches, & uneven terrain or tripping on rocks/stumps
  • Injuries from use of sharp tools for carving, whittling, gardening and/or woodworking, or glue guns and allergic reaction from exposure to paints, paper mâché paste, cement, and other art materials during arts and crafts activities
  • Burns from hot plate, camp fire, or hot food/liquids during cooking activities
  • Drowning or injury while wading or playing in natural bodies of water
  • Accidents on the driveway
  • Risks normally associated with travel in a car driven by staff, hired driver or parent a participant

I authorize Wendy Banning, Director of Learning Outside, as well as all paid and volunteer instructors in whose care my child has been entrusted, to lead the above named child in activities of the type listed above. I understand that there are risks inherent with the activities as well as with transportation to and from each area. I nevertheless voluntarily assume all risks of loss, damage or injury that may be sustained through my child's participation in programs offered by Learning Outside.

I agree to hold Learning Outside, Wendy Banning and all other instructors, volunteers, staff, independent contractors, hired drivers and Learning Outside Board Members as well as the Triangle Land Conservancy harmless for injuries which may occur during such activities or while being transported to and from such activity.
I have read the above and agree to all terms.
Multimedia Image Release
I hereby give permission for my child’s image to be used by Learning Outside and Wendy Banning, Learning Outside’s Director, for outdoor learning presentations, teacher training, publications, advertising and fundraising, including on the Learning Outside websites ( + and the Learning Outside Facebook or Instagram or the Triangle Land Conservancy website.

NOTE: For security reasons, children’s names are not used with photos in any of these places.
Learning Outside Policies
The registration and payment receipts are not a guarantee of enrollment. All enrollments will be confirmed by personal email from Learning Outside to the parent/guardian.
I have read the above statement regarding enrollment.
No refunds for withdrawals:
I accept that there are no refunds for withdrawals.
No weather make up days:
I accept that there are no weather make-up days.
The grants that Learning Outside applies for each year require that we specify the racial and ethnic backgrounds of the children enrolled in our programs. Please check all that apply.
African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
American Indian or Alaskan Native
For NEW families - How did you hear about Learning Outside?
If this is the first semester that you have a youngster enrolled at Learning Outside, please let us know how you found out about us! Check all that apply. Thanks!
Learning Outside’s website or Facebook page
Other online listing
Family friend/work colleague/neighbor
School flyer that came home with your child
Flyer or postcard out around town
Open House or other event at Irvin Nature Preserve
Camp Fair
Community event
Newspaper or print ad
Your Payment Information


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