Adventures Lottery Form 2013

March 12 - April 18, 2013

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Welcome to our online Adventures Lottery Form! We hope this will streamline the registration process for you. Due to the popularity of this program, we use a lottery system to be as fair as possible to all those who wish to enroll. We do our best to accommodate as many requests as possible.

Dates to remember:
- February 1, 2013 - Complete lottery form(s) due.
- February 14, 2013 - Confirmation, payment and cancellation information will be e-mailed to you.
- March 1, 2013 - Payment is due.

Please Note: Children must be toilet-trained to participate in Adventures.

Questions concerning registration? Contact Julia Penca, jpenca@shelburnefarms.org
Questions regarding the Adventures program? Contact Linda Wellings, lwellings@shelburnefarms.org

1. Enrollment & contact information. (If you do not have an answer for a question please type in "N/A")

Enrollment & contact information. (If you do not have an answer for a question please type in "N/A") Child Full Name
Child Preferred Name
Age on January 1, 2013
DOB (mm/dd/yy)
Male or Female
Parent/ Guardian Full Name(s)
Address
City
State
Zip Code
Phone 1 (Home)
Phone 2 (Cell)
Phone 3 (Work)
e-mail address

2. Rank all program possibilities in order of preference in the boxes below. 1=1st choice, 2=2nd choice, etc.
AM sessions: $150 Members, $170 nonmembers
PM sessions: $160 Members, $180 nonmembers

Rank all program possibilities in order of preference in the boxes below. 1=1st choice, 2=2nd choice, etc. AM sessions: $150 Members, $170 nonmembers PM sessions: $160 Members, $180 nonmembers Tuesday 9:30-11:30am (Ages 3 & 4)
Wednesday 9:30-11:30am (Ages 3 & 4)
Thursday 9:30-11:30am (Ages 3 & 4)
Tuesday 12:30-3:15pm (Ages 4 & 5)
Wednesday 12:30-3:15pm (Ages 4 & 5)
Thursday 12:30-3:15pm (Ages 4 & 5)