SUMMER ADVENTURES 2025 Registration Form
Registration and Emergency Contact Information
Child's First and Last Name
Child's birthdate and age
PRIMARY CONTACT
This person will be contacted first for any questions or needs. Please list full name and any phone numbers that would be helpful. Label the phones please (cell) (home) (work).
Primary Contact: Parent/Guardian full name
Phone Number
Email
Address
CHOOSE YOUR ADVENTURE
Check all that apply. 15% discount for multiple weeks or multiple participants from the same family.
Choose all that apply.
August 4 - 8, 2025 / 9:00am -1:00pm / WRITING WORKSHOP / ages 10-13
August 11-15 2025 / 9:00am-1:00pm / OVER IN THE MEADOW / ages 5-7
EMERGENCY CONTACT INFORMATION
Please list one or two additional adults, in addition to primary caregivers for emergency contact. This information will be used in case of injury, late for pick up or any other emergency. List names in the order that you wish to be called. For example, Primary will always be called first. Other names will be called if Primary isn't available. Add any additional notes for each Guardian as needed.
#2 Parent/Guardian's Name, Phone Number, Relationship to child
#3 Parent/Guardian's Name, Phone Number, Relationship to child
WHAT TO BRING EACH DAY
Please set your child up for success for our adventure. We will be out of doors the entire day. The enclosed front porch will help us cool off or warm up as needed. We will walk to Sewelcrest Park for lunch and play. Please make sure your child's belongings are in a backpack. I have a wagon to transport our backpacks on our walk. If the weather is appropriate, we will have a water play day. This checklist can help you prepare for the week. The schedule may change.
Please bring or wear these things.
Hearty Snack/Lunch (refrigerator not available)
Water Bottle
Walking and Climbing shoes or sandals (closed back)
Sunscreen as you prefer (I will have some to reapply)
Rain Gear as needed for rainy days (or an extra set of clothes)
Swimsuit and Towel for water play (or an extra set of clothes)
Does your child have any food allergies, sensitivities or restrictions that I should be aware of?
PERMISSIONS
I give permission for my child to go on walks in the neighborhood and have lunch off premises at Sewellcrest Park.
I give my permission
I do not give my permission
I give my permission for photos or videos of my child to be posted to Space & Grace Learning Website and other forms of advertising such as Social Media and Print Brochures.
I agree
I do not agree
FULL PAYMENT is due at registration. You will receive an INVOICE for payment after you Register. How would you like to pay?
ZELLE
PERSONAL CHECK sent to Space & Grace Learning 3128 SE Salmon St. Portland, OR 97214
Please feel free to call or message me if any other questions come up after you send in this form. 503-467-8935 Mary Jo AbiNader
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