Send form with payment to: Roaring Brook Nature Center
                                                     70 Gracey Rd., Canton, CT 06019

Child's Name (s):________________________ Age:_____ Grade:______

                        _________________________ Age:_____ Grade:______

                       _________________________ Age:_____ Grade:______

                       _________________________ Age:_____ Grade:______

                       _________________________ Age:_____ Grade:______

Parent's Name:__________________________________________________________________

Address: __________________________________________________________

Day telephone #: _____________ Evening phone#:___________________

____I am registering for the AM (10:00 am to Noon) session

____I am registering for the PM (1:00 pm to 3:00 pm) session

I am ___ am not ___ a member of the Roaring Brook/The Children's Museum

Please include payment ($5 per child for members; $6 per child for non-members)