The Westerly Land Trust

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Parent/Guardian Name *

Phone *

Email *

Student's Name *

First

Last

School *

Grade *

Authorized Pick Up: NAME, RELATION, PHONE. *

Students will only be released to caregivers listed here.

Bus Transportation Home *

• Yes
• No (student will be picked up at 5:30 PM at WLT location)

Primary Emergency Contact: NAME, PHONE *

Secondary Emergency Contact: NAME, PHONE *

Medical History

List any medical and/or allergies. If participant has a known medical condition/allergies and is prescribed a medication (i.e. EpiPen, inhaler) the medication and/or 2 EpiPens MUST be brought to program and be on their person.

Does your child have an IEP? *

• Yes
• No

Does the school have permission to discuss helpful information in the IEP with WLT Educators to better support your child? *

• Yes
• No

Bus Drop Off Address *

Address Line 1

City

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Zip Code

LIABILITY WAIVER *

• I agree to the additional terms.

In consideration of receiving permission to participate in (educational) (volunteer) (recreational) opportunities of the Westerly Land Trust (WLT), I (legal guardian if a minor):
1. Understand and acknowledge that I am proceeding at my own risk. I understand that WLT makes no warranties or representation, expressed or implied, regarding the condition or safety of the property itself or the activity to be done.
2. Agree to release, hold harmless and indemnify WLT (including its agents, employees and service volunteers) from any loss, liability or expense with respect to bodily injury (including death) or property damage which might result from or arise of my participation in these activities.

PHOTO RELEASE *

• Yes
• No

WLT and our partners may use photos/recordings to promote future programs. I (legal guardian if minor) grant WLT permission to use any and all photographs and/or recordings taken at this event for publicity and promotion.

STAY UP TO DATE ON OUR EMAILS *

• Yes
• No

Submit

The Westerly Land Trust’s preserves offer an array of ecosystems to explore, providing excellent opportunities for students to study wildlife, habitats, geology, and botany, while connecting with the natural world. Our education initiative supports the Rhode Island Environmental Literacy Plan, Social Emotional Learning (SEL), Next Generation Science Standards (NGSS), and aligns with Guiding Education in Math and Science Network (GEMSnet) science standards to apply science education goals on the land.

We offer guided field trips, teacher support, and afterschool enrichment. For information on how your students can participate in Westerly Land Trust educational programming or to use our preserves for a field trip, please contact Lauren Barber at lbarber@westerlyland24.wpenginepowered.com or phone 401-315-2610 x 1.

WLT/WPS Living Laboratories Spring 2024

For more information on each program / to sign up, find your school and students grade level under the sign up column in the chart below and click the button for the program you want your student to attend.

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