KIDS CLUB
MEMBERSHIP FORM
Southeastern Natural Sciences Academy
PHINIZY SWAMP NATURE PARK

[ ] Cattail Kids Club (K-2nd grade)

[ ] Gator Gang (3rd-5th grade)

[ ] Muskrateers (6th-8th grade)

[ ] Creek Freaks (8th-12th grade)

[ ] Eagle Eyes Birding Club (age 7-16)

Member's Name:

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Parent Name(s):

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Chaperone Name(s) &
phone number:

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(if different from above)

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Address:

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City/State/Zip:

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Telephone:

_______________________________

E-mail:

_________________________________

Member's birth date:

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Annual Membership Dues: $40 (Cattail Kids), $45 (Gator Gang), $50 (Muskrateers), $50 (Creek Freaks), $60 (Youth Birding Club)*

* Youth Birding Club costs $50 for students that are involved in one of the Academy's other Kids' Clubs*

Check enclosed (make payable to Southeastern Natural Sciences Academy)

Please return completed form and check to:

Southeastern Natural Sciences Academy
1858 Lock & Dam Road
Augusta, GA 30906

Or fax to (706) 828-2129
Questions? Call (706) 828-2109