Required forms

Earth 2 Table Permission Form

One form registers your student for afterschool programming, gardening and field trips. Programs are always free of charge.

Student information

First name

Last name

Date of birth

Age

Age is calculated automatically from the date of birth.

Grade

School

Parent / Guardian

Full name

Phone

Email

Emergency contact

Contact name

Contact phone

Medical information, allergies or medications

Volunteer availability

Please choose the day(s) you will volunteer:

Volunteer days

MondayTuesdayWednesdayThursdayFriday

Pick one single time slot:

Time slot

2pm - 5:30pm (snack & homework)

2pm - 4pm (snack & homework)

4pm - 5:30pm (activity & snack)

I give permission for my student to participate in Love Our Nation programs, including Earth 2 Table gardening and supervised on-site activities.I consent to photos and video of my student being used in Love Our Nation materials (optional).

A Florida 501(c)(3) nonprofit educating and empowering Dania Beach youth with life skills for health, education, and preservation of the environment.

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215 NW Fifth Ave, Dania Beach, FL 33004
305-756-0550
Monday – Friday, 2:00 PM – 5:30 PM