Farm Camp Registration Child's name * First Name Last Name Parent's Email * Parent's Phone Number * (###) ### #### Which weeks will your child by attending. * July 3rd, 5th, 6th and 7th July 10th- July 14th July 17th- July 21st July 24th- July 28th Child age * 4 5 6 7 8 9 10 Does your child have any allergies, additional needs or take any medication. . * Yes No If 'yes', please give us more details. * Which descriptions best suits your child * Shy Outgoing Adventurous Cautious Picky eater Open to trying new things Creative Sporty Curious Anything else we should know about your child Emergency contact 1 * First Name Last Name Phone * (###) ### #### Emergency contact 2 * First Name Last Name Phone * (###) ### #### Please list an additional adults with authorization to pick up your child. * This camper is covered by family medical/hospital insurance Yes No Insurance Company Policy Number Subscriber Name Insurance Company Phone Number Are you happy for your child to be photographed and/or filmed. * No images or footage will be used for marketing or social media without additional permission from each parent. Yes No Anything else we should know Thank you!
