Request edit access
Food Farm Fun 2017 Registration
Please send $50 deposit per child to PCCS to complete this registration. Payment in full for each session is due on the first day of the session. Cost is $195/week for one child.
Child 1 Name and Entering Grade in Fall 2017 *
Your answer
Which session(s)? *
Child 2 Name and Entering Grade in Fall 2017
Your answer
Which session(s)?
Child 3 Name and Entering Grade in Fall 2017
Your answer
Which session(s)?
Parent 1 Contact Info: Name, Phone Number(s), e-mail *
Your answer
Parent 2 Contact Info: Name, Phone Number(s), e-mail
Your answer
Emergency Contact Info *
Your answer
Describe any allergies or health concerns for each child registered. *
Your answer
Describe any special needs or information that we should know about your child. *
Your answer
By submitting this form I indicate that Prairie Creek Community School assumes no responsibility for illnesses or injuries sustained as a result of any physical condition or resulting from participating in any Food Farm Fun Summer Camp program or activity. I expressly acknowledge on behalf of my minor children and family members that I assume the risk for any and all illnesses and injuries that may result from participating in these activities. I hereby release and discharge Prairie Creek Community School, its officers, directors, employees and volunteers for any and all claims for accidents, injuries, death, loss or damage which I or my family may suffer as result of participating in these activities. I hereby also authorize the staff of Food Farm Fun Summer Camp to secure medical aid and attention in the event of an emergency, including transport to a medical facility. Checking the box signifies agreement. *
Required
I hereby release photographs and videos of me and all my family members taken by Food Farm Fun staff for promotional purposes, including the Prairie Creek Community School website and promotional materials. *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Prairie Creek Community School. Report Abuse - Terms of Service - Additional Terms