Office Use

   

Child’s Name

Age

Gender

T-shirt size (Historic Camps)

Parent’s Name

Phone Number

Address

Email Address

Emergency Contact Name (other than parent)

Phone Number

Relationship to Child

Please explain any health concerns that we should be aware of:

Date

Camp

Time

Fee

Qty

$ Total

Mon-Wed, June 12-14

Historic Farm Camp-ages 6-12

9 am-12pm

$45

Mon-Wed, June 12-14

Historic Farm Camp-ages 6-12

1 pm-4 pm

$45

Mon-Wed, June 19-21

Historic Farm Camp-ages 6-12

9 am-12pm

$45

Mon-Wed, June 19-21

Historic Farm Camp-ages 6-12

1 pm-4 pm

$45

Thurs, June 15

Farm Science*--ages 8-13

10 am-2pm

$25

Thurs, June 22

Art on the Farm*--ages 8-13

10 am-2pm

$25

* Please bring a lunch to Farm Science and Art on the Farm camps

$ Total:

Payment method (circle/highlight):      PayPal      Check by mail        In person

Note: T-shirts are only included with Historic Farm Camp. If your child is only attending Science or Art Camp and would like a shirt, please include $7.00 more.