MPMS Farm Camp Registration (AGES 8+)

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Please fill out the form below to sign up your 9-12 year old for 2017 Farm Camp at Mountain Pathways. A form must be filled out for each child in the case of siblings. Cost: $225 for the first week ($175 for all additional weeks) for 8:30-2:30 Day Session, 2:30-5:30 aftercare is free (Farm Camp students in aftercare are considered "junior counselors" and will be expected to be role models for the younger children.) Pre-registration is not complete until you have contacted the school to submit a 10% Deposit. Call 828-262-5787, or mail a check to 453 Howard's Creek Rd., Boone, NC, 28607.

Email(s) *

Parent(s) Name(s) *

Child's Name *

Age (as of June 1), and Birthdate *

All Phone Numbers (include name with each number) *

Contact Address *

Names and contact information for all those authorized to pick up child

Hospital Choice in case of emergency *

Additional Emergency Contact Names and Phone Numbers

Is your child allowed to accompany the group on local field trips? *

Yes, my child can go on field trips

No, my child cannot go on field trips

Required

Is your child allowed to participate and appear in photos or films taken at Farm Camp?

Yes, my child can film and be filmed.

No, my child cannot appear in any photos or features.

Clear selection

Please check all weeks you would like to enroll. If you need aftercare, check the appropriate box at the bottom. *

Cost $225 per week for 8:30-2:30 Day Session

June 5-9

June 19-23

July 10-14

July 17-21

AFTERCARE NEEDED FOR ALL WEEKS (2:30-5:30)

AFTERCARE ONLY NEEDED SOME WEEKS (DETERMINE WHEN PAYMENT MADE)

Required

Physician's Name and Phone Number *

Submit

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