Farm Camp 2019
Thank you for you interest in Farm Camp, the ultimate dairy experience at Daluge Farm. Please fill out the form, submit, and we will be in touch to confirm your registration.

With questions, please reach out to Erin and Megan at merin@dalugefarminc.org.

Email address *
Registration Form
Please fill out ONE registration form per child. If you would like a hard-copy registration please send us an email and mail in the completed form.
Participant First Name *
Your answer
Participant Last Name *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Week Attending *
Required
Shirt Size
Parent/Guardian First Names(s) *
Your answer
Parent/Guardian Last Names(s) *
Your answer
Daytime Phone Number *
Your answer
If paying for more than one participant, please list all names here:
Your answer
Liability Release and Medical Form
Please fill out one Liability Release & Medical Form per camper. If you would like a hard-copy of this form please send us an email.
Please check each paragraph stating that you (parent/guardian) have read and understand. *
Required
Your child map be picked up by (include your name) *
Your answer
Your child may not be picked up by
Your answer
Insurance information/Insurer (please provide proof of insurance by mailing a copy or fill out the information here)
Your answer
Policy Holder
Your answer
Amount of Coverage
Your answer
Dietary restrictions/Special considerations/Medical concerns
Your answer
Has anaphylaxis (severe allergic reaction) ever occurred to your child? *
If an allergic reaction occurs, can we administer an oral antihistamine (e.g. Benadryll) if necessary? *
Emergency Contact #1 *
Your answer
Emergency Contact #1 Relationship *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #2 *
Your answer
Emergency Contact #2 Relationship *
Your answer
Emergency Contact #2 Phone Number *
Your answer
Code of Conduct - please check each box stating you (the participant have read and understand) *
Required
How did you hear about Farm Camp? Check all that apply.
Electronic Signature (parent): If behavior problems are not resolved, parents will be called and the youth will have to return at his/her own expense.
Your answer
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