PA DAY CAMP REGISTRATION FORM
Black Creek Community Farm acknowledges that your child has voluntarily enrolled in Farm Camp on the property located at 4929 Jane Street, Toronto. Black Creek Community Farm is a working farm. As such, farm equipment, poultry, and other such hazards inherent to farming activities exist on the property and may pose a danger to your child. You, by signing this release and waiver of liability, on behalf of yourself, and your child hereby release and hold harmless Black Creek Community Farm its officers, directors, and employees from any and all liabilities resulting from any injury your child may sustain in connection with and arising out of such hazards. Please understand that we will take every measure possible to keep you child safe and to ensure that they will not be put in harm’s way.
Email address *
CAMPER INFORMATION
Please take time to fill out all the information. We are required to have all the fields completed in case of an emergency. Please note, upon enrollment you will be required to fill out a Medical Consent Form. Under our Privacy Information policy, we guarantee to keep yours and your child's information private. Information shared for the purpose of enrollment will never be shared to third parties.
First & Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
ALLERGIES / DIETARY RESTRICTIONS
Please list all allergies and dietary restrictions. Indicate the severity, as well as the allergies may trigger an anaphylactic attack.
List of Allergies *
Your answer
Epi-Pen
Dietary Restrictions *
SELECT YOUR CAMP DATE
We will be running PA DAY CAMP throughout the school year. You may register for all of them or one at a time. If spots are filled up, you will be notified and placed on wait list.
PA DAYS *
DO YOU REQUIRE EXTENDED CARE?
Extended care is an early drop off 8:30 AM, late pick-up 4:30 PM, or both. Please note there is an additional fee for extended care: $5.00 for one, $10.00 for both
EXTENDED CARE *
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