Heartland Farm Sanctuary's Summer Camp Registration for 2024
Please complete this form and Heartland's Humane Education staff will manually register your child for the Summer 2024 camp session that you specify.  This will allow you to register your child without including your credit card information if you will be paying for camp by another method (for example through CLTS). 

Please fill out a separate form for each child, so that we can easily tell which information and camp sessions correspond to them.  Thank you! 
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Email *
Jackrabbit Account Name (the name that will represent your account in our registration system, i.e. your family name) *
Primary Contact's First and Last Name *
Primary Contact's Phone Number *
Primary Contact's Email
 *
Primary Contact's Home Address *
Contact #2 First and Last Name (optional)
Contact #2 Phone Number (optional)
Contact #2 Email (optional)
Child's First and Last Name (please only enter one child's information) *
How should we refer to your child?  Feel free to include any information about nicknames, pronouns, etc. (optional)
Child's Birthdate *
MM
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DD
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YYYY
Does your child have any disabilities that our camp staff should be aware of? (leave blank if info was already shared with staff during the enrollment process)

Does your child have any accessibility or behavioral support needs that our camp staff should be aware of?  (leave blank if info was already shared with staff during the enrollment process)
Does your child have any allergies that may affect them during camp?  If yes, are any severe? (required, answer "N/A" if none)
 *

Please list any medications that your child will be taking during camp hours, or will have with them for situational/emergency use (required, answer "N/A" if none):
 *
Photo Release for Child:  With the following answer, you either give or withhold permission to Heartland to photograph your child during their participation in our Summer 2024 programs.  Your answer reflects the understanding that any images and video/audio recorded by Heartland staff are the property of Heartland and may be used on Heartland's website, social media sites, printed flyers, or donor mailings. *
Summer 2024 Camp Session Selections:  Please select only one week per child. 

**Please note the age ranges of each of our three offered groups:  Compassionate Caretakers is intended for kids ages 5-7, Humane Education for kids ages 8-11, and Leadership Camp for kids ages 12-15.
 *
Required
CLTS Caseworker's Name and Contact Information *
Please click the "Submit" button below to complete this registration form and submit your answers.  Thank you!
A copy of your responses will be emailed to the address you provided.
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