Farm Camp Registration & Waiver Form 2017
We are so excited you have decided to register for Farm Camp at Vibrant Farms this summer!

Please fill out this registration form and submit and we will contact you to confirm the registration. Payment must be submitted as well to complete the full registration.

The full cost of the camp is $200.00 per child + HST = $226.00 total. For each additional child from the same household, please apply a 5% discount so it will be $190.00 per child + HST = $214.70 total.

Note that children will need to bring along a nut-free lunch and two snacks to enjoy throughout the day at camp.

Thank you!
FARM CAMPER:
Name of Camper *
Your answer
Relationship to Parent or Guardian *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Gender
Health Card Number *
Your answer
Allergies & Concerns: (please list any allergies & concerns that you feel camp staff should be aware of) *type "none" if there are no allergies or concerns *
Your answer
EMERGENCY CONTACT:
Emergency Contact Name *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
Authorized for Pickup? *
Guardian or Parent:
First Name *
Your answer
Last Name *
Your answer
Email Address: *
Your answer
Street Address *
Your answer
Daytime Phone Number *
Your answer
City *
Your answer
Postal Code
Your answer
AUTHORIZED FOR PICKUP
Is anyone else authorized for pickup of the farm camper listed above?
Names of others authorized for pickup of farm camper and their relationship to child:
Your answer
POLICIES & PERMISSIONS
In registering and permitting my child to attend Vibrant Farms Farm Camp, I, the undersigned parent, guardian or other duly authorized party, hereby agree as follows:

1. To permit my child to participate in the full range of Vibrant Farms Farm Camp activities and authorize the Vibrant Farms Farm Camp Staff, in the event of accident, injury, or illness affecting the above named camper, to authorize on my behalf all medical and other procedures, including admission to hospital and all other necessary treatment, as he/she may deem essential for the care and well-being of the said camper. Such action is to be taken only when immediate contact with the undersigned cannot be made.

2. I have provided all accurate information and have not falsified any records including, but not limited to, age and medication requirements. Failure to provide aforementioned information may result in may result in my child not being allowed to attend camp.

3. I understand there are inherent and other risks of injury involved in recreational time and activities working with animals and on the working farm, I voluntarily accept these risks to my child. I hereby waive and release any and all damages and injuries that may result in participation of Farm Camp at Vibrant Farms, 2669 Carmel Koch Rd., Baden, ON N3A 3R9.

4. Vibrant Farms Farm Camp has a policy of respect and inclusivity and will not tolerate ANY behaviours that constitute bullying, harassment or violence. In the event of an issue arising, parents will be informed and warning issued. We re-serve the right to send participants home if a second incident arises following the warning.

5. I understand that refunds will be issued up to three weeks prior only, and will be subject to a 20% processing fee. Following this, refund requests will be made on a case by case basis.

6. I also understand that photos and/or videos of camp events. I give permission for my/my child’s image, student work, and performance to be photographed, filmed, audio-taped or videotaped for the purpose of using in newsletters, photo galleries, and on our website. At no time will their names or other identifying information be published without your permission.
Registration will not be complete without acknowledging our policies and requirements & checking the box below: *
Required
REGISTRATION & REFUND POLICY:
Registration is on a first come, first served basis. Registration is not considered complete until the registration form including waiver statement are submitted to Vibrant Farms & full payment is completed.

Payment is due upon registration. Payment is accepted by cash, cheque, or etransfer. Please make cheques payable to: Vibrant Farms. eTransfers can be send to orders@vibrantfarms.com (security word is "vibrantfarms" with no spaces.)

The full cost of the camp is $200.00 per child + HST = $226.00 total. For each additional child from the same household, please apply a 5% discount so it will be $190.00 per child + HST = $214.70 total.

Refunds will be issued up to three weeks prior to camp start date only, and will be subject to a 20% processing fee. Following this, refund requests will be made on a case by case basis.

Farm camp is subject to cancellation due to lack of enrollment. Full refunds will be made for camps cancelled by Vibrant Farms.
Submit
Never submit passwords through Google Forms.
This form was created inside of Vibrant Farms.