2017 Farm Camp Registration
Please fill out a new form for each child attending farm camp. Visit http://www.commongroundfarm.org/Education/summer_camp.html for full program details. Please note registration is NOT complete until payment is received. Go to: https://store.commongroundfarm.org/SearchResults.asp?Cat=1514 to pay online or write a check to: Common Ground Farm, PO Box 148, Beacon, NY 12508
From the list below, please check all the camps that your child will attend:
Campers will be put into groups according to age: 3-4, 5-6, 7-9, and 10-12
Required
Would you like to enroll your child in Half Day (3-6 year olds only) or Full Day?
Would you like to add on Before and/or After Care?
Required
Child's Name
Your answer
Child's age at start of camp
Your answer
Birth Date
MM
/
DD
/
YYYY
Address
Your answer
Parent or Guardian's Name 1
Your answer
Parent or Guardian's Cell Phone Number 1
Your answer
Parent or Guardian's Email 1
Your answer
Parent or Guardian's Name 2
Your answer
Parent or Guardian's Cell Phone Number 2
Your answer
Parent or Guardian's Email 2
Your answer
Parent or Guardian's Home Phone Numbers
Your answer
Parent or Guardian's Work Phone Numbers
Your answer
Emergency Contact (List name and phone number)
Your answer
Does your child have any physical, developmental, or learning challenges that might make some activities difficult? If so, please explain:
Your answer
Does your child have any allergies (food, environmental, medicines)? If so, please list them and include allergic symptoms for each:
Your answer
Does your child needs to have medication administered or available while at camp? If so, we will send you a camp medication authorization form.
What is your child's T-shirt size? Please note that T-shirts will be American Apparel, which runs small. If in doubt size up! We will be providing your child with the shirt size requested.
Required
We love to take pictures at Common Ground Farm! Each week we will share the photos taken in an album accessible to parents, and we will share photos on our website and to promote Common Ground Farm's food access mission and programs.
How did you hear about this program?
Your answer
Choose your payment option
Registration is NOT complete until payment is received OR scholarship granted. Go to: http://store.commongroundfarm.org/SearchResults.asp?Cat=1514 to pay online or write a check to: Common Ground Farm, PO Box 148, Beacon, NY 12508. Families who apply for scholarships, please choose the appropriate option.
Required
Full refund (minus $15 processing fee) may be granted if requested by 6/23/17; 50% refund is available if requested between 6/24/17 and 7/16/17. After 7/16/17, no refunds will be granted. If paying by check, send payment in full to: Common Ground Farm, PO Box 148, Beacon, NY 12508
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