Camp Registration Form | Meadows Family Farm

Spring Break Camp Registration

PARENT/GUARDIAN INFORMATION

Parent First name

Parent Last name

Parent Email

Parent Phone Number

EMERGENCY CONTACT (Please list an alternate emergency contact in case we cannot contact the listed parent.

Full Name

Relationship to child

Cell Phone Number

MEDICAL INFORMATION

Does this camper have any allergies?

Does this camper require an EpiPen?

Does this camper have an dietary restrictions?

Does this camper have any medical conditions we need to be aware of?

Does this camper have any restrictions on activity?

Health Card Number

ALTERNATE PICKUP

(Please list 2 people who have your permission to pick up your child in the event that you are unable to. Please let these people know that they will need to present photo ID to pick up your child.

Alternate Pick-up #1

Full Name/ Phone number/ Relationship to Child

Alternate Pick-up #2

Full Name/ Phone number/ Relationship to Child

CAMPER INFORMATION

Camper Full Name

Birthday

Year

Month

Day

Kids Farm Camp Dates

Camp Week #1 (March 17-21)$220

Camp Week #2 (March 24-28)$220

After Hour Care 2-4pm$20