2021 Farm Camp Registration

2021 Farm Camp

All Sessions are for students entering Kindergarten-8th grade for the 2021-2022 school year. Drop off begins at 8 and pickup begins at 4. Before care is available for $5/day. Aftercare is also available for $5/day. Please contact Sierra Krohnemann, Director of Education with any questions. sierrak@thelandsathillsidefarms.org
Email address *
Session(s)- Check all that apply

June 21 – June 25 All About Farm Animals June 28 – July 2 STEM on the Farm July 5 – July 9 All About Farm Animals July 19 – July 23 STEM on the Farm July 26 – July 30 All About Farm Animals
Child's Name (first and last) *
Child's Age *
Child's Grade (entering for 2019-2020 school year) *
Child's T Shirt Size *
Parent/Guardian Name *
Parent/Guardian Full Address *
Parent/Guardian Phone Number *
Parent/Guardian Email *
Emergency Contact Name and Phone Number *
Allergies *

None Hay Fever Poison Ivy Insect Stings Other Drugs Food
Specify food, insect, drug, or other allergy (if applicable)
Health Conditions *

None Bleeding Disorder Convulsions/Epilepsy Learning Disability Behavioral Issues Diabetes Asthma ADD/ADHD
Specify condition and directions for staff (if applicable)
Names and phone numbers of others authorized to pick up your child *
Photo Release: I hereby give my permission for my child's photograph to be used in The Lands at Hillside Farms publications and for advertising and promotions. *

Yes No
Authorization for On-Farm Transportation: I hereby give my permission for my child to be transported by TLHF staff to on-farm destinations a part of the camp experience. *

Yes No
TLHF acknowledges that your child has voluntarily enrolled in Summer Farm Camp on TLHF's property at 65 Hillside Road, Shavertown, PA (the "property"). TLHF is a working farm. As such, heavy duty farming equipment, live animals, electrified fences, and other such hazards inherent to farming activities exist on the Property and may pose a danger to your child. You, by checking the box below for this Release and Waiver of Liability, on behalf of yourself and your child hereby release and hold harmless TLHF and its officers, directors, employees from any and all liability resulting from any injury your child may sustain in connection with and arising out of such hazards or in connection with your child's participation in the Summer Farm Camp, or your child's presence on the Property. *

I understand.
Sign and Date *
I understand that my child is required to bring a hearty lunch, water bottle, and a change of clothes and shoes to camp daily. TLHF will provide snacks unless otherwise specified due to allergies. *

Yes
Drop Off begins at 8:30 am. Pick up begins at 4:30 pm. Before Care and After Care are available for $5/day for each morning or afternoon. *

I do not require before care or after care. I require before care. Before care begins at 7:30. I require after care. After care ends at 5:00. I require BOTH before and after care.
SPECIAL INSTRUCTIONS: Please provide us with any special instructions or requests for your child.
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