Youth Farm Camp Program Registration
Which Program(s) would you like to register for?
*
Pro-D Day Camp
Pro-D Day Camp - Please select which dates you would like you register for:
Thursday, May 5, 2022 - Spring Discovery: May Celebrations (WAITLIST)
Friday, May 6, 2022 - Spring Discovery: Birds & Pollinators (1 SPOT REMAINING)
Back
Next
Have you registered your child for a program with Superior Farms in the past two years?
*
Yes
No
Please enter your Child's Name
*
First Name
Last Name
Do you have another child you wish to register?
*
Yes
No
Has this child been registered for a program with Superior Farms in the past two years?
*
Yes
No
Please enter your Child's name
*
First Name
Last Name
What Program(s) are you registering this child for?
*
Do you have another child you wish to register?
*
Yes
No
Has this child been registered for a program with Superior Farms in the past two years?
*
Yes
No
Please enter your Child's name
*
First Name
Last Name
What programs are you registering this child for?
*
Back
Next
Camper Information
Note: If you have already registered your child and we have their information on file, you do not need to resubmit your information. Our program coordinator will reach out to confirm the information on file. If you are registering both a new child and one that has attended our programs before, we will only need the information from the new child. Thank you.
Child's Name
*
First Name
Middle Name
Last Name
Gender
*
Female
Male
Prefer not to say
Preferred Pronouns (optional)
Date of Birth:
*
/
Month
/
Day
Year
(children turning 5 in 2021 are allowed to participate)
Medical Information
BC Care Card Number
*
Family Doctor
*
Enter Urgent Care if you do not have a family doctor
Doctor's Phone Number
*
Enter Urgent Care number if you do not have a family doctor
Has your child received their tetanus shot
*
Yes
No
Does your child have:
Drug or Environmental Allergies
Medical conditions and/or illnesses
Medications
Dietary restrictions
Developmental considerations (e.g., ASD, ADHD, sensory processing disorders,etc.)
Drug or Environmental Allergies:
Medical conditions and/or illnesses:
Medications - provide details:
Dietary restrictions:
Developmental considerations (e.g., ASD, ADHD, sensory processing disorders,etc.):
Do you have another child to register?
Yes
No
Back
Next
Camper Information
Second Child
Which program(s) will this child be registering for?
Please include dates if applicable. If the children you are registering are all attending the same program and date, disregard.
Child's Name
*
First Name
Middle Name
Last Name
Gender
*
Female
Male
Prefer not to say
Preferred Pronouns (optional)
Date of Birth:
*
/
Month
/
Day
Year
(children turning 5 in 2021 are allowed to participate)
Medical Information
BC Care Card Number:
*
Is the Family Doctor the same as Child 1:
*
Yes
No
Family Doctor
*
Enter Urgent Care if you do not have a family doctor
Doctor's Phone Number
*
Enter Urgent Care number if you do not have a family doctor
Has your child received their tetanus shot
*
Yes
No
Does your child have:
Drug or Environmental Allergies
Medical conditions and/or illnesses
Medications
Dietary restrictions
Developmental considerations (e.g., ASD, ADHD, sensory processing disorders,etc.)
Drug or Environmental Allergies:
Medical conditions and/or illnesses:
Medications - provide details:
Dietary restrictions:
Developmental considerations (e.g., ASD, ADHD, sensory processing disorders,etc.)
Do you have another child to register?
Yes
No
Back
Next
Camper Information
Third Child
Which program(s) will this child be registering for?
Please include dates if applicable. If the children you are registering are all attending the same program and date, disregard.
Child's Name
*
First Name
Middle Name
Last Name
Gender
*
Female
Male
Prefer not to say
Preferred Pronouns (optional)
Date of Birth:
*
/
Month
/
Day
Year
(children turning 5 in 2021 are allowed to participate)
Medical Information
BC Care Card Number:
*
Is the Family Doctor the same as Child 1 & 2:
*
Yes
No
Is the Family Doctor the same as Child 1, Child 2, or Neither:
*
Child 1
Child 2
Neither
Family Doctor
*
Enter "Urgent Care" if you do not have a family doctor
Doctor's Phone Number
*
Please enter a valid phone number.
Has your child received their tetanus shot
*
Yes
No
Does your child have:
Drug or Environmental Allergies
Medical conditions and/or illnesses
Medications
Dietary restrictions
Developmental considerations (e.g., ASD, ADHD, sensory processing disorders,etc.)
Drug or Environmental Allergies:
Medical conditions and/or illnesses:
Medications - provide details:
Dietary restrictions:
Developmental considerations (e.g., ASD, ADHD, sensory processing disorders,etc.)
Back
Next
WAITLIST Camper Information
REQUIRED FOR UNCONFIRMED PRO-D DAY DATES - you will be redirected to the payment page, but payment for these dates are not required for waitlist registration.
Child's Name
*
First Name
Middle Name
Last Name
Gender
*
Female
Male
Prefer not to say
Date of Birth
*
-
Month
-
Day
Year
Date
Back
Next
Primary Parent/Caregiver Details
Primary Guardian Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have a second Parent/Caregiver to register?
*
Yes
No
Back
Next
Secondary Parent/Caregiver Details
Secondary Guardian Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Do they reside at the same address as the Primary parent/caregiver:
*
Yes
No
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Can this parent/guardian pick up the child(ren) from the camp?
*
Yes
No
Back
Next
Emergency Contact Details
Contact 1 - REQUIRED
Full Name
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Secondary Phone Number (optional)
Please enter a valid phone number.
Relationship to child:
*
Does this person have permission to pick up child(ren) from camp:
*
Yes
No
Contact 2 - Optional
Full Name
First Name
Last Name
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number (optional)
Please enter a valid phone number.
Relationship to child:
Does this person have permission to pick up child(ren) from camp:
Yes
No
Contact 3 - Optional
Full Name
First Name
Last Name
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number (optional)
Please enter a valid phone number.
Relationship to child:
Does this person have permission to pick up child(ren) from camp:
Yes
No
Back
Next
Participation Consent & Authorization
Please review:
I have reviewed the description of the Superior Farms farm camp programs and feel that I have sufficiently informed myself about the nature of the camp and the activities involved. I acknowledge that there are inherent risks, dangers, and hazards, not all of them easily foreseeable, associated with my child(ren)’s participation in the farm camp including, but not limited to: during interactions with farm animals; interactions with plant life; use of farm tools; collision with other participant or instructors; impact with objects or equipment used in connection with daily activities; contraction of a contagious disease including, but not limited to, COVID-19; changes in the type of surface and the condition of surfaces, including walkways and forest paths; adverse weather conditions; loss of balance; failure to play safely within one's own ability; theft; consumption of food and drink, whether made by professionals or by nonprofessionals; and negligence of other participants. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. I understand that the foregoing does not list all of the risks or dangers and that participation in the activities involve risks and/or dangers which are not foreseen.
Acknowledging that such risks exist, I hereby release and discharge Superior Farms, its officers, agents, and employees from any and all claims or liability for personal injury or property damage my child(ren) may suffer while participating in the activity.
Participants are expected to be respectful and considerate towards other participants, staff including all instructors, and external partner organization instructors. Participants are expected and required to follow the directions of all instructors, to stay in close proximity to their instructors during the program and not leave without consent and informing camp instructors. If there is a breach of these rules, instructors will discuss the issue with the participant and/or their parents or guardian. In the event that there is a continuous breach of these rules, Superior Farms may require the participant to withdraw from the remainder of the camp session, without reimbursement of any camp fees.
I confirm that I have discussed these rules and expectations with my child.
To the best of my knowledge I have informed Superior Farms of all details regarding my child(ren)'s health. I will notify the camp if my child is exposed to an infectious disease or illness during the three weeks prior to their scheduled camping program and during program participation or if there are other changes to the information I have supplied in this form.
I certify that my dependent has no medical or physical conditions which could interfere with their safety, or else I am willing to assume – and bear the costs of – all risks that may be created, directly or indirectly, by any such condition.
In case of emergency - accident, injury, or illness - involving the registrant, if immediate contact with a designated contact cannot be made, I hereby authorize and grant permission to Superior Farms camp staff to call a medical practitioner or an ambulance for my child to receive the appropriate medical treatment. I agree not to hold Superior Farms responsible for any costs of injury arising out of an emergency situation.
By checking this acknowledgment and electronic signing using your written full name, I hereby consent to my child(ren)’s participation in the camp on the terms and conditions set out above.
Please Initial Here:
*
Name
*
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: