Summer Camp Registration 2022

Seed Song Farm and Center Summer Camp

Registration Form 2022

Camp Dates: June 27th-September 2nd, Monday-Friday*, 9 am - 3 pm

*Earth Heroes Week 7 is Tuesday-Saturday

PLEASE FILL OUT A SEPARATE REGISTRATION FORM FOR EACH CHILD YOU ARE ENROLLING IN CAMP. You may utilize the auto-fill feature when filling out forms for multiple children.

PART A- Child and Parent/Guardian Information

Name of Child *

First Name Last Name

Date of Birth (Month/Date/Year) *

Age of Child (Child must be 4 years old on or before camp start date) *

Gender Child Identifies With: (check box that applies) *

Male Female Prefer not to say Other

Child's Preferred Pronouns (He, She, They)

Parent/Guardian Contact Information

Name of Parent/Guardian 1 *

First Name Last Name

Phone Contact Information: Please indicate the best number to reach you at between 9 AM-3 PM

Best Phone Contact # *

E mail *

example@example.com

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Name of Parent/Guardian 2 (OPTIONAL)

Phone Contact of Parent/Guardian 2 (OPTIONAL)

Emergency Contact Information: Please indicate 2 individuals other than yourself who can act as an emergency contact between the hours of 9 am and 3 pm

Name of Emergency Contact 1 *

First Name Last Name

Phone Number of Emergency Contact 1 *

Name of Emergency Contact 2

First Name Last Name

Phone Number of Emergency Contact 2

How did you hear about our summer camp program? (Check boxes that apply) *

Child has participated in past camp sessions Hudson Valley Parent Chronogram Facebook Instagram Seed Song Newsletter Word of mouth Other

Please provide a copy of the child's immunization history when submitting your application, or bring prior to the child's first day of camp.

Subpart 7-2 of the New York State Sanitary Code requires camps to maintain immunization records for all campers which includes dates for all immunizations against diphtheria, haemophilus influenza type b, hepatitis b, measles, mumps, rubella, poliomyelitis, tetanus and varicella (chickenpox The record must be kept on file for every camper and updated annually.

Immunizations Records Submission: (check box that applies) *

Submitted electronically below Submitted via mail to: Seed Song Farm and Center, 160 Esopus Ave, Kingston, NY 12401 Will submit at Camper Check-In Day 1 of Camp

Upload Immunization Records here

Medical/Dietary/Behavioral Information:

Please include any information you would like us to know about your child, including attaching a copy of any applicable treatment plans or IEP.

Medical Information: (Including Allergies)

Dietary Information: (Including Food/Ingredient Allergies)

Behavioral Information

IEP or Treatment Plan Included with Submission:

Yes No

Upload IEP or Treatment Plan here

Would you like to discuss your child's specific needs with a Camp Director prior to Camp Start Date? (check box that applies)

Yes No

PART B: Attendance Information
Please select ALL weeks you would like to enroll your child

PLEASE NOTE: We will contact you if any of the weeks selected are unavailable because they have reached
maximum enrollment
*ALL CAMPS RUN MONDAY - FRIDAY, 9 am - 3 pm
**Note: Camp Week 9 runs Tuesday - Saturday

Week 1: June 27 - July 1, Young Seed Song Farmers Week

Enroll

Week 2: July 4 - 8, FIRE wind water WORKS

Enroll

Week 3: July 11 - 15, Bird is the Word!

Enroll

Week 4: July 18 - 22, The Land Grows Music

Enroll

Week 5: July 25 - 29, SuperPlants of the Farm & Forest

Enroll

Week 6: August 1 - 5, Sheep, Chickens & Wild Animals

Enroll

Week 7: August 8 - 12, Power to the Pollinators

Enroll

Week 8: August 15 - 19, L is for Locavore!

Enroll

Week 9: * Tuesday, August 22 - Saturday, August 27, Earth Heroes

Enroll

Week 10: August 29 - September 2, Esopus Village Back in Time

Enroll

Total Number of Weeks Enrolled *

Part C: Covid-19 Policy, Cancellation/Refund Policy, Photo Release & Newsletter Information & Agreements

Covid-19 Policy

*Please note: our camp follows Ulster County Department of Health guidelines for Covid-19 safety. Based on the past two years and current projections, it seems likely that Covid restrictions will ease as the weather warms. Accordingly, our camp restrictions delineated below will ease. We will update you about any such changes prior to the start of camp. Our camp is almost entirely outdoors, and we are philosophically committed to allowing children to have as natural and traditional an experience with farm, nature, staff, and peers as permitted by county guidelines, current science, and common sense.

Ulster County COVID-19 Hotline: 845-443-8888

COVID SAFETY PARENTAL AGREEMENT: To ensure that every child has a safe, fun, and meaningful experience at Seed Song Center's Farm Camp, we require every parent to read and sign the following COVID Agreement Form and submit with registration. Upon arrival to camp each day, each child will have their temperature taken. Any child with a temperature above 100. 0 degrees F, will be sent home for the day and require a negative test to return to camp.

By sending your child to camp you are affirming that the child has not exhibited any of the symptoms below: Signs and symptoms of COVID-19: (compiled from WHO checklist)~Shortness of breath ~Loss of taste or smell~Chest tightness ~Dry cough~Temp over 100.0 - ~Aches and pains

Collective Agreement with Seed Song Center camp staff and families: "By sending my child to Seed Song Center's camp, I pledge that my family's habits outside of camp will be transparent and safe on behalf of all camp families and staff. While my child attends camp and for one week prior, my family and/or housemates will keep as safe a distance as practicable from any source of potential contagion. If anyone in my home or my child's home experiences an above-listed symptom of COVID-19 or has had contact with a known positive case in the last 14 days, we will not send our child to camp until we have gotten a negative test. I am aware that my actions at home could seriously impact essential workers and other camper families.

My child will bring a mask to camp each day, and will need to wear it whenever they are in an enclosed or shared space. I will ensure that the person that drops off and picks up my child wears a mask at these times and follows this agreement.

I understand that in order to serve families, Seed Song Center has committed resources to the camp program and staff even knowing the risk that camps may be shut down by New York State due to any community health outbreak, or that one camp group may become infected and need to stay at home. I will share in this risk and am aware that camp fees can not be refunded in the case of a shut-down, as well as in the case of any child illness in which the child's space can not be filled from a waiting list.

Camp Cancellation and Refund Policy

For camp enrollments cancelled up to 30 days prior to camp start date a full refund minus the non-refundable 3% Paypal or Venmo processing fee and a 10% Administrative Processing Fee will be issued.

For camp enrollments cancelled up to 15 days prior to camp start date a full refund minus the non-refundable 3% Paypal or Venmo processing fee and a 20% Administrative Processing Fee will be issued.

For cancellations occurring less than 15 days prior to camp start date a refund will ONLY be issued if the camp is able to fill your child's space. The refund issued will be minus the non-refundable 3% Paypal or Venmo processing fee and a 30% Administrative Processing Fee.

COVID Related Cancellations or Closures: In the event that your child cannot attend camp due to a Positive test result or a quarantine due to exposure a refund will only be issued if we are able to fill your child's space at camp. In the event of a CAMP CLOSURE due to COVID outbreak or lack of adequate staffing NO REFUNDS will be issued.

Photo Release Policy

"I permit Seed Song Center to take photos, videos and sound clips of my child and my child's projects at camp and to use them at its discretion."

Signing here attests that you agree to our COVID-19 Policy, Cancellation Policy, Photo Release Policy, and being subscribed to our semi-weekly Newsletter *

Clear

PART D: Camp Contact Information

QUESTIONS? Contact Education Director, Jasmine Wood at:

jasmine@seedsongform.org *Type "CAMP QUESTION" in the subject line of email

PART E: Payment

Camp Sessions are $370 per week regardless of payment method.

Note: the $370 per week fee is effective February 16, 2022 and for the duration of 2022. The minor increase simplifies and standardizes our payment processing fees across all payment methods (cash, check, credit card, paypal, and Venmo), and incorporates that fee within the standard camp fee— there will no longer be a need to add a processing fee to the base camp fee for any payment methods. Those who registered and paid on or before February 16 will not have to adjust their previous payment. We appreciate your understanding as we continue to grow and require higher-level organizational tools.

Need Financial Assistance for Camp? For Scholarship Information email: info@seedsongfarm.org, Please type "Scholarship Information" in the subject line.

Payment Method: (check box that applies) *

I will pay online at the bottom of this form I will pay by Check via mail Made to: "Seed Song Center" Mailed to: 160 Esopus Avenue, Kingston, NY, 12401 with "Summer Camp, Childs name" in the Subject Line I will pay in Cash (Please do not send cash in mail, set up time for in person "cash drop off" to farm by emailing jasmine@seedsongfarm.org

Total Payment Due: ($370 per week ) *

USD

Accessibility for All! An essential part of our mission is to make healthy farm experiences available to all, to make a tax-deductible donation please enter an amount below.

Donation Amount

USD

(OPTIONAL) Check a box below only if you prefer your donation to be applied to a specific program.

Farm-Feed-Your-Neighbor Camp Scholarship Fund

If paying by Cash or Check, please enter your Total Payment (Registration Deposit+ Donation) here. Enter 0 if paying electronically.

Total Cash/Check Payment

If Paying by Card, Paypal, or Venmo Please enter your Total Payment (Registration Deposit + Donation) here. Enter 0 if paying by Cash or Check.

USD Total Online Payment

To pay with Venmo, click on the Paypal option to find the Venmo button. For Cash or Check Payment, please proceed to the Submit button.

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.