Day Camp Registration Form

Day Camps at the Bruentrup Heritage Farm Registration Form

Summer 2022
Camper's Information

Personal & Health & Contact
Name

First Name Last Name
Birth Date

Month Day Year
Age (at time of camp)
Grade (entering this fall)
T-shirt Size:

Youth Small Adult Smaill Youth Medium Adult Medium Youth Large Adult Large
Blood Type
List Any Allergies and Dietary Restrictions
Medications & Frequency
Email
example@example.com
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent / Guardian Information

(All correspondence and and invoices will be sent to this person)
Name

First Name Last Name
Email
example@example.com
Cell Phone

Area Code Phone Number
Work Phone

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Occupation
Relationship with the Camper
Emergency Contacts and Authorized Pick Up Persons
Program Information

Program & Transportation & Payment
Select Camp Week Farm-to-Table, entering grades 1-3

July 11 - 14, 9 AM - 4 PM July 18 - 21, 9 AM - 4 PM August 1 - 4, 9 AM - 4 PM
Select Camp Week Farm-to-Table, entering grades 4 - 6

Aug 8 - 11, 9 AM - 4 PM
Select Camp Week Hmong Language & Culture entering grades 3 - 7 (please note this is a half day camp, $80 per student)

July 18 - 21, 9 AM - 1 PM
Select Camp Week Arts on the Farm, entering grades 4 - 6

July 25 - 28, 9 AM - 4 PM
Questions or to request information on scholarship funding, email or call MAHS Executive Director, T.J. Malaskee.

Director@MaplewoodHistoricalsociety.org 612.384.5883

My Products

Day Camp at Maplewood Area Historical Society $ 50.00

Deposit for one week of camp at the Bruentrup Heritage Farm to be applied towards total tuition of $190.00 for Farm-to-Table and Arts on the Farm Camps, $80 for Hmong Language Camp due on or before first day of camp. This deposit is only refundable should MAHS need to cancel a camp week but may be applied towards an additional open week of camp.

Total $ 0.00

Credit Card

Terms & Conditions

I, the undersigned, give permission for my child to participate in camp at the Bruentrup Heritage Farm for the days they attend. I am fully aware that to reserve a space, I must make a deposit of $50 per child per one week session and submit this registration form. I fully understand and authorize my child being photographed, video and/or audio recorded for MAHS publicity. I fully understand that my child is responsible for their possessions including daily lunch. I understand that in the event of an emergency affecting my child while participating in camp at the Bruentrup Heritage Farm, a designated employee of MAHS will attempt to contact me and inform me as soon as possible. In the event I cannot be reached, I hereby give permission for my child to be treated or hospitalized by a licensed physician or hospital selected by MAHS.
Date

Month Day Year
Date
Signature

Clear
Should be Empty:

Day Camps at the Bruentrup Heritage Farm Registration Form

Camper's Information

Parent / Guardian Information

Program Information

Questions or to request information on scholarship funding, email or call MAHS Executive Director, T.J. Malaskee.

Credit Card

Terms & Conditions