Summer Camp 2022 at the Bloom Farm Enrollment Form

Summer Fiber Craft Camp 2022 at the Bloom Farm Registration
CHILD INFORMATION:
Child Name *

First Name Last Name
Birth Date *

Month Day Year
Which Camp are you signing up for

June 29th - July 1st July 13th - July 15th July 27th - July29th August 3rd - August 5th
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Emergency Contact Name

First Name Last Name
Emergency Contact Number

Area Code Phone Number
MEDICAL INFORMATION
Physician Name

First Name Last Name
Phone Number

Area Code Phone Number
Please list any medical concerns and allergies you want us to be aware of.
Should be Empty:

Summer Fiber Craft Camp 2022 at the Bloom Farm Registration