Registration Form

Camp will be held for two consecutive weeks (Tuesday - Thursday), June 6-8 and 13-15 for a total of six evenings from 6:00 - 8:30 PM. AgriVenture is designed for youth moving into 3-6 grade at the end of the school year.

Registration Fees ($135/camper) can be paid online securely through Give Lively and must be completed in order to complete the registration process. You will be redirected to the payment site after you submit the camper registration.

Note: After being redirected to the payment site, If you choose "Add NewBank Account" but are unable to locate your bank, please then choose the "Add New Credit Card" button and proceed with payment.

If you are unable to pay the full registration fee, please contact Beth Zarnke at 715-897-7187 or email Memorylanefarm86@gmail.com for a Scholarship Application prior to completion of the registration form below.

Only one camper may be registered at a time.

Camper's Full Name*

First NameLast Name

E-mail Address where you'd like to receive confirmation and information:*

name@gmail.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Birth Date*

MonthDayYear

Current Age:*

Grade Entering Fall 2023*

Gender:*

MaleFemale

Number of years Camper has attended AgriVenture

# of years

Has Camper attended AgriVenture in the past?*

YesNo

Camper T-shirt Size

Emergency Contact Name*

First NameLast Name

Emergency Contact Relationship:*

Emergency Contact Phone Number:*

Area CodePhone Number

List any allergies or sensitivities: (medical, food, etc.): (If none, enter none)*

List any chronic illness and or physical limitations camp should know about: (If none, enter none)*

Current Date:*

MonthDayYear

A 80% refund of camp fee is made if notice is given to Memory Lane Farm by May 7, 2023. A 50% refund is made if notice is provided between 5/7-6/7. Sorry, no refunds will be made once camp starts.

All refunds are processed after the camp ends. We do not prorate fees for attending only a part of the camp week.

2023 Agri-Venture Farm Camp

Camper Information

EMERGENCY INFORMATION