5Heart Summer Day Camp Registration Form

Day Camp Registration Form
Thank you for your interest in our day camp at 5Heart Earthworm Farm. This camp is open to children ages 8-12 years old. To register your child, please provide us with the following information. Please complete a separate form for each child you wish to register.
Program Information

5Heart Earthworm Farm Day Camp is offered on August 9 from 8:30 a.m. to 4:00 p.m. Cost is $75 per child.
Activities include: Worm science and composting, zero waste lunch lesson, nature walk, soil health lesson, worm wall signing and more!
Camper's Information
Name*

First NameLast Name
Birth Date*

MonthDayYear
Age (at time of camp)*
T-Shirt Size*

Youth Medium (Size 10-12)Youth Large (Size 14-16)Youth Extra Large (Size 18-20)Adult MediumAdult Large
List any allergies and other medical information we should be aware of*
Please describe any limitations that would hinder your child's participation in camp activities*
Parent / Guardian Information

(All correspondence will be sent to this person)
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Camper*
Secondary Emergency Contact and Authorized Pick-Up Person
Terms & Conditions

Please review our terms and conditions before completing registration.
Date*

MonthDayYear
Date
Signature*

Clear

Wednesday August 9, 2023$75.00

Total $0.00

Day Camp Registration Form