• Farm Camp Registration Form

    These registration form is required for your children to attend camp.

  • Camper's Information

    Complete this form and you will receive an email with next steps to the email listed as Parent/Guardian 1 in 2-3 business days. You will NOT recieve automatic payment information or reciept.
  • Date of Birth*
     - -

  • NOTE - Farm Kids Camp is for children ages 5-11- If your child was in Kindergarten-5th grade for the 25-26 school year.

    Children need to have completed full-day Kindergarten and be fully potty trained before they are eligible to participate in camp. 

  • Parents' Information

    Parent/Guardian 1
  • Format: (000) 000-0000.
  • How would you like to be reached while your child is at camp?*

  • Parents' Information

    Parent/Guardian 2
  • Format: (000) 000-0000.
  • How would you like to be reached while your child is at camp?

  • Emergency Contacts/Authorized Pickup

    Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within 1 hour of the camp location, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. Both emergency contacts should be able to produce valid photo ID and be authorized to pick up your child from camp.

  • Emergency Contact/Authorized Pick Up

    Emergency Contact #1
  • Format: (000) 000-0000.

  • Emergency Contact/Authorized Pick Up

    Emergency Contact #2
  • Format: (000) 000-0000.

  • Medical / Health Information

  •  -
  • Does your child have any food, medication or environmental allergies?*
  • Allergies? Check all that apply*
  • 0/150
  • Does your child’s allergy/allergies require staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?*
  • Does your child have a special health or medical condition?*
  • 0/150
  • Does the special health or medical condition require child care staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during child care hours?*
  • Is your child currently using any medication? *
  • 0/150
  • Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?*
  • 0/150
  • 0/200
  • 0/200

  • Additional Medication

  • Check all that apply

  • ***Note we are unable to administer medications or accomodate medical requests during camp times if your child's medication meets any of these criteria:

    1. A physician's instruction is needed for a nonprescription medication (e.g. child is underage or underweight per the label instructions); or
    2. It is a sample medication without a prescription label; or
    3. The nonprescription medication is to be given longer than three consecutive days within a fourteen day period or is a topical product or lotion that is being used for a skin ailment and is to be given no longer than fourteen consecutive days; or
    4. The medication contains codeine or aspirin.

    Prigel Family Farm will not provide over the counter medications, suncreens, bug sprays etc. to campers but we will assist with applying products sent from home with parental consent. 

    *** Please note that while there will be a CPR and First Aid trained staff member at all times. there will NOT be a registered nurse on site. Prigel Family Farm reserves the right to require families to provide medical assistance for medication administration that is beyond our scope of training.***

     

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