Farm Club Enrollment Form

Wonderfarm Club Registration Form **ENROLLING FOR NOVEMBER- OCTOBER SESSIONS FULL***

These forms are required for your children to attend club.
Student's Information
Member ID
Student Name*
Preferred Nickname
Date of Birth*

MonthDayYear
Age
Gender
NOTE - Kids Farm Club is for children ages 5-11 (Kindergarten-6th graders) Children need to be fully potty trained before they are eligible to participate in club.
Grade in 2025/26*
School Student Attends
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.

Guardian Information

Primary Contact Point (this person will be contact with all club information)
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
Cell Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How would you like to be reached in case of emergency while your child is at club?*

Phone CallText Message
Contact # 2

Who would you like us to reach if you are not available?
Parent/Guardian 2*

First NameLast Name
Relationship to Child*
E-mail*
Cell Phone*
Home Address Same as Parent/Guardian 1?

Yes
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How would you like to be reached while your child is at club?

Cell PhoneText Message

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 club 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 club.
Emergency Contact/Authorized Pick Up

Emergency Contact #1
Full Name*

First NameLast Name
Primary Phone Number*
Relationship to Child*
Emergency Contact/Authorized Pick Up

Any additional adults authorized to pick up your child.
Full Name*

First NameLast Name
Primary Phone Number*
Relationship to Child*