5Heart Summer Day Camp Registration Form

Day Camp Registration Form

Wednesday, August 7, 2024
Thank you for your interest in our day camp at 5Heart Earthworm Farm. The day camp will be held on Wednesday, August 7th from 8:30 a.m. - 4:00 p.m.

The day camp is designed for children ages 8-12 years old.

Cost is $75 per child. Add a sibling for $50.

Activities include: Worm science, composting and compost pile exploration, zero waste lunch lesson, nature walk, pot a flower, day camp journal, crafts, games, and more!

To register your child, please provide us with the following information.
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*
Are you registering a sibling for the day camp?

Yes - If so, please complete the Sibling Camper Information section belowNo - If not, please proceed to the Parent/Guardian Information section
Sibling Camper Information

If applicable
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*
Work Phone
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Campers*
Secondary Emergency Contact and Authorized Pick-Up Person

First NameLast Name
Secondary Emergency Contact Phone Number
Please enter a valid phone number.
Terms & Conditions

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

MonthDayYear
Date
Signature*

Clear

My Products

Camper One

$75.00

Sibling Camper

$50.00

Total

$0.00

Credit Card

Should be Empty:

Day Camp Registration Form

Camper's Information

Sibling Camper Information

Parent / Guardian Information

Terms & Conditions

Credit Card