Bean Acres Farm Camp Registration
Camper's name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Additional camper
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Additional camper
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Additional camper
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian name
*
First Name
Last Name
Back
Next
Phone Number
*
Format: (000) 000-0000.
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June 1-5
$50.00
$
50.00
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June 8-12
$50.00
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June 15-19 (PRETEEN GIRLS WEEK)
$50.00
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June 22-26
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July 6-10
$50.00
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July 13-17
$50.00
$
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July 20-24
$50.00
$
50.00
Quantity
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July 27-31
$50.00
$
50.00
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Email
*
example@example.com
Submit
Should be Empty: