Farm Camp Registration Form

Student Name*

Parent/Guardian Name*

First NameLast Name

Contact Number:*

Area CodePhone Number

E-mail*

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Permission*

As the parent or legal guardian of listed students, I give my permission for him/her/them to attend Farm Camp activities for the summer 2024 term.

Acknowledgement of Personal Liability and Waiver*

I understand that Farm Camp activities may expose my child/children to some risks and I assume any such risk that may arise therefrom. I accept full responsibility for all medical expenses for any injuries that might occur to my child/children by reason of his/her/their participation. By signing this form, I release Powder Keg Farms, its administrators, directors, faculty, staff, and volunteers (“released parties”) from and against all claims, demands, actions, complaints, suits or other forms of liability that any of them may sustain (a) arising out of my child’s/children's failure to comply with local, state, and federal laws and PKF's policies and procedures; (b) arising out of any damage or injury caused by my child/children, I also agree to indemnify and hold harmless the released parties from any and all related costs, attorney fees, liabilities, settlements, and/or judgments.

Medical Release*

In the event that the parents cannot be contacted and if the injury or illness is life threatening or requires emergency treatment, I authorize the designated representative of Powder Keg Farms to summon any and all professional emergency personnel to attend, transport, and treat listed child/children.

Signature*

Date*

Date

Weekly Farm Camp Options*

Weekly Farm Camp WV Residents (before May 15) $175.00

This covers one week of Farm Camp for residents of West Virginia if paid before May 1, 2024. This camp is for rising second graders through twelfth graders. Camp runs weekly from May 28 through August 30 from 9am to 3:30 pm at Powder Keg Farms in High View, WV. Campers will experience Farming God's Way and learn about herbalism, interact with livestock, go fishing, foraging and on nature hikes and field trips, and hear from visiting educators.

Number of campers	Weeks	Price
1		$175.00
2		$175.00
3		$175.00
4		$175.00
5		$175.00
6		$175.00
7		$175.00
8		$175.00

Item subtotal:$0.00

Weekly Farm Camp WV Residents (after May 15)$185.00

This covers one week of Farm Camp for residents of West Virginia if paid before May 1, 2024. This camp is for rising second graders through twelfth graders. Camp runs weekly from May 28 through August 30 from 9am to 3:30 pm at Powder Keg Farms in High View, WV. Campers will experience Farming God's Way and learn about herbalism, interact with livestock, go fishing, foraging and on nature hikes and field trips, and hear from visiting educators.

Number of campers	Weeks	Price
1		$185.00
2		$185.00
3		$185.00
4		$185.00
5		$185.00
6		$185.00
7		$185.00
8		$185.00

Item subtotal:$0.00

Enter coupon

Total $0.00

Credit Card

Please specify which week(s) you are registering your child/children for.*

Farm Camp Registration

Parent Details

Permission and Medical Release

Credit Card