Spring Break Camp 2025 Registration

Seed Song Farm and Center Spring Break Camp

Registration Form 2025

Monday April 14th- Friday April 18th

STOP! To successfully complete this form, you must provide an electronic copy of your childs immunization records.

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Monday, April 14th-Friday, April 18th
9am to 3pm with before and after-care available
Ages 4 & up

*One form is required for each registrant. You may utilize the auto-fill feature when filling out forms for multiple children.
PART A- Child and Parent/Guardian Information
Name of Child*

First NameLast Name
Date of Birth (Month/Date/Year)*

MonthDayYear
Age of Child (Child must be 4 years old on or before camp start date)
Gender Child Identifies With: (check box that applies)*

MaleFemalePrefer not to sayOther
Child's Preferred Pronouns (He, She, They)
Parent/Guardian Contact Information
Name of Parent/Guardian 1 *

First NameLast Name
Best Phone Contact # to reach you between 9 AM and 3 PM*
E-mail*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Parent/Guardian 2 (OPTIONAL)
Phone Contact of Parent/Guardian 2 (OPTIONAL)
Emergency Contact Information: Please indicate 2 individuals other than yourself who can act as an emergency contact between the hours of 9 am and 3 pm
Name of Emergency Contact 1 *

First NameLast Name
Phone Number of Emergency Contact 1*
How did you hear about our summer camp program? (Check boxes that apply)*

Child has participated in past camp sessionsHudson Valley ParentChronogramFacebookInstagramSeed Song NewsletterWord of mouthOther
PART B: Immunization & Medical Information
Please provide a copy of the child's immunization history by submiting electronically below. This form is required for registration.

Subpart 7-2 of the New York State Sanitary Code requires camps to maintain immunization records for all campers which includes dates for all immunizations against diphtheria, haemophilus influenza type b, hepatitis b, measles, mumps, rubella, poliomyelitis, tetanus and varicella (chickenpox The record must be kept on file for every camper and updated annually.
Please Upload Immunization Records here *

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Medical/Dietary/Behavioral Information:

Please include any information you would like us to know about your child, including attaching a copy of any applicable treatment plans or IEP.
Medical Information: (Including Allergies)
Dietary Information: (Including Food/Ingredient Allergies)
Behavioral Information
IEP or Treatment Plan Included with Submission:

YesNo
Upload IEP or Treatment Plan here

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Would you like to discuss your child's specific needs with a Camp Director prior to Camp Start Date? (check box that applies)

YesNo
Part C: Cancellation/Refund Policy, Photo Release & Newsletter Information

Cancellation Policy

In the event of a public health outbreak, we are unable to give any refunds.

All Registrations Are Final: Once your registration is submitted, it is considered final. No refunds, cancellations, or transfers will be granted unless discussed with the director.
Photo Release Policy
"I permit Seed Song Center to take photos, videos and sound clips of my child and my child's projects at camp and to use them at its discretion."
Signing here attests that you agree to our Cancellation Policy, Photo Release Policy, and being subscribed to our semi-weekly Newsletter*

Clear
PART D: Camp Contact Information

QUESTIONS? Contact Education Director, Jasmine Wood at:

jasmine@seedsongform.org *Type "CAMP QUESTION" in the subject line of email
PART E: Payment

Spring Break Camp is $385 per week.

Registration fees are due in full. If you are unable to pay in full, please don't let this deter you from registering. Email us at info@seedsongfarm.org with the subject line "payment plan"
As of 2024, a unique coupon code is required to submit payment by check or cash.

If you prefer to pay by check or cash, please email info@seedsongfarm.org for a unique code to enter at check out.
Accessibility for All! An essential part of our mission is to make healthy farm experiences available to all, to make a tax-deductible donation please enter an amount below.
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Spring Break Camp
$385.00

Donation to Seed Song Center Donate to the Immigrant Camper Fund
$ Free Amount

Total

$0.00
To pay with Venmo: click on the Paypal option to find the Venmo button.

To pay by check or cash: please email info@seedsongfarm.org for a unique code to enter at check out.

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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