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)*

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)*

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 *

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

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*

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.

My Products

Spring Break Camp

$385.00

Donation to Seed Song Center

Donate to the Immigrant Camper Fund

$ Free Amount

Enter coupon

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

Choose from one of the PayPal options to make your payment.