Bantam Farm Mommy & Me Registration Form 2025

Mommy & Me Camp Registration

Bantam Farm (1823 Farmington Ave. Pottstown PA 19464)
Camper Information
First Camper's Name

First NameLast Name
First Camper's Birth Date

MonthDayYear
First Camper's Gender

MaleFemale
First Camper's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Second Camper's Name

First NameLast Name
Second Camper's Birth Date

MonthDayYear
Second Camper's Gender

MaleFemale
Second Camper's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Adult Information (Adult who will be in attendance for the event)
Name

First NameLast Name
Cell Number
E-mail
example@example.com
Registration Options (These are per camper so please select 2 if registering two campers)
prevnext( X )
1 Day Registration (Monday 6/16)
We will be focused on cows all day! We will end with a petting zoo & a tractor ride (weather depending)

$60.00 Quantity



1 Day Registration (Tuesday 6/17)
We will be focusing on rabbits all day! We will end with a petting zoo & a tractor ride (weather depending)

$60.00 Quantity



1 Day Registration (Wednesday 6/18)
We will be focused on pigs all day! We will end with a petting zoo & a tractor ride (weather depending)

$60.00 Quantity
Item subtotal:$0.00



1 Day Registration (Thursday 6/19)
We will be focused on chickens all day! We will end with a petting zoo & a tractor ride (weather depending)

$60.00 Quantity



Week of Camp (Monday 6/16-Thursday 6/19)
You will get to experience cow, rabbit, chicken, & pig day! We will end each day with a petting zoo & a tractor ride (weather depending).

$200.00 Quantity



Total

$0.00
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Bantam Farm during the selected camp. In exchange for the acceptance of said child’s candidacy by Bantam Farm, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Bantam Farm for any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Bantam Farm. including all teachers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities that involve animals, etc. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Confirmation

BY ACKNOWLEDGING AND TYPING MY NAME BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Name
Date

MonthDayYear
Date
Should be Empty:

Mommy & Me Camp Registration

Camper Information