Summer Camp Registration 2025

Seed Song Farm and Center

Summer Camp Registration Form 2025

Monday June 30th-Friday August 29

9 Week Program, Weekly Registration

9 AM-3 PM, Monday-Friday

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

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PART A- Child and Parent/Guardian Information
Name of Child*

First NameLast Name
Date of Birth*

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
Parent/Guardian 1 (Required)
Name *

First NameLast Name
Best Phone Number between 9 AM and 3 PM*
E-mail*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 (Optional)
Name

First NameLast Name
Phone Number
E-mail
example@example.com
Emergency Contact Information

Please indicate an individual other than yourself who can act as an emergency contact between the hours of 9 am and 3 pm
Name of Emergency Contact *

First NameLast Name
Phone Number of Emergency Contact*

Area CodePhone Number
Email of Emergency Contact *
example@example.com
PART B- Immunization & Medical Information
Please provide a copy of the child's immunization history using the box below

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.

If you experience an emergency that will not allow your child to attend camp, please email us at jasmine@seedsongfarm.org
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 COVID-19 Policy, 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@seedsongfarm.org *Type "CAMP QUESTION" in the subject line of email
How did you hear about our summer camp program? (Check boxes that apply)*

Child has participated in past camp sessionsHudson Valley Parent AdChronogramFacebookInstagramSeed Song NewsletterWord of mouthRoad SignsFlyersAt a Seed Song EventRadioOther
Part E: Scheduling & Payment
Payment

Camp Sessions are $390 per week
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.
Payment Options

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.
***To pay by Cash or Check: Email info@seedsongfarm.org for a unique coupon code

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

To inquire about financial assistance or payment plan: Email info@seedsongfarm.org