Fiddle Leaf Farm Registration

Fiddle Leaf Farm Camp Registration
Camper Information
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender
Camp Week
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
T-Shirt Size
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alternative Phone Number
Format: (000) 000-0000.
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 this organization, during the selected camp. In exchange for the acceptance of said child’s candidacy by this organization. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless this organization. All its respective officers, agents, and representatives from any and all liability for injuries to the said child arising out of traveling to, participating in, or returning from selected camp sessions.

An equine activity sponsor, an equine professional, or any other person engaged in an equine activity, shall not be liable for an injury or the death of a participant resulting from the inherent risks of equine activities and, except as provided in paragraph III of this section, no participant's representative shall make any claim against, maintain an action against, or recover from any other person for injury, loss, damage, or death of a participant resulting from any of the inherent risks of equine activities.N.H. Rev. Stat. § 508:19
Confirmation

By acknowledging and signing 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.
E-Signature
Date

MonthDayYear
Date
Should be Empty:

Fiddle Leaf Farm Camp Registration

Camper Information

Parent/Guardian Information

Emergency Information