Farm Camp Registration Form

Eastcliff Farm Camp Registration

Summer 2025
Camper's Information
Last Name*
First Name*
Middle Name*
Gender*

MaleFemale
Address*
City*
Province*
Postal Code*
Birth Date*

MonthDayYear
Grade entering in the fall*
Please select a camp week

Session 1: June 20 - 25, 5 nightsSession 2: July 13 - 19, 6 nights
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Parent /Legal Guardian 2*
Relation 2*
Cell Phone 2*

Area CodePhone Number
Work Phone 2

Area CodePhone Number
Other Phone*

Area CodePhone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Emergency Number #2*

Area CodePhone Number
Email Confirmation
Parents Email (camper confirmation will be sent by email, if left blank it will be mailed)
Camper's Email
Health Information
Are immunications up to date?

YesNo
Date of last tetanus shot
Any activity the camper should be restricted from?
Any physical or other condition that would require special attention or medication while at camp?
List all medications, both prescribed and over the counter, all medications will be turned into the camp director except rescue inhalers, bring all medication in original containers.
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
Activities of Interest

Select up to 5 activities that would be of interest
archerybirdwatchingwoodworkingjewelry smithingbread making/bakingsewingflower pressing or arrangingcut & paste craftsknitting and/or feltingmaking jam or preserves
Camper Photo Release
I agree that photos of my child can be taken on used on for camp social media purposes

YesNo
Payment Information

Invoice with total amount owing will be sent once registration is completed.
Camp Fees

Session 1: $600, 5 nightsSession 2: $750, 6 nights
- Be certain to enter your email address correctly on the registration form to receive confirmation via email with in 2 weeks
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. The camp carries secondary insurance. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites.
Electronic signature, please initials*
Should be Empty:

Eastcliff Farm Camp Registration

Camper's Information

Parent or Legal Guardian Information

Emergency Contact Info

Email Confirmation

Health Information

Activities of Interest

Camper Photo Release

Payment Information