Farmyard Explorers Registration Form

Farmyard Explorers Registration Form

To book for a place in the the camp, you must complete the form below accurately.
Date of Camp*

MonthDayYear
Date
Camper Name*

First NameLast Name
Birth Date*

MonthDayYear
Age*
Desired Name Tag*
Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about Camp?*

Family Information
Parent/Guardian's Name*

First NameLast Name
Contact Phone Number*
Email Address*
Parent/Guardian's Name

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

Medical Information
Does your child have any allergies?*

YesNo
Does your require an EpiPen?*

YesN/A
If you answered yes to the above questions, please provide details of your child's allergy, including details about your child's anaphylaxis (if applicable).
If your child requires an EpiPen, please provide a non-expired EpiPens for your child to carry with them at all times.
Will your child be taking any medications while at camp? Please note: Medicine must be brought to camp in its original packaging.*

YesNo
If you answered yes to the above question, please fill out the following section:
Medication Name
Dose
Please provide the reason your child requires this medication, along with any important details about administration—including dosage, timing, and specific instructions. Indicate whether your child is able to take the medication independently or will require staff assistance.

Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Relationship to Camper*
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Relationship to Camper*

Medical Waiver
- I have reviewed the description of the Superior Farms farm camp programs and feel that I have sufficiently informed myself about the nature of the camp and the activities involved.
- I acknowledge that there are inherent risks, dangers, and hazards, not all of them easily foreseeable, associated with my child(ren)’s participation in the farm camp including, but not limited to: during interactions with farm animals; interactions with plant life; use of farming and construction tools; use of tools for crafting, such as hammers, carving knives, hot glue guns, scissors; during nature play, which may include building and playing with loose parts, climbing trees, etc.; collision with other participant or instructors; impact with objects or equipment used in connection with daily activities; contraction of a contagious disease including, but not limited to, COVID-19; changes in the type of surface and the condition of surfaces, including walkways and forest paths; adverse weather conditions; loss of balance; failure to play safely within one's own ability; theft; consumption of food and drink, whether made by professionals or by nonprofessionals; and negligence of other participants.
- I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.
- I understand that the foregoing does not list all of the risks or dangers and that participation in the activities involve risks and/or dangers which are not foreseen.
- Acknowledging that such risks exist, I hereby release and discharge Superior Farms, its officers, agents, and employees from any and all claims or liability for personal injury or property damage my child(ren) may suffer while participating in the activity.
- To the best of my knowledge I will inform Superior Farms of all details regarding my child(ren)'s health. I will notify the camp if my child is exposed to an infectious disease or illness during the week prior to their scheduled camping program and during program participation or if there are other changes to the information I have supplied.
- I understand that if my child falls ill while at camp, this may lead to the child having to leave camp early and not being able to return.
- I certify that my dependent has no medical or physical conditions which could interfere with their safety or the safety of others, or else I am willing to assume – and bear the costs of – all risks that may be created, directly or indirectly, by any such condition.
- In case of emergency - accident, injury, or illness - involving the registrant, if immediate contact with a designated contact cannot be made, I hereby authorize and grant permission to Superior Farms camp staff to call a medical practitioner or an ambulance for my child to receive the appropriate medical treatment. I agree not to hold Superior Farms responsible for any costs of injury arising out of an emergency situation.
- By checking the following acknowledgment and electronically signing, you will hereby consent to my child(ren)’s participation in the camp on the terms and conditions set out.
Checking this box confirms that you have read the medical waiver, that you understand it, and that you agree to be bound by it.
Name*

First NameLast Name
Signature*

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Date*

MonthDayYear
Date

Conduct Waiver

Please read and sign below.
- During camp, we strive to create a safe environment for both campers and employees. We expect and encourage each camper to maintain a positive level of respect for everyone. It is our intention to work with campers and caregivers to find solutions to behavioural challenges whenever possible.
- Caregivers are asked to inform the Children's Program Director of any specific needs or consideration their child might require in advance of the start of camp in order to ensure camp is a positive experience for all participants.
  Participants and their caregivers are expected to be respectful and considerate towards other participants, staff, and external partner organization instructors.
- Camp participants are expected and required to follow the directions of all instructors, to stay in close proximity to their instructors during the program and not leave without consent and informing camp instructors.
- After the first breach of these rules, instructors will discuss the issue with the participant and their parents or guardian and a behaviour contract or safety plan may be put in place to help guide everyone in maintaining a safe camp environment.
- A behaviour contract may be initiated in the case of constant swearing, being disrespectful to camp leaders and/or campers, not respecting the rules set out on day 1 of camp, wandering away from the group without notice, being disparaging about activities or plans for the day (note: we respect every child’s autonomy to participate or not participate in an activity), acting in a way that causes frequent disruptions or need for intervention throughout the day.
- In the event that there is a continuous breach of these rules, Superior Farms may require the participant to withdraw from the remainder of the camp session, without reimbursement of any camp fees.
- If a camper is behaving in a way that negatively affects the camp experience or that is jeopardizing their own or others’ safety, that camper may be asked to leave camp without refund. This behaviour includes, but is not limited to: bullying, physical assault, inability or refusal to follow safety guidelines, theft, and bringing weapons or other inappropriate items to camp.
- I confirm that I will discuss these rules and expectations with my child.
Signature*

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Date*

MonthDayYear
Date

Financial Waiver

Please read and sign below.
- I understand that full payment is required at the time of registration through the Superior Farms website.
- I acknowledge that no refunds will be issued if a reservation is cancelled less than 1 week prior to the session start date. Cancellations made at least 1 week in advance are 90% refundable (10% is retained as an administration fee).
- In the event that Superior Farms cancels your session, a full refund or full credit toward a future program will be offered.
- Refunds will not be issued for missed camp days or shortened camp weeks due to camper illness, inclement weather, or participant withdrawal.
- Superior Farms reserves the right to withdraw a camper from the program if their behavior repeatedly goes against our conduct expectations or creates an unsafe or disruptive environment for others. In such cases, no refund will be issued for missed camp days.
- Signing below indicates that you have read and agree to the above terms.
Signature*

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Date*

MonthDayYear
Date

Photo Release
Photo Permission - I hereby give my consent to Superior Farms to use my child's photograph or video and likeness for lawful purposes including in its publications, including its advertising and website.*

Yes, I consent.No, I do not consent.
Do we have your permission to share photos of your child - whether individually or in a group with parents whose child attended camp the same week as your child?*

Yes, I consent.No, I do not consent.
Should be Empty:

Farmyard Explorers Registration Form

Family Information

Medical Information

If you answered yes to the above question, please fill out the following section:

Emergency Contact Information

Medical Waiver

Conduct Waiver

Financial Waiver

Photo Release