Field Trip Registration Form (Deposit)

VFV Field Trips Registration Form

Use this form to register your field trip and choose to pay online via PayPal or by check. Once submitted, we’ll confirm your date and send payment instructions. We can’t wait to welcome your class to the farm!
Name of School/Program*
Principal/Director*
School Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Desired Field Trip Date(s)/Time(s)*
School/Program Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Teacher/Point of Contact*

First NameLast Name
Email*
example@example.com
Cell Phone for Day of Trip (must be a cell phone)*
Please enter a valid phone number.Format: (000) 000-0000.
Age/Grade Level(s) Participating*

Field Trip Attendees
Total Number of Students Attending ($10 per Student.)*
We understand changing enrollment numbers for the day of the trip will be adjusted.
Total Number of Teachers, Aides, School Staff (Free!)*
Free
Optional
Total Number of Parents/Chaperones (Non-Teaching Staff, $5 per Parent or Chaperone)
Total Number of Non-Student Children ($10 per child)
Would you like to extend your trip time from 90 minutes to 2 hours? ($2 per student & parent/chaperone)
Would you like the use of our picnic tables for a 30 minute lunch after or before your field trip? ($2 per student & parent/chaperone)
Total Amount in US$
This amount reflects all selected attendees and any optional add-ons. Final numbers can be adjusted prior to your visit if needed. Only 30% of the total amount is needed as deposit.

Complete Your Form:
Pennsylvania has enacted Act 27 requiring participants in any ‘agritourism’ location to be aware of the following:“AGREEMENT AND WARNING: I understand and acknowledge that, except for limited circumstances listed below, an agritourism activity provider is not liable for any injury to or death of a participant resulting from an agritourism activity. Our school understands the acceptance of all risk of injury, death, property damage and other loss that may result from an agritourism activity. I understand that an agritourism activity provider is not protected from liability if the provider: (1) Performs an act in a grossly negligent manner and causes injury or damages to a participant. (2) Purposefully causes a participant’s injury. (3) Acts or fails to act in a way that constitutes criminal conduct. (4) Recklessly fails to warn or guard against a dangerous condition that causes injury or damages to a participant. A dangerous condition is a condition that creates an imminent and substantial risk of injury or damages to a participant.”If you have any questions on the above wording, please let us know.*

By checking this box and signing below, our school agrees to the extended Terms & Conditions provided. Our school assumes full responsibility for its students, teachers, chaperones, bus drivers, and all others in attendance with the group and will not hold Valley Fruits & Veggies liable in any manner. Bus/van drivers & transportation vehicles MUST remain at Valley Fruits & Veggies during the scheduled trip.
Signature*

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30% Deposit Amount Required for Your Field Trip Group:
Online via PayPal/Credit Card (To be invoiced)Check via Mail
Check Deposit Note:

*Please make checks payable to Valley Fruits & Veggies and mail to: 4515 Briarwood Dr, Nazareth, PA 18064

Deposit checks are due within 15 days of completing this form to hold your date.

For questions, contact Deb Colitas at deb@valleyfruitsandveggies.com.
Should be Empty:

VFV Field Trips Registration Form

Field Trip Attendees

Optional

Complete Your Form: