2026 Mini Farm Camp Registration Form

2024 Mini Farm Camp Registration
Please fill out ONE form per child

Mini Camp will be held:

Session 1:June 9th-June11th and will run from 9:00am-12:00pm

Session 2: June 16th-18th and will run from 9:00am-12:00pm

Mini Camp is for children ages 4 (as of 2/1/26) & 5 (entering Kindergarten).

Drop off will take place at our Education Center.

Drop off begins no earlier than 8:45am.

Cost of the Mini Camp is $100
Fill In Your Child's Information Below
Email address*
Mini Camp Session:*
What week is your child signed up for?*

Session 1: June 9th-11thSession 2: June 16th-18th
CHILD'S name (first and last)*
Child's Age*
Child's Grade (entering for 2026-2027 school year)*
Child's T Shirt Size*
PARENT/GUARDIAN Name*
Parent/Guardian Full Address*
Parent/Guardian Phone Number*
Emergency Contact Name and Phone Number*
Allergies*

NoneHay FeverPoison IvyInsect StingsOther DrugsFoodOther
Specify food, insect, drug, or other allergy (if applicable)
Health Conditions*

NoneBleeding DisorderConvulsions/EpilepsyLearning DisabilityBehavioral IssuesDiabetesAsthmaADD/ADHDOther
Specify condition and directions for staff (if applicable)
Names and phone numbers of others authorized to pick up your child*
Photo Release: I hereby give my permission for my child's photograph to be used in The Lands at Hillside Farms publications and for advertising and promotions. *

YesNo
Authorization for On-Farm Transportation: I hereby give my permission for my child to be transported by TLHF staff to on-farm destinations a part of the camp experience. *

YesNo
TLHF acknowledges that your child has voluntarily enrolled in Summer Farm Camp on TLHF's property at 65 Hillside Road, Shavertown, PA (the "property"). TLHF is a working farm. As such, heavy duty farming equipment, live animals, electrified fences, and other such hazards inherent to farming activities exist on the Property and may pose a danger to your child. You, by checking the box below for this Release and Waiver of Liability, on behalf of yourself and your child hereby release and hold harmless TLHF and its officers, directors, employees from any and all liability resulting from any injury your child may sustain in connection with and arising out of such hazards or in connection with your child's participation in the Summer Farm Camp, or your child's presence on the Property.*

I understand.
Sign and Date*
SPECIAL INSTRUCTIONS: Please provide us with any special instructions or requests for your child.
Should be Empty:

2024 Mini Farm Camp Registration

Fill In Your Child's Information Below