Farm Camp Registration

Farm Camp Registration

Vireo Farm, Bainbridge Island WA
Student Information

Please provide the participant's details below.
Student's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Information

Contact details for the parent or legal guardian.
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Emergency Contact Information

Please provide an emergency contact (other than parent/guardian).
Emergency Contact Name

First NameLast Name
Emergency Contact Relationship to Student
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information

Please provide any relevant medical details.
Does the student have any allergies or medical conditions? If yes, please specify.
Medical Release Consent

Consent for emergency medical treatment.
Do you authorize the camp staff to seek emergency medical treatment for your child if necessary?
Photo Release Consent

Consent for use of photographs taken during the event.
Do you grant permission for your child to be photographed during the camp for promotional or educational purposes?
T-Shirt Size
Any additional information
Liability Form

Please read and acknowledge the liability waiver below.
Liability Waiver
By participating in this event, I acknowledge and agree that I, my heirs, executors, administrators, and assigns, hereby release and hold harmless the event organizers, their employees, volunteers, agents, and the host farm from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, injury, or death that may occur during the event. I understand and fully accept the risks involved and agree not to hold the organizers or host farm responsible for any injury or damage incurred. This release and waiver shall be binding upon me and my successors.
Signature
Please select 1 or more weeks to register
Categories:All

All

Week 3: July 13- 17
prevnext( X )
Week 3: July 13- 17

Registration Deposit 3
Week 3

$150.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Farm Camp Registration

Student Information

Parent/Guardian Information

Emergency Contact Information

Medical Information

Medical Release Consent

Photo Release Consent

Liability Form

Please select 1 or more weeks to register

Payment Methods