Harvest Moon Farm Summer Camp Registration Form 🌞🌿

Harvest Moon Farm Summer Camp Registration Form 🌞🌿

Please complete one registration per child. Cost is $65 per day. Campers will need to bring a sack lunch, we will provide snacks, water & lemonade. Other details, including a packing list, will be emailed about two weeks prior to camp dates. Select your dates, fill out your contact info, agree to the waivers, and complete your payment. We look forward to playing outside with your kids this summer! Please visit our website at www.harvestmoonfarm.net with full itinerary & details!
Camper's Full Name*

First NameLast Name
Parent/Guardian Full Name*

First NameLast Name
Parent/guardian 2 Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name & Phone Number (if parents cannot be reached)
Camper's Age (as of June 1, 2026)*
Camper's Grade Entering Fall 2026*
Camper's Gender*
Camper's School*
Please list any dietary restrictions or food allergies.
Please list any medical conditions, allergies or other information that we need to know for your child to be safe.
June 12, 2026June 23, 2026June 24, 2026July 2, 2026July 10, 2026August 6, 2026August 7, 2026
Parent Signature
Parent Signature Date

MonthDayYear
Date

Camp Session Payment*

June 12, 2026

$65.00

June 23, 2026

$65.00

June 24, 2026

$65.00

July 2, 2026

$65.00

July 10, 2026

$65.00

August 6, 2026

$65.00

August 7, 2026

$65.00

Total

$0.00