Summer Date Nights on the Farm

Summer Date Night Program on the Farm!

A weekly Opportunity for parents to have a night for themselves
What to Expect:

Earth School Instructors Kennedy Hunt and Rachel Barrick are offering weekly meaningful childcare for your family on most Friday nights throughout June and July from 4:30 pm - 8:30 pm!

Children will get the opportunity to connect with other children over a meal, try new fruits and vegetables, partake in a group activity, and engage in wind-down techniques before settling in for a movie. Activities will vary by week, including games, crafts, learning songs, hikes around the farm, and much more.

Cost:

The cost for the first child is $35 per child per night. Additional children will be reduced to $30 per child per night. Payments can be made through this form towards the end.

Your child's spot is secured once payment is received. If fewer than 5 children are enrolled by 8pm on the Thursday before the session, all payments will be returned and the session will not be held.

How to Prepare:

Children are expected to bring a packed meal for dinner, and are welcome to bring any night-time comforts like blankets, pillows, or (minimal) stuffies. Other things you may consider packing: bug spray, change of clothes, extra snacks, weather appropriate gear. We kindly ask to refrain from bringing personal toys to avoid loss of items or distraction amongst the crew.

Eat your Colors Program:

For each session, Kennedy Hunt will be preparing a fruit or vegetable for students to promote healthy eating and encourage a diverse and whole diet. This is driven out of a desire to introduce children to new foods or familiar foods prepared in a new way and share the gift of color and variety in foods that grow from the earth. Donations are appreciated but not expected/required. Any food preferences listed on this form will be accounted for in the preparation of the food.

Questions, Comments, Concerns, and any other Feedback:

This is not only the first time a program like this has been held on the farm, but the first time either Kennedy or Rachel are hosting one like this. If there is anything you think we should consider, please add it to the comment box at the end of this form. We want to work together with parents to create a meaningful experience for parents and children :)

Contact Information:

Kennedy Hunt: 615-618-8704

Rachel Barrick: 865-304-5108

Please let us know who will be dropping off and picking up your child for each session as they arise :)

All pick-ups will be confirmed with a photo ID. Thank you!
Child Name

First NameLast Name
Child's Birthday

MonthDayYear
Date
Child's Allergies/ Medical Conditions/ Pertinent Health Information:
Child 2 Birthday

MonthDayYear
Date
Child 2 Name (If enrolling more than 1 child; disregard if not)

First NameLast Name
Child 2's Allergies/ Medical Conditions/ Pertinent Health Information:
Child 3 Name (If enrolling more than 2 children; disregard if not)

First NameLast Name
Child 3 Birthday

MonthDayYear
Date
Child 3's Allergies/ Medical Conditions/ Pertinent Health Information:
Is there anything additional you would like us to know as relates to your child’s (or children, if more than one child enrolled) emotional/behavioral health?
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Individuals who you provide permission to pick-up your child from camp:
Please list 2-3 additional emergency contacts:
Core to the Earth School's mission is to be a place of sanctuary for children's growth and learning. Because of this, harmful behaviors of any kind (hitting, kicking, destroying other children's art and work, name calling, bullying, verbal threats, etc.) are not tolerated. If these types of behaviors occur or if children are not abiding by safety guidelines, the Earth School will make efforts to guide and mentor children in the direction of healthy, respectful behaviors. However, if these behaviors are of a flagrant nature, or continue despite efforts at careful intervention, the Earth School reserves the right to unenroll a student from any summer program. If this occurs, payment will be reimbursed for any days not attended (to determine this, the cost of the program will be divided by the number of days the program is in session).
Student Media Release and Consent
At the Earth School, we want our students’ experiences to be shared more fully with family, friends, and our community of supporters. We communicate the story and vision of the Earth School to our community of supporters for program awareness and fundraising efforts to continue providing scholarships. We highlight the activities and projects our students take part in on various outlets, such as our website, our Instagram, Facebook, and potentially in brochures, or other types of media, both to share about the Earth School and also to advocate for increased nature-connection experiences for youth.
Please note that we respect all families’ choices when it comes to media. If you have particular exclusions you would like to list, please note this below or list any exclusions. Thank you
Notes:

Submission of this form and the non-refundable program fee confirms your child's enrollment in our summer programming. We look forward to seeing you all on the farm this summer!
prevnext( X )
Date Night Program
$35 Per Child/Per Night

Additional Children: $30 Per Child/Per Night

$35.00 Quantity

Additional Children
$30 Per Child/ Per Night

$30.00 Quantity

Total

$0.00
Child(ren)'s Medical Care & Health Information
If you are enrolling more than one child, and their physician/pediatrician or preferred medical facility is different than the one listed above, please provide those details below:
Child's Physician/Pediatrician and Phone Number
Preferred Medical Facility:
Insurance Company
Insurance Policy/Group Number:
Policy Holder:
Should my child(ren), *Enter child/children's name(s)* become ill or suffer an accident of any character while he/she is in the care of Fauna Forest Farm, the directors or their employees shall make every effort to contact me immediately. In the event that Fauna Forest Farm is unable to reach me immediately, the directors and/or the designated employee(s) shall be authorized to secure and consent to such medical attention, treatment, and services for my child as may be deemed necessary by a licensed medical or healthcare professional. Any qualified person providing such required medical attention, treatment, or services may accept such consent as if given by me in person. I agree to assume responsibility for payment of all medical costs incurred.
blank
Parent/ Guardian Name:
Parent/Guardian Signature:
Liability Waiver
I fully acknowledge that participation in any and all programming and events at Fauna Forest Farm includes possible risks or hazards. I give permission for my child(ren), *Enter child/children's name(s)* to attend Fauna Forest Farm programming. I also absolve and forever release Fauna Forest Farm, it’s teachers, director, property owners, affiliates, successors and assigns, officers, employees, representatives, partners, agents and anyone claiming through them (collectively, the “Released Party”) in their individual and/or corporate capacities from any and all claim, liabilities, obligations, promises, agreements, disputes, demands, causes of action of any nature and kind, known or unknown, which I may have or claim to have against Releasee or any of the Released Parties arising out of or relating to any injury, loss or damage to person and property that may be sustained as a result of participation in Fauna Forest Farm.

I understand that my child(ren)’s participation in Fauna Forest Farm involves inherent risks of physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent paralysis and/or death, and I assume all related risks and do voluntarily permit my child to participate in Fauna Forest Farm.

I agree to indemnify the “Released Party” against any and all claims, actions, lawsuits, damages, and judgments, including attorney’s fee, arising out of or relating to my child(ren)’s participation in Fauna Forest Farm.

This Release for Participation in Fauna Forest Farm shall not be in any way construed as an admission by the “Released Party” that it has acted wrongfully with respect to me, my child or any other person, that it admits liability or responsibility at any time for any purpose, or that I have any rights whatsoever against the “Released Party”.

This Release shall be binding upon and inure to the benefit of the parties and their respective heirs, administrators, personal representatives, executors, successors and assigns. I have authority to release the Claims and have not assigned, or transferred any Claims to any other party. The provisions of the Release are severable. If any provisions are held to be invalid or unenforceable, it shall not affect the validity or enforceability or any other provision. This Release constitutes the entire agreement between the parties and supersedes any and all prior oral or written agreement between the parties concerning the subject matter of this Release. This Release may not be altered, amended or modified, except by a written document signed by both parties. The terms of the Release shall be governed by and construed in accordance with the laws of the State of Tennessee.
Parent/Guardian Signature
Signature
Should be Empty:

Summer Date Night Program on the Farm!

Student Media Release and Consent

Submission of this form and the non-refundable program fee confirms your child's enrollment in our summer programming. We look forward to seeing you all on the farm this summer!*

Child(ren)'s Medical Care & Health Information

Liability Waiver

Submission of this form and the non-refundable program fee confirms your child's enrollment in our summer programming. We look forward to seeing you all on the farm this summer!