Kids Summer Camp Sign-Up Form
Please fill out the information below to register for the Cinder Ridge summer camp.
Camper's Full Name
*
First Name
Last Name
Camper's Date of Birth
*
-
Month
-
Day
Year
Date
Grade for 2026-2027 school year:
Please Select
Kinder
First
Second
Third
Fourth
Fifth
Please select t-shirt size for the camper:
Please Select
X-Small
Small
Medium
Large
X-Large
Camp includes a T-shirt for every camper!
If you are signing up more than one camper, please list NAME, BIRTH DATE, GRADE, and T-SHIRT size below:
Ex: Madison Parks, 10.3.2015, Fourth, Small
Parent/Guardian Information
The parents/guardians listed below will be the primary emergency contact person and authorized pickup person for the camper.
Parent/Guardian Full Name:
*
First Name
Last Name
Relation:
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Full Name:
*
First Name
Last Name
Relation:
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Additional Authorized Pickup Persons
If the parents/ guardians are not the only adults allowed to pick up the child from camp, please list other adults you give permission to pick your child up.
Full Name:
*
First Name
Last Name
Relation:
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
MEDICAL INFORMATION
Allergies- Please list any allergies including food allergies:
*
Does the child have any current medical conditions? If yes, please list them below:
*
Does the child require any specific medication (i.e. insulin or seizure medication)? If yes, please list them below:
*
Any required medication should be accompanied by a physicians note and specific instructions in a seperate bag labeled with the child's name and given directly to camp staff each day at drop off.
Authorization
I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, and treatment which may deem necessary.
I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
I confirm that all information given in this form is true, complete, and accurate.
I understand that a waiver must be completed for the dates of this summer camp.
I understand that if dates are missed, they are forfeited. They will not be allowed to be made up on other weeks.
I understand that this is a fully working farm and children should come dressed appropriately. Clothes/shoes may get dirty!
Campers should come dressed in hats, sunscreen, and comfortable close-toed shoes. (Slide-on boots, old tennis shoes, or crocs work best. No sandals!)
I understand that I must pack a lunch and refillable water bottle daily for my child.
I understand that the drop-off time is no earlier than 8:45am.
I understand that the pickup time is at 1:00pm.
Failure to pick up the child by 1:15 p.m. will result in a $20 fee per every 30 minutes late.
I understand that if my child's behavior becomes a hindrance to the learning and safety of themselves or others, they will need to be picked up from camp and will not be allowed to return. No refund will be given.
I understand that my child will go out into the fields on the farm to view and harvest produce and learn how the plants are grown.
It is suggested that campers bring a small bag/backpack with their name on it with extra sunscreen and a change of clothes in case of accidents or spills.
In the event that one of the days is canceled due to rain, the camp day will be made up on Friday of that same week. Campers will be notified via email.
Parent/Guardian Signature
*
Please choose which week your child will attend camp:
*
July 27th-30th
Payment:
*
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Campers
* $30 discount per additional campers
$130.00
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130.00
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Credit Card
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