Clone of Summer Camp Detailed Registration Form

Growing Together at Pascuales' Farm

A Day Camp for Elementary Explorers

Join us for a full day on the land! Campers will explore soil, water, plants, and animals, and discover how they all work together on a real working farm. Through guided farm walks, hands-on chores, soil and water investigations, nature art, and a take-home planting project, kids will connect with nature through their senses — and take a piece of the farm home with them.

When:November 2 & 3, 2026, 9:00am–3:00pm — choose one day or both!"

Who: Elementary school students grades: (K–5)

Where: Pascuales' Farm, 11237 Plaza Rd Ext, Charlotte, NC

Cost: $65 per camper, per day

Bring: Lunch, water, and a snack

Spaces are limited to 20 campers per day — register now to save your child's spot!

This camp is a collaboration between Rooted by Cia and Pascuales' Farm, bringing together land-based education and the joy of real farm life.

Pricing Descriptions

1. Single Day Camper

Price: $65

Description: Full day of farm exploration for one camper — choose Nov 2 or Nov 3. Includes farm chores, soil & water discovery, nature art, and a take-home planting project. Grades K–5. Bring lunch, water, and a snack.

2. Both Days (Nov 2 & 3) — Save $10

Price: $120

Description: One camper, both days of "Growing Together at Pascuales' Farm." A full two-day farm adventure at a savings over booking each day separately. Ages K–5. Bring lunch, water, and a nut-free snack each day.

3. Sibling Ticket — Single Day

Price: $55

Description: For an additional camper from the same family attending one day. Please purchase alongside a Single Day or Both Days ticket for your first camper. Same activities, same magic, sibling savings.

4. Sibling Ticket — Both Days

Price: $110

Description: For an additional camper from the same family attending both Nov 2 and Nov 3. Please purchase alongside a Both Days ticket for your first camper.

Camp Day

Camper Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Camper Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Allergies (food, insect bites, medication, etc.):

Physician's Name:

Physician's Phone:

Health Insurance Provider:

Health, Safety & Accommodation Disclosure

Growing Together at Pascuales' Farm is an outdoor, activity-based day camp involving direct contact with farm animals, natural terrain, gardening tools, and physical movement throughout the day. Camp staff provide general group supervision consistent with a standard day camp ratio; we are not able to provide one-on-one aides or medical care.

By registering, parents/guardians confirm that their camper is able to safely participate in farm-based group activities with this level of supervision, and agree to disclose in advance any allergies (beyond nuts), medical conditions, physical limitations, or behavioral/sensory considerations that camp staff should be aware of.

We're committed to working with families to make the day work well for their child wherever we reasonably can — please contact us directly before registering if you'd like to discuss your camper's specific needs.

Pick-Up Authorization:Please list all persons authorized to pick up your child:

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Pascuales' Farm during the selected camp day. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Pascuales' Farm, Rooted by Cia and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Pascuales Farm and Rooted by Cia including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all day camp activities.

Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Pascuales' Farm. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Media Release: I give / do not give (circle one) permission for Pascuales Farm and Rooted by Cia to use photographs or videos of my child for promotional and educational purposes.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Signature

To Complete Payment https://www.pascualesfarm.com/store/

My Products

Single Day Camper Description: Full day of farm exploration for one camper — choose Nov 2 or Nov 3. Includes farm chores, soil & water discovery, nature art, and a take-home planting project. Grades K–5. Bring lunch, water, and a snack.

$65.00

Both Days (Nov 2 & 3) — Save $10 Description: One camper, both days of "Growing Together at Pascuales' Farm." A full two-day farm adventure at a savings over booking each day separately. Ages K–5. Bring lunch, water, and a nut-free snack each day.

$120.00

Sibling Ticket — Single Day Description: For an additional camper from the same family attending one day. Please purchase alongside a Single Day or Both Days ticket for your first camper. Same activities, same magic, sibling savings.

$55.00 Quantity

Sibling Ticket — Both Days Description: For an additional camper from the same family attending both Nov 2 and Nov 3. Please purchase alongside a Both Days ticket for your first camper.

$110.00 Quantity

Total

Credit Card

Day Camp Registration

Camper Information:

My Products

Credit Card