Summer Camp Student Registration
Please complete the following sections to register your student.
Parent Information
Parent Name:
*
Parent First Name
Parent Last Name
Parent Email
*
example@example.com
Parent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Select your childs camp from the options below:
Week 1: June 22-26 (Little Gardeners) $350
*
Week 2: June 29-July 3 (Farm Friends) $350
*
Week 3: July 6-10 (Makers Market) $350
*
Week 4: July 13-17 (Little Gardeners) $350
*
Week 5: July 20-24 (Farm Friends) $350
*
Student Information
Student Name
*
Student First Name
Student Last Name
Student Birthday
*
-
Month
-
Day
Year
Date
Student's Incoming Grade
*
Kindergarten
1st
2nd
3rd
4th
5th
Does the student have an SST or IEP?
SST
IEP
None
Additional Information about SST or IEP
Select add-ons
Early Drop-Off ($75/week)
Please Select
No thanks
Yes, Monday-Friday (7:30 AM – 8:30 AM)
Drop off your Camper anytime between 7am and 8am.
Extended Pick-Up ($75/Week)
Please Select
No thanks
Yes, Extended Pick-Up (3:00 PM – 4:00 PM)
Pickup your Camper anytime between 3pm and 4pm
Early Drop-Off + Extended Pick-Up (All Week) - $135
Please Select
No thanks
Yes
Combine the two for savings!
Photo/Media Permission
*
I DO give permission for photo/media use
I DO NOT give permission for photo/media use
Parent/Guardian Signature
*
Emergency Contact Information
Please provide details for someone we can contact in case of emergency.
Full Name of Emergency Contact
*
First Name
Last Name
Relationship to Student
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Emergency Contact Name
First Name
Last Name
Alternate Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pick Up
Please provide the contact details of the person authorized to pick up the student.
Authorized Pick Up Person Full Name
*
First Name
Last Name
Authorized Pick Up Person Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Student
*
Authorized Pick Up Person Full Name (2)
First Name
Last Name
Authorized Pick Up Person Phone Number (2)
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Student (2)
Authorized Pick Up Person Full Name (3)
First Name
Last Name
Authorized Pick Up Person Phone Number (3)
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Student (3)
Medical Information
Please provide relevant medical details for the student.
Does the student have any allergies or medical conditions we should be aware of?
*
No
Yes (please specify)
If yes, please specify allergies or medical conditions:
Is the student currently taking any medication?
*
No
Yes (please specify)
If yes, please list current medications:
Medical Emergency Information
In the event of a medical emergency. Lilac Farms is not responsible for any medical expenses incurred. Parents/guardians will be notified immediately and are responsible for all related medical bills.
Sponsor's Full Name
*
First Name
Last Name
Insurance Carrier Name
*
Policy Number
*
I acknowledge that Lilac Farms is not repsonsible for any medical expenses and I give permission for emergency medical treatment if necessary.
*
Sun Protection & Sunscreen Consent
Lilac Farms Camp is an outdoor-based camp held on private property. Campers spend significant time outside participating in games, nature exploration, crafts, animal interactions, and hands-on learning activities. To help protect campers from sun exposure: Parents/guardians are required to apply sunscreen to their child before arrival each day. Campers should be taught how to apply sunscreen to themselves whenever possible. Each camper must bring clearly labeled sunscreen from home. Camp staff will provide reminders and supervision for reapplication as needed, especially during extended outdoor activities.
Sunscreen Application Consent
*
I GIVE permission for Lilac Farms Camp staff to remind and/or assist my child with sunscreen application
I DO NOT GIVE permission for Lilac Farms Camp staff to assist with sunscreen application
Food & Beverage Authorization
Lilac Farms Summer Camp may provide water and occasional snacks to campers. Campers may also participate in supervised food and drink preparation activities as part of hands-on farm and educational experiences. By signing below, I give permission for my child to consume snacks and beverages provided at camp and to participate in food and drink preparation activities. I understand that food items may contain common allergens and that Lilac Farms cannot guarantee an allergen-free environment. I agree to notify Lilac Farms in writing of any food allergies, dietary restrictions, or medical conditions prior to participation. I understand that while water and occasional snacks may be provided, it remains my responsibility to send a daily lunch, water bottle, and additional snacks as outlined in the Required Daily Items section.
Food & Beverage Participation Consent
*
I GIVE permission for my child to consume snacks and beverages provided at camp and to participate in food and drink preparation activities
I DO NOT GIVE permission for my child to consume snacks and beverages provided at camp
I DO NOT GIVE permission for my child to participate in food and drink preparation activities
Signature of Parent/Guardian
*
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*
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