Kids' Camp Registration Form

To sign up for our Kids' Camp, simply print and mail the form below.

Camper Information:

Name: ____________________________________________________________________

Age:  ______________________   Male or Female

School attended this year:  ____________________________________________________

Grade completed this year: ____________________________________________________

Special interests, hobbies, passions: 

___________________________________________________________________________

___________________________________________________________________________

Please list any identified special needs your child has: (ADHD, allergies, behavioral disorders, physical limitations, etc... This information helps us to ensure your child's safety):

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Parent Information:

Name:  _____________________________________________________________________

Address:  ___________________________________________________________________

Phone(s) :  __________________________________________________________________

E-mail:  ____________________________________________________________________

Emergency name & number :  _________________________________________________

I, ________________________________ give permission for Cure Organic Farm Kids' Camp to be responsible for my child, __________________________ during the agreed upon times listed below on this registration form.  By signing this form I understand that if I am more than 5 minutes late picking my child up, I will be charged a $10 fee.

Parent signature: _____________________________________________________________

Date: _____________________________