Camper name

Birthday

Month

Day

Year

Multi-line address

Country/Region

Address

City

Zip / Postal code

Camper age at start of camp

Parent/Guardian 1 Name

Parent/Guardian 1 Email

Parent/Guardian 1 Phone

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Emergency Contact Name (to be contacted after Parent/Guardians unless otherwise specified)

Emergency Contact Phone

Please indicate order of who to call in case of emergency.

Authorized Pickup 1

Authorized Pickup 1 Phone

Authorized Pickup 2

Authorized Pickup 2 Phone

Authorized Pickup 3

Authorized Pickup 3 Phone

Child Health/Medical Information

Please note that Immunization Records and Physical Exam Report from your child’s doctor must be received in order to have your registration considered complete.

Please email forms to thenestatgreigfarm@gmail.com.

Doctor Name

Doctor Phone

Doctor Address

Does your child have any physical, developmental, or learning challenges that might make some activities difficult? If so, please explain:

Does your child have any allergies (food, environmental, medicines)? If so, please list them and include allergic symptoms for each:

Are there any limitations or restrictions for your child to participate in Farm Camp?

Please include any other medical information that would be important for us to know.

Sunscreen and Repellent: Please apply sunscreen and bug repellent on your child before drop-off in the morning. If you would like us to apply sunscreen and/or bug repellent (that you supply) again at lunchtime, please check the appropriate box below.

Please ASSIST my child with reapplying sunscreen and/or bug repellent at lunch time.

NONE - I do not need my child to reapply sunscreen or bug repellent at lunch time.

General Questions

What else would you like us to know about your child?

The camp facilities do not allow us to accommodate children that are in diapers. Please confirm your child is toilet trained.

Yes, my child is toilet trained.

Other

Camp Selection

Please indicate which weeks you would like to enroll for. Tuition is $625 per week if paid by check or Zelle or $644 per week if paid by credit card. Payment options can be selected at checkout.

Registration and Materials Fee

$75

Payment & Cancellation Policy

At Enrollment: Full payment of all camp fees is due at the time of registration to secure your camper’s spot.
Cancellations before March 15: If you cancel your registration on or before March 15, you will receive a 50% refund of the total camp fees.
Cancellations after March 15: Starting March 16, all payments are strictly non-refundable. No refunds or credits will be issued for missed days, late arrivals, or voluntary withdrawals..
Medical Exception: Exceptions are made only for major medical events (e.g., hospitalization, broken bones). This requires a Physician’s Statement certifying the child is medically unfit to participate.
Note: We do not offer refunds for minor illnesses, individual missed days, or withdrawals after the session begins.

I acknowledge and agree to the Payment & Refund Policy.

Signature

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