Your child's name *

First Name

Last Name

Date of Birth

Must turn 3 by Sept 1

MM

DD

YYYY

Which weeks are you enrolling your child ? *

Minimum enrollment for the 3-4s program is 2 consecutive weeks.

Week 1 (June 30 - July 3 / no camp July 4)

Week 2 (July 7 - 11)

Week 3 ( July 14 - 18)

Week 4 (July 21- 25)

Week 5 ( July 28 - Aug 1 )

Week 6 ( Aug 4 - 8)

Week 7 (Aug 11- 15)

Week 8 (Aug 18 - 22)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name

First Name

Last Name

Phone

(###)

###

####

Name

First Name

Last Name

Phone

(###)

###

####

Name *

First Name

Last Name

Phone *

(###)

###

####

General Release

Please read carefully. This is an acknowledgment, waiver and release from liability. I acknowledge that participating in Farm Day ("Program") carries with it a potential for injury. I hereby assume the risks inherent in that participation by my child, or children, and by myself. I acknowledge that my statements in this waiver and release from liability are being accepted by Farm Day in consideration for allowing me and my child to participate in the Program and in any events or activities related thereto. I hereby take the following actions for myself, my executors, administrators, heirs, next of kin, successors, assigns, and anyone else who might claim or sue on my behalf, and I expressly acknowledge that it is my intent to take these actions: 1. I waive, release, and discharge from any and all claims losses, or liabilities for death, personal injury, partial or permanent disability, property damage, medical or hospital bills, accidents, theft or damage of any kind, including economic losses, which may arise out of or relate to my or my child or children participating in the Program, anyone associated with Farm Day and its respective heirs, executors, administrators, legal representatives, successors, and assigns, including employees, directors and trustees, from liabilities that are caused by the negligent act or omissions of the persons I am hereby releasing or are caused by the negligent acts of the persons I am hereby releasing or are caused by the negligent acts or omissions of any other person or entity. 2. I acknowledge that there may be risks associated with participation in The Program and I hereby assume those risks. All such risks being known and appreciated by me, I further acknowledge that these risks include risks that may be the result of the negligence of Farm Day or of its employees, directors, trustees, agents or associates. 3. I indemnify and hold harmless Farm Day from any and all claims made or liabilities assessed against them as a result of a. my actions or inactions, and b. the actions, inactions, or negligence of others including those parties hereby indemnified. I hereby affirm that I am eighteen (18) years or old or older, I have read this document, and I understand its contents. *

I have read and consent to the terms above.

Additional Terms and Conditions

It is hereby understood and agreed that Farm Day has the right to suspend or terminate the enrollment of any camper at any time for any reason and at its sole discretion. It is further understood and agreed that Farm Day may at any time, at its sole discretion, suspend, cancel or amend any Farm Day summer camp enrollment contract subject only outstanding balance for camp days paid for but not enjoyed. I agree that my child has permission to take part in any and all activities. I agree to complete and promptly return to Farm Day any additional permission slips, releases and/or medical forms regarding my enrolled camper. Further, I understand that the Camper Medical Information and Authorization is due by JUNE 1, regardless of the camper's start date. I agree that Farm Day may use the camper's portrait, likeness, artwork, written work, or electronic media that he or she develops in connection with Farm Day activities or in publicizing Farm Day, and that, except as prohibited by law, Farm Day may use my camper's information and records at its sole discretion. All programs are contingent on minimum enrollment. The viability of any given week will be determined by the Program Director, with 2 weeks notice given if any changes are to be made to the program. If enrollment is cancelled before May 1, tuition will be refunded in full, less a $250 administrative fee. There are no refunds if enrollment is cancelled after May 1 or if your child is withdrawn, expelled, suspended or does not attend Farm Day for any reason. This program is exclusively outdoors, rain or shine. In the case of extremely inclement weather, camp will be cancelled for the day. Parents will be notified by email if camp needs to be cancelled for the day due to weather. Credits for the following summer will be offered for cancelled days; there will be no refunds for days cancelled due to weather.

I have read and consent to the above terms.