2019 Camp Registration

PHILLIES BRIDGE FARM PROJECT

2019 SUMMER CAMP REGISTRATION

If you have questions about our Summer Camp, please check our general information and FAQ pages.

CAMPER INFORMATION

Please select the number of campers you are registering.

#*

Are you a CSA shareholder?*

YesNo

*CSA Shareholders receive a $25 discount per family per camp season. Click here to sign up for a CSA share or to learn more.

Camper #1

Child 1's First Name*

Child 1's Last Name*

Child 1's Age*

Child 1's Grade (fall 2019)*

Identifies as (gender)*

Please provide any information that will help us make camp an enjoyable and safe experience for your child in the spaces below. The Camp Director will contact you for additional information, if necessary.

Child 1's Special Needs

Child 1's Dietary Restrictions

Child 1's Allergies*

YesNo

If yes, Child 1's Allergies Details

If your child will need to take medication while at camp, please describe below.

Child 1's Medication

Describe

Please note: Medications will be self-administered under supervision of camp staff. Medication will only be dispensed if it is stored in its original container and labelled as follows:Prescription Medications: full name of child, date prescription filled, expiration date, directions for use (including dosage and time of treatment), instructions for storage, precautions, name and address of dispensing pharmacy, name of physician prescribing medication.Non-prescription Medications: full name of child, directions for use (including dosage and time of treatment), instructions for storage, precautions, authorization from parent/guardian or physician.

Children are divided into groups by age. We do our best to accommodate group placement requests for children of similar ages. Please indicate if there is a particular friend you would like to have in your child"s group. If registering siblings who are close in age, please note whether you would prefer that they be placed in the same group or in different groups.

Child 1's Friend Request

Your first child must be be 4-12 years old to participate in our summer camp. Campers must turn 4 before January 1st 2019 to attend summer sessions.

D.O.B. Child 1*

Please choose from the following sessions:

Session 3 - week SIX - August 5 - 9 $350

Camper #2

Child 2's First Name*

Child 2's Last Name*

Child 2's Age*

Child 2's Grade (fall 2019)*

Identifies as (gender)*

Child 2's Special Needs

Child 2's Dietary Restrictions

Child 2's Allergies*

YesNo

If yes, Child 2's Allergies Details

If your child will need to take medication while at camp, please describe below.

Child 2's Medication

Describe

Please note: Medications will be self-administered under supervision of camp staff. Medication will only be dispensed if it is stored in its original container and labelled as follows:Prescription Medications: full name of child, date prescription filled, expiration date, directions for use (including dosage and time of treatment), instructions for storage, precautions, name and address of dispensing pharmacy, name of physician prescribing medication.Non-prescription Medications: full name of child, directions for use (including dosage and time of treatment), instructions for storage, precautions, authorization from parent/guardian or physician.

Child 2's Friend Request

Your second child must be be 4-12 years old to participate in our summer camp. Campers must turn 4 before January 1st 2019 to attend summer sessions.

D.O.B. Child 2*

Please choose from the following sessions:

Session 3 - week SIX - August 5 - 9 $350

PARENT/GUARDIAN INFORMATION

Parent/Guardian #1

Parent 1's First Name*

Parent 1's Last Name*

Phone 1*

E-Mail 1*

Parent/Guardian #2

Parent 2's First Name

Parent 2's Last Name

Phone 2

E-Mail 2

CONTACT INFORMATION

Mailing Address*

City*

State*

ZIP*

EMERGENCY CONTACTS

Please provide names and phone numbers for two different emergency contacts other than the child(ren)"s parent(s)/guardian(s).

Emergency Contact Name 1*

Emergency Contact Phone 1*

Emergency Contact Name 2*

Emergency Contact Phone 2*

Additional people authorized to pick up camper(s) (aside from parents/guardians or emergency contacts), if applicable:

Authorized Pick-up Name 1

Authorized Pick-up Phone 1

Authorized Pick-up Name 2

Authorized Pick-up Phone 2

DISCOUNTS & DONATIONS

DISCOUNTS
Sibling Discount: $25

CSA Shareholder Discount: Families who are shareholders for the 2018 growing season receive $25 off their total registration fee.

If you would like to apply to receive a scholarship please contact us at info@philliesbridge.org prior to registration.

DONATIONS
If you would like to make a donation to our Camp Scholarship Fund today, please indicate the amount below. Thank you!

Donation $

OTHER INFORMATION

Please tell us how you found out about the Farm Camp - please check ONE. Thank you!

Camper Contact List: We will send out an e-mail with the contact information of registered campers to help families facilitate carpooling and friendships.

Do you wish for your contact information to be shared? Please check below:

YesNo

Photo Release: We will occasionally take photographs of camp programs for use in promotional materials, both in print and online. Children in our photographs are never identified by name. Do you give permission for your child to be photographed? Please check below:

YesNo

Consent to Treat/Release: I hereby authorize my child(ren) to participate in Phillies Bridge Farm Project summer camp. My child(ren) is/are physically able to participate in outdoor activities. I hereby release the Phillies Bridge Farm Project, and their employees and volunteers, from any claims, damage, or expense sustained by my child(ren) in connection with such participation. In case of medical emergency, I give the camp health director or designee the authority to obtain the emergency medical treatment for my child(ren) in case the parent/guardian or parent/guardian"s representative cannot be reached. I understand that because this program takes place on a farm there is a risk of tetanus, and that Phillies Bridge Farm Project, Inc. recommends that I check with my physician to make sure my child(ren)"s tetanus shots are up to date.[Please indicate your consent by checking the box below.]

Consent*

true

Refund and Cancellation Policy: Full payment or a $150 non-refundable deposit PER CHILD is required to hold a spot for your child(ren). The balance of the camp tuition is due by June 1st, 2019. Refunds are available (less a $150 non-refundable fee per child) for registration cancellations up to 30 days before the first day of your child's camp session. For cancellation with less than 30 days notice, no refund or credit will be provided. We have established this refund policy in order to ensure that we can cover the costs of our programs, fill all available camper slots, and hire the appropriate number of staff based on the number of program participants. Please indicate your agreement to these terms by checking the box below.

I Agree*

true

Payment Method: Due to high processing fees we prefer to receive payment by check, but we can also accept payment by credit or debit card (Visa, MasterCard, or Discover only) or through PayPal. Please check your method of payment below.

If you wish to send the $150 non-refundable, non-transferable deposit per child only rather than paying in full, please choose "check" and mail it in. The balance of your payment will be due by June 1st, 2019. Thank you!

A $35 registration fee is included in your total.

You MUST pay in full as we are passed June 1st.

Thank you!

Total:

Method*

Payment

USDThank You!

Please click on "Proceed to Checkout" below to pay by credit/debit card or through a PayPal account to complete your registration. You will be redirected to PayPal to complete the transaction. (A PayPal account is not required to pay by credit or debit card.)