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2021 Summer Farm Camp Registration Form
Thank you for your interest in Coastal Roots Farm's Summer Farm Camp! Fill out the form below to register. Please note, space is limited and is filled on a first come, first serve basis. 


* indicates required fields





















Camp Participant Information






Preferred pronouns refer to the set of pronouns that an individual prefers that others use in order to reflect that person's gender identity.









Check this box each time if you are filling out multiple registrations for Farm Camp.















Camper's Background Information 





















Emergency Contact #1 (additional parent/legal guardian if applicable)


















Coastal Roots Farm – Spring Camp

Terms, Conditions and Release of Liability Waiver




I attest that I am the Parent or Legal Guardian of the Child named in this Waiver and Release, and that I have the authority to execute this Waiver and Release on behalf of the Minor.  In consideration for participating in Coastal Roots Farm’s 2021 Farm Camps (“Program” – includes Spring, Summer, Fall, Winter, and After-School Farm Camps for the 2021 calendar year), both Child and Parent/Legal Guardian hereby freely and voluntarily, without duress, execute this Release.   
Please click on the checkboxes, make a choice, or initial at the bottom of each section:

DEFINITIONS 


Initials

ACKNOWLEDGMENT AND ASSUMPTION OF RISKS


Initials

RELEASE AND INDEMNIFICATION


Initials

FACILITY RULES AND BEHAVIOR GUIDELINES AND AGREEMENTS


Initials

FOOD RELEASE


PHOTO RELEASE


COVID-19 SAFETY AND PROTOCOLS 



Initials

CONSENT TO MEDICAL TREATMENT 


Only fill this out if you DO NOT WANT medical treatment for your child:
By typing my name, I acknowledge that I DO NOT want any type of medical treatment provided to my child.



MEDICAL EXPENSES


Initials
By typing my name, I acknowledge that I have read and understood the terms and conditions of sending my Child(ren) to Coastal Roots Farms After-School Camp.



PAYMENT

$
.00


Payment Information

$
This price includes a 2.5% discount because you are registering siblings for camp.