Participant's Name *
Participant's Name
Parent or Legal Guardian *
Parent or Legal Guardian
Parent/Guardian Phone *
Parent/Guardian Phone
Address *
Address
Emergency Contact 1 *
Emergency Contact 1
Emergency Contact 1 Phone *
Emergency Contact 1 Phone
Emergency Contact 2 *
Emergency Contact 2
Emergency Contact 2 Phone *
Emergency Contact 2 Phone
Select Camp Dates *
Please specify any health concerns, allergies, physical activity restrictions, or other information you want the director or counselors to be aware of on behalf of your child's welfare. Also indicate if your child requires any special dietary needs and current prescribed medications:
Medical Release *
TFF's primary medication policy is to administer only lifesaving medicines such as epi-pens and rescue inhalers. I understand I must provide an Authorization to Administer Medication form, properly filled out and signed by both my child's pediatrician and authorized parent/guardians. I understand that all medication must be in the original containers labels with the child's name, name of the medication, direction for the administration and date of the prescription. If this policy is not properly followed, I understand that the medication cannot be in the custody of Terra Firma Farm staff, and, if necessary, the child will be sent home. No special refunds or credits will be given for any camp missed for this reason. Terra Firma Farm cannot be responsible for any lifesaving medication that should have been provided for a child and wasn't. I understand that any requests to accommodate exceptions to this policy must be brought to the attention of the camp director. Any medication provided for a camper will be kept at camp for the duration of the camp week. I understand that it is my responsibility to ask for the return of any unused medication, and that all unused medication shall be destroyed if not picked up within one week folllowing the camper's departure.
Safety *
I understand that a farm and nature is unpredictable and holds a large amount of risk that could lead to serious injury or even death I agree to indemnify and hold harmless Terra Firma Farm and staff for any and all claims connected with participation in any activity that is any way connected with camp.
Cancellation Policy *
Cancellations must be received in writing at least FOUR (4) weeks prior to your child’s first week of camp. A refund will be issued minus a $65 administrative fee. Cancellations received within less than four weeks notice will not receive a refund The administrative fee is non-refundable and non-transferable. If you’d rather transfer to a different week, you can do so by submitting a transfer request, which must be received 72 hours prior to your child’s first week of camp. Transfer fee is $15.
Discipline *
At any time during camp, I understand that the Camp Director has the right to expel any child who in the Camp Director's sole judgement is disruptive, disrespectful or jeopardizes his or her own safety, other campers' safety or staff safety. The Camp Director has the right to expel any child whose parents or guardians, in the Camp Director's sole judgement, make unreasonable demands upon the camp. No refunds or credits will be given for a child expelled from camp.
Emergency Authorization
Should my child be taken to the hospital for emergency purposes I hereby grant permission to the attending physician and staff to administer anesthesia, medical, x-ray and surgical procedures as may be deemed necessary or advisable. I understand that an attempt will be made to contact me in an emergency. However, in the event that I cannot be reached, I hereby give Terra Firma Farm Staff full permission to authorize any emergency medical treatment necessary.
Photography Release *
I grant permission for Terra Firma Farm to photograph my child and use the images for educational and promotional purposes to assist the organization in informing its members, the press and general public about its work. I give this permission without fee or limitation.