Sunrock Farm Camp
Registration- Summer
2010
Phone:
859-781-5502
Fax: 859-572-0260 Address: 103 Gibson Lane, Wilder, KY 41076
Check the appropriate session(s)
Traditional Camp:
9:30-2:30 Extended Traditional 8:30-5:30
Pre-K Camp: 9:30-1:30
Youth Camp: 9:30-2:30
Session 1: June 13-17___ Session 1: June 13-17____ Session
1: June 13-15____ June 20-24 ____
Session 2: June 20-24 ____ Session 5: July 20-24____ Session 2: June 20-22____ July 11-15____
Session 3: June 27-July 1___
Session 3: June 27-29____ July 25-29____
Session 4: July 11-15 ___ Session 4: July 11-13_____
Session 5: July 18-22 ___
Session 6: July 25-29___
Session 7: August 1-5 ___
Parent/camper day: July 8 ___
**Pre-K camp ONLY.____ My child will
participate in Pre-K added hour program.. ($15.00 extra per day)
(PLEASE PRINT)
ChildŐs name (include
nickname):__________________________________________________________________________________________________________
Name of parent(s) or
guardian(s): _______________________________________________________________________________________________________
Address: __________________________________________________________________________________________________________________________
(Street #)
(City,
State) (Zip)
Home Phone: ( )___________________________________________________
Work phone: (
)____________________________________________
Cell Phone: ( )_____________________________________________________
EMAIL:
_____________________________________________________
ChildŐs last grade
completed _____________________ ChildŐs age on 1st day of camp session __________________ ChildŐs date
of birth: ______________________
In case of emergency, we
will call the above phone numbers then: (please list an alternate:)
Name: __________________________________________________________________________ Phone: ( )________________________________________
Family Physician:
Name:
_______________________________________________________________ Phone: ( )________________________________________
Does the child have
allergies, special needs, or any other restrictions? ____ Yes ____
No
If ŇyesÓ: What are these
____________________________________________________________________________________________________________________
(If
needed, please use other sheets of paper to describe the restrictions.)
Sunrock Farm reserves the right (1) to refuse registration for health reasons. For example, the farm environment may not be good for children with
severe hay allergies; (2) to cancel (with pro-rated refund) a camper's attendance for health or disciplinary reasons.
Make checks payable to Sunrock
Farm, 103 Gibson Lane, Wilder, KY 41076. Sorry, no credit cards accepted.
You will receive a confirmation packet, via Email or regular post, with information within two weeks of sending the registration.
If a refund is necessary, a $40/camper
processing fee will be charged. The balance of the fee is refundable ONLY in
the case of
serious
illness or accident (with a physicianŐs statement), death in the immediate
family, moving out of the area, or if the child is required to
attend
summer school. Appropriate documentation is required. If a session
enrollment is low, the session will be cancelled and fees returned.
ŇI agree not to send
my child to summer day camp unless she/he is in good physical condition and has
not been exposed
to a
communicable disease. My child has permission to receive emergency medical
care. I understand that photos of camp activities
may be taken during the course of the summer and
used in farm advertising and publications."
Signature of parent/guardian ______________________________________________ Date:_______________
Comments & special requests:
____________________________________________________________________________________________