Sunrock Farm
Summer Day Camp Registration 2012
Phone: 859-781-5502 Email: email@sunrockfarm.org 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: 9:30-2:30
Session
1: June 11-15___ Session
1: June 11-15____ Session 1:
June 11-13 ____ June 18-22___
Session 2: June 18-22 ____ Session 5: July 16-20____ Session
2: June 18-20____ July 9-13____
Session 3: June 25-June 29____ Session 3: June 25-27____ July 30-Aug. 3___
Session 4: July 9-13 ___
Session 4: July 9-11 ____
Session 5: July 16-20 ___
Parent/camper Day: 9:30-2:30
Session 6: July 23-27 ___ Fri. July 6 ___
Session 7: July 30-August 3___ Fri. August 10___
*Pre-K camp ONLY. ___ My child will participate in Pre-K added
hour program. ($15.00 extra per day)
(PLEASE PRINT CLEARLY)
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: ___________________________________________
Phone:(
)_________________________
Does the child have
allergies, special needs, or any restrictions? ____ Yes ____
No
If ŇyesÓ: What are these
______________________________________________________________________________
(Please
use the back of this paper to describe the restrictions.)
ChildŐs current
medications/reasons_______________________________________________________________________
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:
_____________________________________________________________________________
New to the farm? How did you hear about
us?_____________________________________________________________________
Check us out online! Website:
www.sunrockfarm.org www.facebook.com/sunrockfarm