Traditional Camp (ages 4-11 years) Check the date(s) you wish to attend.

All days are 9:30am to 2:30pm

Fri., March 30___ Mon.,  April 2___ Tues., April 3___ Wed., April 4___ Thurs., April 5___ Fri., April 6___ 

 

Youth Camp (ages 12-15 years) - Wed., April 4___

Please print clearly:

Child's name (nickname?)_________________________________________________________________________________

 

Name of parent(s) or guardian(s)____________________________________________________________________________

Address:_______________________________________________________________________________________________

                       (# and Street)                                                                           (City, State)                          (Zip)

Home Phone __________________________________    Work phone _____________________________________________

 

Cell Phone ____________________________________     Email__________________________________________________

Child’s grade: _____________             Child’s age: _____________           Child’s date of birth: ____________________

In case of emergency we call the above phone numbers OR: (please list an alternate)

 

 Name:_________________________________________________________     Phone:________________________________

Physician's Name:_________________________________________________    Phone:_________________________________ 

Does the child have allergies, special needs, or other restrictions?        Yes         No

If “yes”, what are they?_____________________________________________________________________________________

(If needed, please use the back of this registration form to describe the restrictions.)

Child's 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 camp days due to insufficient registration or extreme weather conditions (with full refund).  A confirmation will be sent to acknowledge your registration.

Camp fee is $50 per day.  Please send check/money order (sorry no charge cards) along with this form to:

Sunrock Farm, 103 Gibson Lane, Wilder, KY  41076       Phone: 859-781-5502   Fax:  859-572-0260

Refund Policy:  There will be a $20 per camper non-refundable processing fee charged for cancellations. The balance of the fee is refundable ONLY in the case of serious illness or accident (with a physician’s statement), or death in the immediate family.

 

"I give my child permission to attend spring break camp.  I agree not to send my child to 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 my be taken during the course of spring camp and used in advertising Sunrock Farm".

Signature of parent/guardian________________________________________________  Date_________________

Comments/special requests_______________________________________________________________________

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For office use only:  Date registration form received at Sunrock____________ 

Check amount__________________________  Check number and date____________________________