Camp Farmstead
Fill out the form carefully for registration.
FIRST CAMPER
Name
First Name Last Name
Birthday
Month Day Year
Date
Gender
SECOND CAMPER
Name
First Name Last Name
Birthday
Month Day Year
Date
Gender
THIRD CAMPER
Name
First Name Last Name
Birthday
Month Day Year
Date
Gender
PARENTS AND GUARDIAN
Guardian #1
First Name Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Guardian #2
First Name Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code

I HAVE READ THE AGREEMENT, FULLY UNDERSTAND IT, AND GRANT PERMISSION FOR MY CHILD TO PARTICIPATE IN THE PROGRAM IDENTIFIED ABOVE.
Date
Month Day Year
Date
Signature
Clear
Should be Empty:

Camp Farmstead

FIRST CAMPER