Farm Camp 2.0 Registration

Farm Camp 2.0 Registration
Welcome to Farm Camp 2.0!

We are excited to offer this unqiue learning experience for your child.

Farm Camp 2.0 focuses on STEM - Science, Technology, Engineering and Math. Agriculture is immersed in these four disciplines. Think about your daily routine and you will quickly realize agriculture's importance. From the food we eat, to the clothes we wear, and to the fuel in our vehicles. Agriculture is everywhere!

Agriculture falls hand-in-hand with STEM learning. Whether it is the science behind the seeds planted and the soil they are planted in, engineering and technology used to move commodities around the country and the world, or the mathematical concepts needed to develop these technologies, it is clear that agriculture is heavily reliant on STEM.

CAMP DETAILS:
- Camps are Monday through Thursday
- Camp hours are 9am to 12pm
- Camps are limited to 20 kids
- Camp is for kids ages 10-12 years old
CAMP DATES & LOCATIONS:
- Morrison, Farm Bureau building: June 22-25
- Prophetstown, High School: July 6-9
- Erie, High School: July 13-16
- Rock Falls, Community Building: July 27-30
- Sterling, High School: August 3-6
REGISTRATION:
- The registration fee is $20 per child. Fee must be paid prior to the start of each camp to reserve a spot.
- Registration for all camps is taken on a first come, first serve basis.
- An online payment option is available at the end of this registration form. Payment can also be sent to the Farm Bureau office.
QUESTIONS?

Contact Matt Lillpop with Farm Bureau: (815) 441-8572 (call/text) | matt.wcfb@gmail.com

Child #2: Name

First NameLast Name
Child #2: Date of Birth

MonthDayYear
Date
Child #2: Gender
Child #2: Describe any food allergies or concerns, if any.
Child #2: Describe any chronic illnesses or medical conditions, if any.
Child #2: Any need to take prescribed medications during camp? Does the child carry an inhaler or other medical device? If so, describe and provide instructions.
I am registering another child:

Child #3: Name

First NameLast Name
Child #3: Date of Birth

MonthDayYear
Date
Child #3: Gender
Child #3: Describe any food allergies or concerns, if any.
Child #3: Describe any chronic illnesses or medical conditions, if any.
Child #3: Any need to take prescribed medications during camp? Does the child carry an inhaler or other medical device? If so, describe and provide instructions.
I am registering another child:

Child #4: Name

First NameLast Name
Child #4: Date of Birth

MonthDayYear
Date
Child #4: Gender
Child #4: Describe any food allergies or concerns, if any.
Child #4: Describe any chronic illnesses or medical conditions, if any.
Child #4: Any need to take prescribed medications during camp? Does the child carry an inhaler or other medical device? If so, describe and provide instructions.

Parent/Guardian Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Permission to text cell number:
Use Parent as Emergency Contact:

Emergency Contact Information
Name

First NameLast Name
Relationship to Child
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Permission to text cell number:

Participant Waiver
This Participant Waiver executed on the date below by the below signee ("Participant") releases Whiteside County Farm Bureau and Whiteside County Farm Bureau Foundation, nonprofit corporations organized and existing under the laws of the State of Illinois and each of its directors, officers, employees and agents (collectively "Farm Bureau" and "Foundation"). The Participant desires to attend Farm Camp 2.0 ("Activity") hosted by Farm Bureau and the Foundation. I hereby voluntarily execute this Participant Waiver under the following terms:

Waiver and Release: I, the Participant, release and forever discharge and hold harmless Farm Bureau and Foundation, its officers, directors, agents and emplyees and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from Activity attendance and participation. I understand and acknowledge that this release discharges Farm Bureau from any liability or claim that I may have again Farm Bureau and Foundation with respect to bodily injury, personal injury, illness, death, or property damage that may result from Activity attendance or occurring while I am participating in the Activity.

Photographic Release: I grant and convey to Farm Bureau and Foundation all right, title, and interests in any and all photographs, images, video, or audio recordings of me or my likeness or voice made by Farm Bureau and Foundation in connection with my Activity attendance and participation.

Other: As a Participant, I expressly agree that this release is intended to be as board and inclusive as permitted by the laws of the State of Illiois and that this release shall be governed by and interpreted in accordance with the laws of the State of Illinois. I agree that in the event that any clause or provision of this release is deemed invalid, the enforceability of the remaining provisions of this release shall not be affected.
Parent/Guardian Signature

Registration Fee Payment
Use the registration form below to complete your Farm Camp 2.0 registration. If you prefer to mail payment, please make payment payable to:

Whiteside County Farm Bureau Foundation

100 East Knox Street

Morrison, IL 61270
Camp Registration Fee
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Farm Camp 2.0 Registration Fee
$20 per child

$20.00 Quantity
Item subtotal:$0.00

Total

$0.00
Payment Methods

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Farm Camp 2.0 Registration

Parent/Guardian Information

Emergency Contact Information

Participant Waiver

Registration Fee Payment

Camp Registration Fee

Payment Methods