The Farm 2026 Summer Camp Enrollment Form

The Farm 2026 Summer Camp Enrollment Form
Summer Camp Information
Camps are designed for rising kindergarten through 7th grade and include a variety of daily activities and farm education. Your child is guaranteed to create some lasting memories at The Farm this summer.

Camps Include:

Daily Farm Lessons

Daily Crafts

Games

Pond Fishing

Playgrounds

Farm Animal Education

Barrel Train Rides

Snacks

and More!

Each day will feature a new theme and lesson focus such as farm animal care, pollinators/ bee keeping, soil and water, fruits and vegetables! Kids will get hands-on experiences of picking fruits and vegetables to taste, caring for farm animals, meeting and learning from the Surry County Beekeepers and more!

Camp Dates
2026 Dates

Week 1: July 6-9

Week 2: July 13-16

Camp Hours
Monday- Thursday

Drop off 8:45am, Pickup -1pm

Camp Cost
$130 per camper per week

*Campers will need to bring a bag lunch, refillable water bottle, change of clothes (in case of accident and for water games), and wear sunscreen, comfortable clothes, closed toe shoes and a hat.
Camper's Information
Camper's Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Grade for 2026-2027 school year:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information

The parents/guardians listed below will be the primary emergency contact person and authorized pickup person for the camper.
Name*

First NameLast Name
Relation*
Primary Phone Number*

Area CodePhone Number
Primary Email (this email will be used for basic communication about camp)*
example@example.com
Name

First NameLast Name
Relation
Phone Number

Area CodePhone Number
Email
example@example.com
Additional Authorized Pickup Persons

If the parents/ guardians are not the only adults allowed to pick up the child from camp, please list other adults you give permission to pick your child up. In extreme cases when parents cannot be reached in case of emergency, authorized pickup persons may be called.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relation
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relation
Medical Information
Does the child have any allergies including food allergies? If yes, please list them below:*
Does the child have any current medical conditions? If yes, please list them below:*
Does the child require any specific medication (i.e. insulin or seizure medication)? If yes, please list them below:*
Any required medication should be accompanied by a physicians note and specific instructions in a seperate bag labeled with the child's name and given directly to camp staff each day at drop off.
Payment Details
Please choose which week your child will attend camp:*
prevnext( X )
Week 1$130.00
July 6-9

Week 2$130.00
July 13-16

Total $0.00
Authorization
- I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
- I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
- I confirm that all information given in this form is true, complete, and accurate.
- I understand that a waiver must be completed for the dates of this summer camp.
- I understand that if dates are missed, they are forfeited. They will not be allowed to be made up on other weeks.
- I understand that this is a fully working farm and children should come dressed appropriately. Clothes/shoes may get dirty!
- Campers should come dressed in hats, sunscreen, and comfortable close-toed shoes. (Slide-on boots, old tennis shoes, or crocs work best. No sandals!)
- I understand that I must pack a lunch and refillable water bottle daily for my child.
- I understand that the drop-off time is no earlier than 8:45am.
- I understand that the pickup time is at 1:00pm.
- Failure to pick up the child by 1:15 p.m. will result in a $20 fee per every 15 minutes late.
- I understand that if my child's behavior becomes a hindrance to the learning and safety of themselves or others, they will need to be picked up from camp and will not be allowed to return. No refund will be given.
- I understand that my child will go out into the fields on the farm to view and harvest produce for their snacks such as watermelon, cantaloupe, blackberries (thornless), cucumbers, and tomatoes to learn how the plants are grown.
- It is suggested that campers bring a small bag/backpack with their name on it with extra sunscreen and a change of clothes in case of accidents or spills.
- In the event that one of the days is canceled due to rain, the camp day will be made up on Friday of that same week. Campers will be notified via email. If multiple dates are rained out during the week, the week of July 21st may be used to reschedule dates.
Parent/Guardian Signature*

Powered by Jotform SignClear
***Due to an update/browser issue, if this form does not submit the first time you attempt to submit, please try again on a different device.***

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

The Farm 2026 Summer Camp Enrollment Form

Summer Camp Information

Camper's Information

Parent/Guardian Information

Additional Authorized Pickup Persons

Medical Information

Payment Details

Authorization