Upland Hills Farm Fall Camp Registration
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Email *
Campers First & Last Name: *
Gender *
Birth Date: *
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Sessions:                                                                                       *
Sessions are Monday, Wednesday and Fridays from 9:30am - 3:30pm, Sessions will be marked Full/Wait List once they are full. Only Sessions 2, 4, 6, 8 are available to choose your day(s) to attend. Select the even week and then the day(s) your child will attend. *Check only the session(s) you would like to register for:  
Required
Photo Release: *
 I give permission and consent for Upland Hills Farm to take pictures of my child during camp session activities. I also give permission that any photographs may be published and used by Upland Hills Farm to illustrate and promote the camp experience on our web page, Facebook and/or Instagram accounts.
Friendship Requests:
We will do our best to honor friendship requests. Children must be the same age or grade.
Parent(s) Name(s): *
Address: *
Parent Contact Telephone Number: *
Separate phone numbers with a comma
Emergency Contact: *
Include name, relationship to camper, and telephone number
Health Provider and Insurance Information: *
Include Physicians Name, Telephone Number, Health Insurance Provide and Policy Number
Is your child up to date on immunizations? *
Does your child have any life threatening allergies? *
If yes, what is the allergy and do they carry an epi-pen?
Medical or other conditions we should know about:
Does your child have any restrictions from certain activities?
Do you have any concerns our staff should be aware of?
Will your child be taking any medication during camp hours?
**If you need to send medication for your child the container must be clearly marked with the child’s name and instructions for dispensing. To avoid confusion and the possibility of the medication being lost or not dispensed properly, it should be given to their counselor when they are dropped off at camp. Do not send medication in your child’s lunch. We prefer to dispense medication during lunch from 11:45 a.m. to 12:30 p.m.
Emergency Release: *
In the event of any emergency, I authorize Upland Hills Farm to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my minor child’s immediate care and agree that I will be responsible for payment of any and all medical services rendered. I understand that this authorization includes transporting my child by ambulance if necessary, to the nearest medical treatment facility or hospital if I am unable to be reached first.
Education:
Will your child need to work on assignments during camp hours? if so please provide details below on how/what they will need to work on. Please know homework information should be sent to mail@uplandhillsfarm.com prior to the start of the camp day to ensure it is completed during camp hours. Please be sure to include thorough instructions. We will do our best to get assignments completed within the one hour allotted time.
Disclaimer: *
Activities at Upland Hills Farm include a variety of traditional sports, games, activities and events that will make it difficult at times to implement social distancing. Upland Hills Farm is a place where children, and staff are often in contact and near each other every day. Upland Hills Farm will continue to take health precautions this fall. Precautions during fall activities will include encouraging hand washing, more use of hand sanitizer, more cleaning down of high touch areas, etc. children or staff that have become ill will be sent home. Please know even taking these other extra precautions, children will still be exposed to the risk of contracting the Coronavirus or possibly some other illness. The activities and risks of Fall Camp are an integral part of the farm experience. If eliminated, campers would be deprived of the opportunity for the growth and development which Upland Hills Farm campers and families expect. If your child is ill, please keep them home from camp. All campers will be subject to a temperature check upon arrival. I, Parent, have read and understand the Camp activities and risk of exposure to the Coronavirus. I acknowledge and assume the risks and dangers described above with my child being enrolled at Camp. I have discussed the activities and risks with my child, who understands them and wishes to participate in the activities of the Fall Camp community.
Cancellation Policy: *
Cancellation Policy: Full Refunds will be provided under the following circumstances:  your child or family is exposed to COVID-19 and unable to attend the session they have signed up for or your child’s school returns to in-person learning and is no longer able to attend. Cancellations and Refunds Requests must be received no later then the end of the business day Friday before your session is set to begin. We reserve the right to review and deny refund requests.
Payment Policy: *
Sessions are $225.00 per week and due by the first day of your registered camp session.  A $50.00 deposit is required to hold your child's spot in each registered session. If you need to make payment arrangements please contact us - mail@uplandhillsfarm.com. By registering you acknowledge balance due and will make arrangements immediately for deposit.
I have read and understand the emergency release information, photo release, disclaimer, cancellation policy and payment policy. Please enter your full name below to agree and submit your registration: *
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