2024 Family Events - Pumpkin Picking

Pumpkin Picking at Windy Knoll Farm!

Registration open through 10/4, or until capacity is reached

Join Jacob's Chance friends in celebrating the fall season with some pumpkin pickin' fun! Each participant will pick 2 pumpkins from the patch and then enjoy a hayride and snacks with friends.

Special thanks to our good friend Billy Dew for hosting this annual event and inviting us back each year!

Date: Tuesday, October 8th

Time: 12:30-2pm

Location: Windy Knoll Farm (10094 Windy Knoll Dr, Mechanicsville, VA 23116)

Cost: $5

Ages: 5-40

Amount *	Quantity
$5 - Participant fee
$0 - Total financial assistance

Refund Policy *

Jacob's Chance is able to process refunds upon request, up to one week prior to the start of the program/session, minus a 10% processing fee. We will not process refunds for fees below $10.

I acknowledge and accept the terms of the refund policy.

Optional Donation - Support the Mission!

$100

$50

$25

$10

Family Contact Information

Parent/Guardian Name *

First Name

Last Name

Email *

Verify Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Participant Information

Name *

First Name

Last Name

Birthdate *

(mm/dd/yyyy)

Participant Diagnosis *

Any accommodations requested/helpful tidbits? *

Is there anything we should know about the participant to ensure they have the most success possible? *IMPORTANT* - Per our policies, "we are unable to provide assistance with the following: toileting, wheelchair transfers, feeding, and any other ADLs." If your participant requires this type of assistance, a parent/guardian/caregiver must stay onsite the duration of the program. If you have any questions, please feel free to give us a call!

Does the participant have any allergies? (dietary or outdoor) *

Jacob's Chance will not administer any medication, so any rescue medication must be brought and administered by guardian/participant

Outdoor activity considerations: We will be outdoors for the entirety of the program. Is there anything else we should know to ensure your participant has the most success possible? *

Demographic Data *

Data collection is used only for grant compliance and internal review purposes. Check all that apply

Caucasian

Black or African American

Asian

Indigenous American or Native American

Native Hawaiian or Pacific Islander

Hispanic or Latino

Not of Hispanic Origin

Not interested in reporting

Gender Identity *

Data collection is used only for grant compliance and internal review purposes. Check all that apply

Male

Female

Non-binary

Other

Not interested in reporting

Requested pronouns (examples: he/him, they/them, she/her)

Policy Agreements/Waivers

Jacob’s Chance requires all participants, family members, caregivers, staff, board members, and volunteers to conduct themselves in a safe and respectful manner to help maintain a comfortable, safe, and fun environment. In order to engage in Jacob's Chance programs, everyone must read thoroughly and agree to the terms established by the documents below.

Jacob's Chance Code of Conduct

Jacob's Chance Program Policies

Jacob's Chance Risk, Media, & Concussion Waivers

I have read fully, and agree to the terms established by the waivers/policies linked above. *

Yes

Name of the person responding to the above waivers/policies, on behalf of the participant registered. *

First Name

Last Name

Add 3% to my total amount to help cover the payment processing fees