Community Food Initiatives · Sprouts Summer School Garden Camp 2024 Registration

Parent/Guardian Contact Information

Please share contact information for the parent/caregiver of the child who will be attending camp.

Name

*

First Name

Last Name

Email

*

Verify Email

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone - Cell or Other number where you can be reached during camp days

*

Phone - Home

Phone - work

Participant Information

Please share information about the child who will be attending Sprouts Camp.

Camper's First and Last name

*

School

*

What school does your child attend?

East Elementary

Morrison Gordon Elementary

Grade in 2023-2024 school year

*

1st Grade

2nd Grade

Health and Accessibility Info

*

We welcome participants of all abilities to Sprouts Summer School Garden Camp! Does your camper have any specific health or accessibility needs? (please list campers name and all medications, allergies, or other health information that you’d like us to know about your camper)

Additional Camper Info

*

Please share any additional information that will help us give your camper a great experience. For example: fears, challenges, concerns, etc.

Emergency Contact #1

*

Please share the name and number of an emergency contact that we can reach out to in the event we are not able to reach you during camp.

Emergency Contact #2

*

Please share the name and number of a back-up emergency contact that we can reach out to in the event we are not able to reach you or the other contact listed.

Healthcare provider information

*

Participant’s Healthcare provider name, location, phone number

Permission to Pick-Up

*

Names of people who have permission to pick up your participant from camp (no others will be permitted to pick up your participant).

Media Release

*

I give permission for photos videos or audio of my camper to be used by CFI and partner organizations (yes/no).

Handbook Acknowledgements and Agreements

Please read the camp handbook online here before completing the next section of the form:

https://communityfoodinitiatives.org/file_download/inline/d07b5359-8853-4956-88b5-3a9c8941385a

Handbook

*

I acknowledge that I have read and understand the Sprouts Summer camp handbook. A pdf copy of the handbook can be downloaded from https://communityfoodinitiatives.org/programs/school-gardens.html

Medical Plan Acceptance

*

I have read the medical plan in the Camp Handbook and agreed to the terms within. I will not send my camper to Sprouts School Garden Summer Camp with symptoms of illness

Permission to Treat

*

I give permission to Program staff to provide routine first aid care and in the event of a serious illness or injury, I give Program staff permission to seek and authorize emergency medical treatment ( legal guardian name as my signature)

Permission and Release

*

I release Community Food Initiatives from any responsibility for injury or illness that may occur while my camper participates. I give permission for my camper to participate in the Sprouts School Garden Summer Camp (legal guardian name as my signature).

Payment or Scholarship Request

You have the option to request a full scholarship, pay by cash or check later, or pay online. If you are paying now you will be able to submit payment information after clicking the "Register for Camp" button

I am requesting a full scholarship

*

Full (100%) Partial (50%) scholarships are available. If you are requesting a partial ($75) scholarship, please check "No" to this question.

No

Yes

I will pay later by check or cash

*

Yes

No

Online Camp Tuition Payment	Quantity
$150 - I am able to pay full tuition for my child to participate and would like to pay now
$75 - I am requesting a partial scholarship for my child to participate and would like to pay now