Registration Form
Wolfe's Neck Farm Vacation Camp

Junior Counselors- Please fill out this form instead: Junior Counselor Application Form

Camper's First Name *

Last Name *

Full Legal Name (First, Middle, Last) *

Street Address *

City *

State *

Zip Code *

Birthdate [format: 2/25/1995] *

Grade Entering in the Fall *

Gender *

Returning Camper *

Years at Camp *

T-shirt Size *

Age Group: *

I authorize Wolfe’s Neck Farm to use my child’s

photo or likeness in promotional or informational

materials which may be distributed to the general
public in print and digital media.

*

Buddy Requested 🛈

Contact Information

Parent #1 Contact Information

Parent 1 First Name *

Parent 1 Last Name *

Relationship to Child *

Preferred Phone *

Home Phone

Work Phone

Cell Phone

Email Address *

Please email me Summer Camp updates

How did you hear about Wolfe's Neck Farm Summer Camp? (Check all that apply) *

Parent #2 Contact Information

Parent 2 First Name

Parent 2 Last Name

Relationship to Child

Preferred Phone

Home Phone

Work Phone

Cell Phone

Email Address

Please email Summer Camp updates

Non-Parent Emergency Contact Information

Contact First Name *

Last Name *

Relationship to Child *

Preferred Phone *

Home Phone

Work Phone

Cell Phone

Medical Information

*All fields required. Please enter "N/A" if not applicable to your child.

Please list all known allergies and treatment if exposed *

I authorize Wolfe's Neck Farm Day Camp staff to administer the following medications (include dosage) *

Please list any past medical treatments *

Any special dietary needs (i.e. Vegetarian, Religious, Lactose Intolerant) *

Behavioral or other information Camp staff should know to ensure your child has a positive camp experience *

I authorize Wolfe's Neck Farm Day Camp staff to re-apply sunscreen to exposed areas subject to sunburn *

We are required to have a copy of each camper's immunization records on file. If you have a digital copy (or are able to scan your document) please upload it here. If not, you may fax it to (207) 865-4884 or mail to Wolfe's Neck Farm Summer Camp, 184 Burnett Road, Freeport, ME 04032.

Additional File Upload

Summer Camp Weeks

IF THE WEEK YOU ARE INTERESTED IN IS LISTED AS "FULL"

PLEASE EMAIL: education@wolfesneckfarm.org and we will put you on our waitlist. Thank you!!!

Please note: Registration closes on Thursdays at noon for the following week.

Morning Care ($20/wk) and After Care ($30/wk) are available at a flat-rate (we cannot pro-rate).

Summer Camp - Peapods AM
(Age 4 (by 6/1/13)-Kindergarten)

8:30 AM - 12:00 PM
Half-day Program
Offered only some weeks
*Choose only AM OR PM

Summer Camp - Peapods PM
(Age 4 (by 6/1/13)-Kindergarten)
12:30-4:00 PM
Half-day program
Offered only some weeks
*Choose only AM OR PM

Peapods July 15-19 (FULL)

Peapods August 12-16 (FULL)

Summer Camp - Seedlings
(Entering Grades 1-2)

8:30 AM - 4:00 PM

Summer Camp - Farm Kids
(Entering 3rd-5th Grade)

8:30 AM - 4:00 PM

Summer Camp - Farmward Bound
(Entering 6th-9th Grade)

8:30 AM - 4:00 PM

Farmward Bound - July 8-12 (FULL)

Farmward Bound - July 22-26 (FULL)

Farmward Bound - August 5-9 (FULL)

Farmward Bound - August 19-23 (FULL)

Summer Camp - Morning Care
(All age groups)

7:30-8:30 AM

Summer Camp - After Care
(All age groups except Peapods AM)

4:00-5:30 PM

Membership & Donations

Sponsor a Camper! If you would like to donate (any amount) to the Summer Camp Scholarship Fund, please enter the amount here:

Become a Member and Save! Members receive a one-time $25 discount towards Summer Camp and a variety of other benefits throughout the year. Your membership dues are fully tax-deductible. Please note: this discount will be applied to only one registration per membership per year. *

I am a current Friend of the Farm Member	Family Membership - New ($35 per year)	Family Membership - Renewal ($35 per year)
Sponsor ($100 per year)	No thank you.

If you are becoming a member, please list the name(s) you would like printed on your membership card:

Summer Camp Discounts

CAMP & CAMP DISCOUNT: Enter "CAMP" in the box below for 15% off if you plan to camp at our campground for 5 nights or more while your child is at camp. Discount is valid for both Summer Camp and Campsite. We will contact you within 2 business days (M-F) to book your campsite.

SUMMER CAMP MEMBER DISCOUNT: If you are a member, enter "MEMBER" in the box below to receive a one-time $25.00 discount towards summer camp. Please note this can only be applied to one registration per membership per year.

SUMMER CAMP EARLYBIRD DISCOUNT: If summer camp registration form is completed before 2/15, and tuition is paid in full at time of registration, type "EARLY" in the box below to receive 5% off each week of summer camp.

SUMMER CAMP MULTI-WEEK DISCOUNT: If you are registering your child for multiple weeks of summer camp type "MULTI" in the box below to receive 5% off each week of summer camp.

SUMMER CAMP MULTI-CHILD DISCOUNT: If you are registering multiple children for summer camp, type "SIBLING" in the box below to receive 5% off each week of summer camp.

SUMMER CAMP ACTIVE MILITARY DISCOUNT: If the camper has a parent who is an Active Military Service Member, enter "ACTIVE" in the box below to receive 5% off each week of summer camp.

Payment Options

SUMMER CAMP:
• Payment is due at time of registration. If you are unable to pay in full at this time, payment options may be available. Please contact the office for further details at (207) 865-4469x104.
• Refunds for cancellations after May 15th will not be given.
• Tuition will not be refunded for campers who leave camp for behavioral reasons. *

Pay Total Tuition Now	Deposit Only (No Longer Available- Past 5/15)
Submitting Scholarship Application (No Longer Available - Now Full for 2013)

Payment Method: Please note that camper registration will not be processed until payment is received. If you are applying for a need-based scholarship, you may click here to download application form. *

Credit Card

Check (Payable to Wolfe's Neck Farm, 184 Burnett Road, Freeport, Maine 04032)

Submitting Scholarship Application

Name on Card

Credit Card Type

Expiration Date (mm/yy)

CVV Code

Billing Address (if different from above)

City

State

Zip Code

By submitting this form, I am agreeing to the following:

My child has permission to participate in all camp activities. I understand that these activities may include certain risks, and I assume these risks on my own behalf and on behalf of my child.

I authorize Wolfe’s Neck Farm to administer the medications listed above to my child, and acknowledge that my child will not be provided any medication I have not authorized. I further authorize Wolfe’s Neck Farm to secure medical or other treatment for my child at my expense if I am unable to be reached in an emergency.

In consideration for my child’s participation in camp activities, on my own behalf and on behalf of my child and our heirs, personal representatives, and assigns, I hereby agree not to sue and to waive, release, and discharge Wolfe’s Neck Farm and its subsidiaries and affiliates, officers, directors, agents, employees, and volunteers, of and from any and all claims, causes of action, and damages, which arise out of, or are connected in any way, directly or indirectly, with my child’s participation in the Wolfe’s Neck Farm Summer Camp program, including, but not limited to, any claims of negligence.

Additional Comments:

Please acknowledge that you have read and agree to the above statements *

Yes, I agree

Attended previously	Word of mouth	Internet search	Poster	Received Postcard
Local news	Facebook	Parent & Family Magazine	Newsletter	Email
Campground Stay	Farm Visit	Online Camp Directory	Summer Camp Brochure	The Forecaster
Portland Press Herald	MySummerCamps.com	Camp Expo	Flyer from School	Open House
Tri-Town Weekly Flyer	Other Other