Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1Enrollment2Family Information3Emergency and Liability4Permission5PaymentEnrollment * Summer Camp Fall Enrollment Tuition *Price: $90.00Tuition *Price: $299.00Preferred Summer Camp Start Date *June 29July 6July 13July 20July 27August 3August 10Preferred Fall Semester Start Date *September 8September 9September 10NextStudent Name *Student Date of Birth *Parent Name *Parent Phone Number *Parent Email *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIf you are attending with a friend, please list their name here. We will make every effort to ensure you are placed in the same farm camp or class.PreviousNextEmergency Contact Name *Emergency Phone Number *Medical Conditions or AllergiesI understand that participation in farm activities involves inherent risks including animals, tools, terrain, and outdoor conditions. I assume all risks and release Dewey Acres Farm School from liability. I authorize emergency medical care if needed. (Please type first and last name) *By typing your first and last name, you agree to these terms.PreviousNextI give permission for Dewey Acres Farm School to use photos or videos of my child(ren) for educational, marketing, and promotional purposes (including website and social media). *Yes, I give permissionNo, I do not give permissionSignature *By typing your first and last name, you agree to these terms.Date *PreviousNextTotal$0.00Stripe Credit Card * Parent to Farm Submit
