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 *You may enter a custom payment amount to pay half up front, pay for all siblings together, or make other arrangements. The default tuition is shown in the box.Minimum Price: $10.00Tuition *You may enter a custom payment amount to pay half up front, pay for all siblings together, or make other arrangements. The default tuition is shown in the box.Minimum Price: $10.00Preferred Summer Camp Start Date *July 6July 13July 20July 27August 3August 10 Dewey Phone Acres Preferred Fall Semester Start Date *September 9 (Wednesdays)September 10 (Thursdays)NextStudent Name *Student Date of Birth *mm/dd/yyyyParent 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$0.00I paid through the UFA MarketplaceYesNoStripe Credit Card *Submit
