Aldor Acres Kids Camp

“Be a Farm Kid for a Day”

Registration Form 2016

Parents/Guardians: Please complete all information on this form and mail, email, or faxcompleted application along with payment to:Aldor Acres Ltd. 24990 – 84th Langley, BC V1M 3P4 Fax:604-882-0719
Questions: Contact Melissa Anderson - 778-808-5953
Aldor Acres Kids Camp
Ages 5-12
1 Day Camp / $65 / Circle One: July 12 July 14 July 19 July 21
2 Day Camp / $120 / Circle Two: July 12 July 14 July 19 July 21
*Taxes Included **Limited Space Available. Camp runs from 9:00am to 4:00pm. Pick up & drop off at Aldor Acres Family Farm – 24990 84th Ave, Langley 604-888-0788 ***CALL IF INTERESTED IN MORE THAN 2 DAYS***
Contact Information
Name of Farmer:
Date of Birth (yyyy/mm/dd): / Age (as of 1st day of camp):
Parent/Guardian Name(s):
Home Phone:
Email (for farm camp communications): / Parent’s Cell phone: / Parent’s Cell Phone:
Street Address:
City: Postal Code:
Emergency Contact: In an emergency we will make every effort to contact the custodial parent(s), if for some reason they are unreachable please include an alternate emergency contact.
Name:
Relationship to child:
Home Phone: / Alternate Phone:
Health Information
  1. Does the camper have any physical, cognitive, emotional or behavioural limitations/challenges that would require assistance and/or modifications to the program to enable him/her to participate fully in the camp? YES NO
If yes, please specify: ______
  1. Are there any dietary needs/restrictions we should be aware of?
______
  1. Does your child have any serious or life threatening allergies? YES NO
Please specify: ______
If yes, does your child use an epipen? YES NO

General Consent Statement

During the course of the week(s) your child will participate in a variety of activities while under supervision, which may include but is not limited to:

  • Animal interaction (cleaning, grooming, caring for)
  • Arts and crafts (use of scissors, glue, craft materials)
  • Active games (physical activities that may involve balls, running, jumping, tossing etc.)
  • Use of equipment (for gardening, barn cleanup, cooking, etc.)

Payment:
2 Day Camp Cost: $120 1 Day Camp Cost: $65
Total camp cost:_$______
Cash: Cheque (made out to Aldor Acres Ltd.):
*All cancellations received 2 weeks before the scheduled camp session will receive a full refund of camp fees. Cancellations received less than 2 weeks prior to affected camp session will not be eligible for a refund*
Office use only: / Date Received: / Time Received: / Processed by: