Farm & Arts Day Camp Scholarship Applicant Form 2024 Farm & Arts Day Camp - Scholarship Campers may only attend one session. The application process contains two steps: 1. Application Form (this form) 2. On-line Health Form - to be completed by parent Both must be submitted for the application to be complete. Upon submission of this Application Form, you will be directed to the Health Form (the link will also be emailed to you).Session*-SELECT ONE-Session 1: June 24-July 5, 2024: 9:30 am to 2:30 pm, Monday - FridaySession 2: July 8 - July 19, 2024: 9:30 am to 2:30 pm, Monday - FridaySession 3: July 22 - August 2, 2024: 9:30 am to 2:30 pm, Monday - FridayCamper's InformationName* First Last Gender* Birth date- please include year* Month Day Year Name of Parent or Responsible Adult* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell (preferred)/Home Phone Number*Work NumberEmail* You will receive all correspondence to this email. Add '[email protected]' to your address book to ensure delivery.Alternate Contact Name First Last Alternate Contact Phone NumberDo you wish for your child to use our free transportation to and from Oakdale Park? Yes No How were you referred to our scholarship program?*Does your child have particular food sensitivities, allergies, or dietary restrictions?*Is there anything else we should know about your child?*Emergency ContactsUse this area to list the individual(s) we may contact in an emergency and you authorize to pick up your camper from camp at the end of a session in the event that you are unable to do so.1. Name* First Last Relationship to Camper* Cell (preferred)/Home Phone*Work Phone2. Name First Last Relationship to Camper Cell (preferred)/Home PhoneWork PhonePermission for ActivityMy/Our child has permission to engage in all activities including supervised swimming and incidental immersion (wading through streams) at on/off campus sites during camp unless otherwise noted by the physician or me.Parent Initials* Sunscreen & Insect RepellentI consent to allow my child to use sunscreen and insect repellent they have brought to camp or that is supplied by the camp.Parent Initials* Participation AgreementOnce your application is received by this office, you will receive an email which will include a link to our Health Form. Please complete and return as soon as possible. If the session you applied for is full, we will contact you with alternative dates. Cancellation Policy: We need to be informed of any cancellations as soon as possible, so as to offer the opportunity to another child. The sessions are for 2 weeks, Monday through Friday. I hereby enroll my child in Farm & Arts Day Camp. In signing this application, I certify that my child is healthy and free of problems that could adversely affect their stay or that of other campers at Hawthorne Valley. I understand that my child must comply with the camp’s rules and standards of conduct and that the organization may terminate my child’s participation in the camp program if they do not maintain these standards. Once application is received, you will receive an email with the on-line link to our health forms. I do not wish to have photos of my child used for camp promotion or publicity. Name of Parent/Legal Guardian* First Last Date* MM slash DD slash YYYY CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ
