Farm Camp Application

Thank you for deciding to send your child to Hawthorne Valley Farm Camp! We can’t wait to see you this summer. Please complete the registration form below. You will be required to make a $500 deposit when you submit this form.

Upon submission of this Application Form and your deposit, you will be directed to the Health Form which must also be filled out for your application to be considered complete.

Camp Session Dates & Costs

Please select the date you would like your child to attend.

Farm Explorers is limited to 28 campers per session
Earth Stewards is limited to 16 campers per session
Financial aid (up to 15% of the tuition) is available for camp sessions longer than 6 days. See Payment Section for more information.

PLEASE NOTE: There are NO ADJUSTMENTS to the tuition for late arrival or early departure in a session for any reason.

Camp Session*

Camper's Information

Name*

First Last

Gender*

Birth date- please include year*

If you were referred to our camp by another family, please let us know their name

Grade entering Fall '22, name of school, and how many years attended Hawthorne Valley Farm Camp*

Bunk Mate Request

Limited to one request per child. Must be mutual.

Parent/Legal Guardian 1*

First Last

Cell (preferred)/Home Phone Number*

Work Number

Email*

You will receive all correspondence to this email. Add '[email protected]' to your address book to ensure delivery.

Parent/Legal Guardian 1 should be contacted in case of emergency and has permission to pick up camper?*

Yes
No

Camper & Parent/Legal Guardian 1 Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Occupation*

Parent/Legal Guardian 2

First Last

Cell (preferred)/Home Phone Number

Work Number

Email

FYI, Parent 1 is the primary contact person for emails. If you would like Parent 2 to be sent all camp emails, please add email. Also, add '[email protected]' to your address book to ensure delivery.

Parent/Legal Guardian 2 should be contacted in case of emergency and has permission to pick up camper?

Yes
No

Does Parent/Legal Guardian 2 live with camper?

Yes
No

Occupation

Emergency Contacts

Use this area to list the individual we may contact in an emergency if you are unavailable.

Name*

First Last

Relationship to Camper*

Cell (preferred)/Home Phone*

Work Phone

If someone other than the Parents/Legal Guardians listed in the previous section will be dropping off or picking up your child for camp, please provide their contact information here.

Name

First Last

Relationship to Camper

Cell (preferred)/Home Number

Work Number

Applications will only be accepted if the following questions/medical information/permissions are completed

Camper Readiness. This is a residential camp. There is no phone contact and no visits during the entire length of the camp; the only exception is if the camper becomes ill.

Does your child sleep alone in a separate room from the parents?*

Yes
No

Has your child had more than one 'successful' overnight stay away from family?*

Yes
No

Is your child experiencing any changes in their home life (recent move, illness, death of loved one or pet, divorce, etc)?*

Yes
No

Does your child have special needs (physical, social, educational, or emotional)?*

Yes
No

Does your child need any special considerations for issues such as bed wetting, sleep walking, recent injuries or illness that might affect your child's camp experience and ability to participate in activities?*

Yes
No

Is your child willing and able to eat whole foods and fresh vegetables? Participate in farm life - including animal care, cleaning, and garden work?*

Does your child get along with other children? What would you like your child to gain from this camp experience?*

Photo Permission*

Yes
No

Parent Initials*

My initials denote permission for HV Summer Camp to use photos of my child for camp promotion and publicity OR click "No" above.

How did you hear about Hawthorne Valley*

Please check one and use space below to write the place/name if applicable.

Name/Place/URL*

Farm Camp Health Form - to be completed by parents

To complete your child's application, you must also complete the online Farm Camp Health Form which you will be redirected to upon submission of this application. Applications will not be considered complete unless both forms are received.

Payment Instructions

DEPOSIT: There is a $500 deposit due with this application payable by credit card.

FULL PAYMENT: Once the camp application, deposit and health form is complete, and your child is accepted into camp, you will be sent an email with a payment link. Full payment needs to be received on or before June 1, 2023, or your child will not be able to attend camp. Please Note: For multiple payments, there will be a $5 processing fee per payment. A single payment for the full amount will be required for applications processed on or after May 15. All prices listed on our payment link reflect the deduction of the deposit amount.

Refund Policy

We need to be informed of any cancellations by email ([email protected]) AND phone at 518-672-4465 x201 as soon as possible, so as to offer the opportunity to another child.

CAMP DEPOSIT is refundable up to 30 days of receipt of the camp application (minus a $75 administrative fee). After 30 days, the deposit is non-refundable. Refunds will be issued by check and mailed to the camper family within 4 WEEKS of the request.

CAMP TUITION: Refunds of camp tuition are determined on a case-by-case basis by camp management. The factors involved in issuing refunds are timeliness of the request, the reason for the cancellation and the ability to replace the camper. After the request is reviewed, you will receive an email with the amount of the refund. All refunds are issued by check and mailed to the camper family within 4 WEEKS of the request.
Please email [email protected] with all refund requests stating reason for the refund.

Financial Aid

Through generous donations, we have a small amount of financial aid available for campers. Financial aid is offered to campers attending a camp session that is longer than 6 days. The range of the amount of financial aid provided is 10% to 15% of the tuition. The amount of the award is determined on the financial need of the family, the number of families requesting aid, and the amount of aid available that year.

Please email [email protected] for more information and the financial aid application.

Participation Agreement

I hereby enroll my child in Hawthorne Valley Farm Summer 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. The organization may terminate my child's participation in the camp program if they do not maintain these standards. If my child is dismissed from camp, or arrives late, I understand that there will be no tuition reimbursement.

I understand that my child CANNOT ATTEND CAMP WITHOUT:

1. A completed application form.
2. A completed health form.
3. Full Payment by June 1, 2023
4. A current physical exam from a doctor DATED AFTER AUGUST 14, 2022

These forms need to be received in our office at the latest 4 WEEKS prior to the first day of camp.

I have read and agree to the payment and refund policies.

Hawthorne Valley is not responsible for lost, stolen, or damaged personal articles.

Name of Parent/Legal Guardian*

First Last

Date*

Deposit

Price:

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

2023 Farm Camp Application

Camp Session Dates & Costs

Camper's Information

Emergency Contacts

Applications will only be accepted if the following questions/medical information/permissions are completed

Farm Camp Health Form - to be completed by parents

Payment Instructions

Refund Policy

Financial Aid

Participation Agreement