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Country Spirit Summer Camp Registration & Waiver Form 

Registrations & Refunds

Please note that all registrations and payments for Country Spirit Summer Camp are firm, and refunds will not be issued. Your registration can be transferred to another child between the ages of 7-10 years old. 

I Agree


Camp Times

Camp starts promptly at 9:00 am and ends promptly at 3:00 pm. Late arrivals (3:15 pm or later) are subject to an additional charge of $20.00. 

I Agree


Horse Riding

Country Spirit Camp is not a horse riding camp, however every Friday, if the weather is appropriate, Camper's will be able to enjoy a horse ride that is led by Emily or Stephanie, where camper's must wear helmets, (bike helmets are acceptable) and Spirit will be held the entire time for a nice leisurely walk. 

By agreeing & signing below, you agree that should any injury occur, of any kind, whether horse riding or not, you will not sue Stephanie Van de Ven, Emily Johnson, or Country Spirit Wellness Farm. 

I Agree

Payment

Payment is due upfront for the number of weeks you choose for your child to enjoy camp in order to reserve your spot. The fee is $300 per week, per child. Please pack a lunch and snacks. 

I Agree

You can e-transfer Stephanie, owner, directly: asktrustgrow@gmail.com 

I Agree
 

First Aid & Safety

Emily, Johnny and Stephanie all have their vulnerable police check (current) and first aid experience. In the event of an emergency, we will call 911 and we will dispatch an ambulance if necessary, and any additional ambulatory fees or costs will be yours to pay. 

I Agree
 

Scrapes & Injuries

Scrapers, scratches, and bruises will happen on the farm as there are plenty of trees, and opportunities for Camper's to run, play, and be free! We have a first aid kit with us at all times. 

I Agree
 

CAMP DATES: 

Camp dates are subject to availability and are first-come, first-serve. If the week that you'd like to reserve is not available, we will offer you other weeks. ( listed below for you to select)

I Agree

LUNCHES

Please pack a lunch daily, no nuts! 

I Agree


Please refer to the Camp Info & Registration Package Info online for a checklist of things to bring, including bike helmets for the week. 

I Agree

LINK: https://www.countryspiritwellnessfarm.ca/camp



First Camper's Information Name

First Name*

Last Name*

Phone*
First Camper's Information Date of Birth*
First Camper's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
First Camper's Information Signature*
Second Camper's Information Name

First Name*

Last Name*

Phone*
Second Camper's Information Date of Birth*
Second Camper's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
Third Camper's Information Name

First Name*

Last Name*

Phone*
Third Camper's Information Date of Birth*
Third Camper's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
Fourth Camper's Information Name

First Name*

Last Name*

Phone*
Fourth Camper's Information Date of Birth*
Fourth Camper's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
Fifth Camper's Information Name

First Name*

Last Name*

Phone*
Fifth Camper's Information Date of Birth*
Fifth Camper's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
Sixth Camper's Information Name

First Name*

Last Name*

Phone*
Sixth Camper's Information Date of Birth*
Sixth Camper's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
Seventh Camper's Information Name

First Name*

Last Name*

Phone*
Seventh Camper's Information Date of Birth*
Seventh Camper's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
Eighth Camper's Information Name

First Name*

Last Name*

Phone*
Eighth Camper's Information Date of Birth*
Eighth Camper's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
Ninth Camper's Information Name

First Name*

Last Name*

Phone*
Ninth Camper's Information Date of Birth*
Ninth Camper's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
Tenth Camper's Information Name

First Name*

Last Name*

Phone*
Tenth Camper's Information Date of Birth*
Tenth Camper's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
Parent or Guardian's Information Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Who is authorized to pick up your children at the end of the camp day?

Authorized:
Camper's Information Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Camp Dates To Choose From
Please Choose the weeks you'd like to enroll your child in Country Spirit Summer Camp! If more than one week, please indicate in the text box below. *
July 4th - July 8th
July 11th - July 15th
July 18th - July 22nd
July 25 - July 29
August 1 - 5
August 8 - 12
August 15 - 19
August 22 - 26

I'd like to register for several weeks. My selections are:
Social Media & Photographs
We will be taking lots of pictures and videos, sharing them online, and sharing them with you! Please indicate if this is not acceptable. *
No
Yes
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Information Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Information Date of Birth*
Parent or Guardian's Information Current Age

Please indicate how old your child is currently.
Severe Allergies? (we are NUT free only)*
No
Yes
Please explain

Severe Allergies Information
Parent or Guardian's Information Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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