2017 Junior Fiddlehead (ages 5-6) Summer Day Camp Registration Form

Our Junior Fiddleheads program is designed specifically for 5-6 year-olds as they are ready for a full-day program but still need the care and attention appropriate for their age. The Junior Fiddleheads will explore all aspects of our farm while engaging in nature rich activities led by experienced staff. Our hands-on activities are perfect for the emerging explorers of our natural world!

Week: *

Total before discounts & additional options:

$0.00

Discounts (Click all that apply):

Early Registration

Before Jan. 15th (10%)

Jan. 16th-April 1st (5%)

April 2nd-Summer (0%)

Multiple Weeks

5+ Weeks (10%)

2-4 Weeks (5%)

1 Week (0%)

Returning Camper

Returner (5%)

New Camper (0%)

Current CSA Member

Yes(5%)

No (0%)

Sibling Same Week

Yes (5%)

No (0%)

Military

Military Farmily(5%)

Not Military (0%)

Extended Care: Our camp day runs from 8:30am - 4pm. Our extended care options allow families to start the camp day as early as 7:30 am and go as late as 5:30 pm. (Please indicate the number of weeks you will need extended care.)

*Note: Discounts do not apply to extended care.

	Morning Care: 7:30am - 8:30am ($16/week)
	Afternoon Care: 4pm - 5:30 pm ($28/week)

Transportation: Campers will arrive to camp by 8:30 am and depart camp at approximately 4:15 pm. Click here to learn more about our transportation. (Please enter the number of weeks that you will need transportation.)

*Note: Discounts do not apply to transportation.

Transportation ($60/week)

Final Total:

$0.00

Camper Information

First Name *

Last Name *

Age (during camp) *

Birthday (mm/dd/yy) *

Sex: *

School *

Grade (next fall) *

Previous summers at Fernbrook *

Photo Agreement *

Parent Information

Parent #1 Contact Information:

First Name *

Last Name *

Primary Phone # *

Secondary Phone Number *

Email Address *

Confirm Email Address *

Street Address *

City *

State *

Zip Code *

Address Line 2

Employer *

Parent #2 Contact Information:

First Name *

Last Name *

Primary Phone # *

Secondary Phone Number *

Email Address

Confirm Email Address

Street Address (If different from above.)

City

State

Zip Code

Address Line 2

Employer *

Non-Parent Emergency Contact Information:

First Name *

Last Name *

Relationship to You *

Primary Phone Number *

Secondary Phone Number *

How did you hear about Fernbrook Farms' Summer Camp? (Check all that apply.) *

Medical Information

If not applicable, please indicate N/A in the related field.

Please list all known allergies and treatment if exposed. *

Please list any behavioral or other pertinent information Fernbrook staff should know to ensure your child has a positive camp experience. *

Please list any past medical treatments that would pertain to your child's success at camp. *

Is your child fully up-to-date with all immunizations? *

My child's insurance carrier: *

Policy #: *

My child's physician's name: *

Physician's Telephone Number: *

Payment Information

Name on Card *

Address on card: (if different from above)

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVV *

For information on our registration and cancellation policies, click here.
Terms & Conditions (view here): *

Payment Options: Please choose one. *REMINDER: YOU MUST PAY IN FULL BY EARLY REGISTRATION DEADLINES TO RECEIVE THE EARLY DISCOUNT. *

Pay in Full NOW

Pay 50% now and 50% on Jan. 15 (10% early registration discount.)

Pay 50% now and 50% on April 1st (5% early registration discount.)

Pay 50% now and 50% on June 1st (No early registration discount.)

Other (Call 609-298-4028 to set up your payment plan.)

Please consider making a donation to Fernbrook Farms Environmental Education Center!

Fernbrook Farms Environmental Education Center (FFEEC) is a non-profit 501-c-3 organization committed to providing hands-on educational experiences to all young people and needs & welcomes gifts of every amount from all friends. Small and large gifts multiply into major support for the important work of FFEEC's programs. All donations are tax deductible.

We thank you for your support!

Donation Amount

Attended Camp Previously	Attended other Fernbrook event	Friend	Internet Search
Facebook	Fernbrook's CSA	Fernbrook's Monthly Emails	Open House
Camp Fair: MFS	Camp Fair: Quakerbridge Mall	Camp Fair: Morrestown Mall	Newspaper
Metro Kids	PrincetonKids.com	Princeton Scoop	Other Other