Register - Full Moon Rising Farm | Whidbey Island Summer Camps

Please fill out one form per camper. If your camper is attending multiple camps, only one form is required but please select all desired camps. A non-refundable registration deposit of $100.00 is required for each camp attended, to be paid via Credit Card or Check upon completion of the registration form.

A completed Registration form and deposit are necessary for enrollment. Please contact Anne Petersen if you have any questions, (360)-622-6385 or fullmoonrisingfarm@gmail.com. After June 15th, 2019, full payment is required at time of registration. Thank you.

We do have scholarships available for those who qualify. Please contact us for more information. We make it a mission to turn no one away from coming to our programs.

2019 Camp Registration Form (1)

For Full Moon Rising Farm Summer Camps

Camps and Programs This Summer*
- Songbird Camp | July 8-11th | Mixed | 7-12yrs | $365
- The Mystery and Mythology of Metal Work| July-8-9 | 11-15 yrs |$165
- Farm Life | July 15-19th | Mixed | 6-12yrs | $375
- Coyote Camp | July 22-26th | Mixed | 7-12yrs | $375
- Green Arts Camp | July 29- Aug 2 | Mixed | 5-12yrs | $350
- Green Art Camp | August 5-9th | Mixed | 5-12yrs | $350
- The Mystery and Mythology of Metal Work | Aug 5-6| 11-15 yrs | $165
- Apprentice Program | $195
Please select from the list the desired camp(s) with the corresponding date(s). All dates are for 2019.
Quick Camper Info
Name*
First Last
Quick Guardian Info
Name*
First Last
Relationship:*
Best contact phone number:*
Email*
Quick Second Guardian Info
Name*
First Last
Relationship:*
Best contact phone number:*
Email*
Detailed Camper Information
Name*
First Last
Birthdate*
Gender*
Child prefers to be called:
Age as of July 1 2019*
Grade fall 2019*
Siblings Names and Ages (if applicable)
Camper mainly Lives with:*
Please provide full name(s)
Years at Full Moon Rising Farm*
Relationship:*
Camper address and Parent/Guardian Info*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Best contact phone number:*
2nd best contact phone number:
Email*
Camper also lives with (if applicable)
Relationship:
Camper address and Parent/Guardian Info
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Best contact phone number:
2nd best contact phone number:
1. Why does your child want to come to FMRF camp? (in her/his words)*
2. Why do you want your child to come to FMRF camp?*
Has your child ever been to camp before (including FMRF) ? Please describe the experience. If not has your child articulated any fears or worries about coming to camp?*
How did you learn of FMRF?*
- Family attended before
- Word of mouth
- internet/Website
- Advertisement
- Social Media
- News paper
- Other
Any allergies (food, bees etc)? If yes please note below*
Please describe the allergy, the reaction that may incur and the medication or treatment necessary to treat.
Food
Children attending FMRF Camp must be able to: 1. 2. 3.
Refund policy
Child's T-Shirt Size*
Emergency Contact(s)
Name*
First Last
Name
First Last
Phone*
Phone
Parent/Guardian Authorization
I certify that this health information is complete and true to my best knowledge. The camper above has permission to engage in all camp activities except as noted as restrictions. In the event I cannot be reached in an emergency, I hereby give permission to FMRF to secure treatment.
Signature of Parent/Guardian*
Date*
Date Format: MM slash DD slash YYYY
Relationship to camper*
Untitled
- First Choice
- Second Choice
- Third Choice

2019 Camp Registration Form (1)

Quick Camper Info

Quick Guardian Info

Quick Second Guardian Info

Detailed Camper Information

Emergency Contact(s)

Parent/Guardian Authorization