2015 Little Farmers Camp Registration

2015 “LITTLE FARMERS CAMP REGISTRATION” REGISTRATION FORM Instructions for Filling out Form:

1. Registration is due 2 weeks prior to 1st camp day registered for to guarantee space and craft supplies. Please call prior to registering if past deadline.

2. Please write the child’s name and check the dates he/she wishes to attend

3. Multiply the number of days by $25.00 and place in the column 7 highlighted in blue.

4. Total the amount due for all the children and place in the yellow box.

5. Make checks payable to Simmons Farm

6. Send Check, 2015 “Little Farmers Camp Registration form page 1 and the Medical Information and Release Registration Form page 2 to:

Simmons Farm

Attn. Little Farmers Camp

483 Justabout Rd

Venetia, PA 15367

Weeks Child's July 7th July 14th July 21st July 28th August 4th Total Name Corn Big Rigs Flowers Animals Peaches Days Days X $25.00

1 2 3 4 5 T0TAL DUE

2015 Page 1 2015 “LITTLE FARMERS CAMP REGISTRATION” REGISTRATION FORM

Any questions please call Simmons Farm at 724-941-1490 or email us at: [email protected]

Visit our website for more details on daily activities at: www.simmonsfarm.com

2015 Page 1