<p> 2015 “LITTLE FARMERS CAMP REGISTRATION” REGISTRATION FORM Instructions for Filling out Form:</p><p>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.</p><p>2. Please write the child’s name and check the dates he/she wishes to attend</p><p>3. Multiply the number of days by $25.00 and place in the column 7 highlighted in blue.</p><p>4. Total the amount due for all the children and place in the yellow box.</p><p>5. Make checks payable to Simmons Farm</p><p>6. Send Check, 2015 “Little Farmers Camp Registration form page 1 and the Medical Information and Release Registration Form page 2 to: </p><p>Simmons Farm</p><p>Attn. Little Farmers Camp </p><p>483 Justabout Rd </p><p>Venetia, PA 15367</p><p>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</p><p>1 2 3 4 5 T0TAL DUE </p><p>2015 Page 1 2015 “LITTLE FARMERS CAMP REGISTRATION” REGISTRATION FORM</p><p>Any questions please call Simmons Farm at 724-941-1490 or email us at: [email protected] </p><p>Visit our website for more details on daily activities at: www.simmonsfarm.com</p><p>2015 Page 1</p>