The following information will help us during the registration process as well as during the summer.

Feel free to add a page or two if you have additional information about your child to tell us.

Children attending Camp Full Belly Farm must be able to:

- Live in rustic conditions without electricity and modern conveniences.
- Eat provided meals and drink water regularly.
- Follow directions and participate willingly in camp activities, daily chores, and community living activities.
- Refrain from violence, hitting, verbal assault, bullying, or any similar behavior.
- Listen well, show respect for others, live/ work/ play/ interact in large and small groups without constant
one-on-one assistance.
- Participate in normal activities related to self- care/ health/ hygiene. Please let us know if your child has
episodes of bed-wetting.
- Follow directions and rules as explained by the camp staff.

1. Does your child have any medical, physical, intellectual, or emotional conditions that may affect his/ her
ability to meet the above necessities and partake safely in the physically active and community oriented
life at Camp Full Belly Farm? No_________ Yes_______
If yes, please explain:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

2. Does your child have any dietary restrictions/ needs? No_______ Yes______
If yes, please explain:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

3. Does your child take any prescription drugs? No_______ Yes_______

If yes, please bring the medication, with instructions, in a labeled Ziplock bag to camp. Written
directions must accompany medication or else we will not administer the prescription.
Prescription:___________________ Reason:________________ Time Taken:_____________
Prescription:___________________ Reason:________________ Time Taken:_____________
Prescription:___________________ Reason:________________ Time Taken:_____________

4. Has your child ever been to an overnight camp before? Please describe the experience. Has your child
articulated any fears or worries about coming to overnight camp?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

5. What farming activities interest your child the most?

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
6. How did your hear about Camp Full Belly Farm?
____ Word of Mouth ____ Hoes Down ____ Relative Attended
____ CSA ____ Farmers Market ____ Other:_________________
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