Kid's Camp 

Cooking Matters Camp for 5-8th graders

Quiet Creek Herb Farm & School of Country Living

June 9-10, 2014

12-6 p.m.

Parents/Guardians attend 5-6 p.m. for dinner

Registration Form

Student Name ____________________________________________________________

Age ____________________________________________________________________

Parent/Guardian Names _____________________________________________________________

Address _______________________________________________________________

Town, State, Zip ________________________________________________________

School Name for 2014-15  ________________________________________________________________

E-mail address for parent and/or student _______________________________________


Grade Level in School for 2014-15 ______________________________________

Phone Number___________________________________________________________

Emergency Contact Phone (cell # if available) ________________________________

Emergency Contact Name _________________________________________________

Student’s Pertinent Allergies (i.e. food, bees, etc)________________________________

Medication that will be brought to camp _______________________________________

(Refrigeration needed for medication? __________

I (student) ___________________________ am committed to attend the two days of herb camp June 9-10. Each day, I (parent/guardian) _______________________ will attend the dinners at 5 p.m.  We grant permission for photographs and video to be taken of student.

Signature Student ________________________________________________________

Signature Parent/Guardian __________________________________________________

 

Applications due June 1, 2014 with enclosed $15 check refundable registration deposit , if child attends both days check will be returned  (make checks to Quiet Creek Herb Farm).  .

Send application and check payable to Quiet Creek,  93 Quiet Creek Lane, Brookville, PA 15825


Please pack a lunch for each day and bring a water bottle, dinner will be provided. 

 
Questions?  Call Claire at 849-9662 or e-mail at [email protected]