Summer Program – Session 5, “Move Over Big Dog” Pyrenees Week, August 8-12, 2022

$319.00

DO NOT FORGET TO ADD THE BUS BELOW IF YOU NEED IT (BOTTOM OF THIS PAGE)

Get out of the city and grow, learn and thrive at our educational Farm Program for children. Enjoy one of six weeks of The Summer Program with hands-on, educational activities with more than 30+ farm animals including chickens, geese, goats, rabbits, pig, cow, horses and ponies, and cats and dogs too! Learn the care and maintenance of each of the farm animals and get active with gardening, game time, learn to ride a horse and more. Academics are important; the entire program is taught by an experienced, Oregon State Certified Teacher with over 40 years of livestock experience. We are a non-profit, children’s program with a goal to “teach and reach” children and youth. Please bring a sack lunch.

For students going into 2nd-6th grades. 18 students max. $319 per week. $58 for the bus.

You must be an adult and over the age of 18 to fill out this registration information below. Only adults can register their child that is under the age of 18.

Session Full

Student First Name *

Student Middle Initial *

Student Last Initial *

Gender *

Student Grade (now or as of September) *

Student Birthday During the Week or on Saturday *

If so which day?

How did you hear about OMF *

What is the Fastest Way to Get in Touch with you *

We have your child; we must be able to reach you in an emergency.

Alternative Phone Number *

Alternative Emergency Contact other than Parent/Guardian *

Emergency Contact Phone Number *

Special behaviors/notes *

Are there any Medical, Behavioral, Academic or Emotional concerns regarding this student that we need to be informed of to better support his or her learning? Please answer thoroughly; this information is used to ensure that your child has a successful, educational experience. If not applicable, then please type “NA.”

Unless OMF obtains the container with preprinted, pharmacy instructions and a written release and instructions from you we cannot dispense any prescription medications. For nonprescription medications, we must have a written note with instructions, date and signature of parent or guardian along with original container. Please do not give any medications directly to the student to be taken while at OMF to ensure that another child does not come in contact with your medication. Your understanding is appreciated!

Special behaviors of this student and/or any medications that they are taking? If not, please type in N.A. (required).

Photo Release *

I hereby grant OMF, Inc. the right to use forever any film, video, audio, photographs, slides or combination thereof, for inclusion in any promotional or advertising purposes of OMF, Inc. and my child agrees to appear without pay. I also give my permission for my child to be interviewed, quoted and have first name only printed in media for the promotional purposes of OMF, Inc.” (Please select “No” if you do not want pictures or interviews taken of this student.)

Yes

General Waiver *

The above-named student may participate in any of the programs offered this year at Old McDonald’s Farm, Inc. (OMF, Inc.). I have the authority to act on this student’s behalf and I release OMF, Inc. and its representatives from liability in the event of accidental injury or illness. I give my permission for this student to receive emergency medical treatment. I accept full responsibility for any expense incurred in providing medical treatment for this child. I understand the inherent risks of working on a farm, in a garden, in nature, with farm animals and including working with and riding horses.

I, the Parent/Guardian of the aforementioned student, accept the terms and conditions of the General Waiver.

Yes

I understand that there are no refunds *

PLEASE NOTE: WE CANNOT OFFER REFUNDS.
By clicking here you acknowledge that there are NO REFUNDS available to you for any reason. Your funds have been spent and are put towards the care and feeding of our 30 ‘teaching tools,’ our Farm Program animals. If you are unable to join us for a program class or an event in which you signed up and paid, then you can take these funds as a tax-deductible donation to our non-profit, children’s charity. Please let us know in advance so we can open it up to another family and then afterward, we will send you via the mail, a donation thank you for tax purposes. OMF, Inc. is a small non-profit, children’s program and we do not have the funds to return to you nor the staff to handle the extra administrative work. Please note: WE DO NOT OFFER REFUNDS!

I, the Parent/Guardian of the aforementioned student, accept that there are no refunds offered from Old McDonald’s Farm, Inc.

Yes

Sorry. There are no spots left

Important Notes

No Notes at this time.