Student Camp Counselor

If so which day?

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

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).

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.)

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.

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.