Spring/Summer Programs Registration 2017 Camper 1 info * First and Last Name of Camper 1 * Birthdate Camper 1 MM / DD / YYYY * Grade entering this fall: Below, please register for camp(s) that match the grade your child will enter this fall. * Camp Session(s) Organic Farm Day Camp for Grades 3-5: June 26-30 / $250 Organic Farm Day Camp for Grades 6-8: July 17-21 / $250 Farm-to-Table Culinary Day Camp for Grades 5-8: July 30-August 5 / $250 * Day Camp Extras (optional) Transportation to/from Iowa City: $50 per camper per week * Parent/Guardian Contact Info Name Address City/Town State/Province ZIP/Postal Code Email Address Phone Number * Second parent/guardian household OR emergency contact: Name and relationship (e.g. Jane Jones, stepmom) Address City/Town State/Province ZIP/Postal Code Email Address Phone Number * Do you want to register another camper from your household? Yes No * How did you hear about Scattergood Summer Camps? Facebook posting or ad Iowa Public Radio Word of mouth Farmers Market table Flyer or poster Little Village Blog or website posting Attended last year Word of mouth Other (please specify) Register!