2011 Teacher Workday/ Holiday Mini-Camp Registration and Agreement

Please fill out online 1) this registration form and 2) a completed Emergency/Permission Form 3) Please send a non-refundable deposit of $15 for each day you want to reserve a space to: Spence's Farm, 6407 Mill House Rd., Chapel Hill, NC 27516.

Prepayment is required. Please see fee schedule to choose services. Please fill out one form per child, (10% discount for 2nd sibling).

Today's Date

Please check one:

Original Registration

Schedule Change Request

* Child's First Name

* Child's Last Name

Sex

Age

Date of Birth

School Child will attend 2010-2011

If other please specify:

Current AS Student (free Aftercare)

10% discount for additional siblings (does not include Enrichment classes or before/after care)

2nd Child

2nd Child's Last Name

School Child will attend 2009-2010

Sex

Age

Date of Birth

Current AS Student (free Aftercare)

Mother/Guardian name

Father/Guardian name

Mother/Email address

Father/Email address

* Street Address

Address Line 2

* City

* State

* Zip Code

Mother/Guardian Home Phone

Father/Home phone

Mother/Guardian Mobile Phone

Father/Mobile phone

Father/Work phone

Mother/Guardian Work Phone

How did you hear about Spence's Farm Mini-Camp Program?

If referred by a friend or family member please tell us their name so we can thank them.

Mini Camps Please select the dates you want to reserve:

	Mini Camp Apr thru Aug
April 1
April 18
April 19
April 20
April 21
April 22
April 25
June 6
June 7
June 8
June 9
June 10
August 22
August 23
August 24
August 25
August 26

Horse Immersion Mini Camps Please select the dates you want to reserve:

	Horse Camp Apr thru Aug
April 1
April 18
April 19
April 20
April 21
April 22
April 25
June 6
June 7
June 8
June 9
June 10
August 22
August 23
August 24
August 25
August 26

Do you need extended care?

AM

PM

Both

Neither

If AM extended care is needed, what is your estimated time of arrival?

Mini-Camp Day:       8:30-3:00 pm           cost:   $50/day/child      deposit $15 /day/child

Before/After Care: 7:30-8:00am/3:30-6:00pm   cost: $10/day/child

Balance of total fees due: the 25^th of the previous month of the Mini-Camp date.

Custom Mini-Camps: If you don't see the dates you need, we offer custom mini-camps for your school or group. Our minimum is 6 campers for custom days. Please call for more information.

Please send a backpack with two snacks, a lunch and water bottle with your child. Extra clothes are always a good idea, as well as sturdy, closed-toe shoes, or boots that can get dirty.

Sample Mini-Camp Schedule

7:30-8:00 Early Care 12:15-1:15 Lunch

8:30-9:00 Group Session 1:15-2:45 3rd Class Period

9:00-10:30 1st Class Period 2:45-3:00 Acknowledgements

10:30-10:45 Snack

10:45-12:15 2nd Class Period

Spence's Farm 6407 Mill House Road Chapel Hill, NC 27516
phone: (919) 968-8581 fax: (919) 968-7618
email: spencesfarm@aol.com

* Indicates Response Required

attended camp	roadside sign
attended a festival or event	referred by a friend or family member
web search	publication
other (please specify)