Evening and Weekend Programs

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Please fill out online 1) this registration form and 2) a completed Emergency/Permission Form

Payment for programs are due no later than drop off. An invoice for a non-refundable deposit of $15.00/program will be emailed to you and due upon receipt.

Please check one: When canceling a registration please complete this form and select the dates you want to cancel.

New Customer

Returning Customer

Registration Change Request

Cancel My Previous Registration

Child's First Name *

Child's Last Name *

Sex

Age

Date of Birth

Street Address *

Apt/Suite

City *

State *

Zip Code *

2nd Child

2nd Child's Last Name

Sex

Age

Date of Birth

Parent 1- FIRST name *

Parent 1- LAST name *

Parent 1- Mobile Phone *

Parent 1- Work Phone

Parent 1- Home Phone

Parent 1- Email *

Parent 2- FIRST name

Parent 2- LAST name

Parent 2- Mobile phone

Parent 2- Work phone

Parent 2- Home phone

Parent 2- Email

Special Programs Please select the dates you want to reserve: You must select at least one item.

	you must have at least one item
Parent's Night Out December 13, 2019 6pm - 10pm - $30.00/child - Winter Crafts	you must have at least one item
Chapel Hill Carrboro Christmas Parade December 14, 2019 8:30am - 12:30pm - FREE -	you must have at least one item
Parent's Night Out February 14, 2020 6pm - 10pm - $30.00/child - Share what we love	you must have at least one item
Parent's Night Out March 13, 2020 6pm - 10pm - $30.00/child - Night Nature	you must have at least one item
Parent's Night Out April 10, 2020 6pm - 10pm - $30.00/child - Creative Expressions	you must have at least one item
Parent's Night Out May 18, 2020 6pm - 10pm - $30.00/child - Night Nature	you must have at least one item

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

Under North Carolina law, there is no liability for an injury to or death of a participant in an agritourism activity conducted at this agritourism location if such injury or death results from the inherent risks of the agritourism activity. NC G.S. 99E-30

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

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