Advancing community philanthropy since 1928.
Pikes Peak Community Foundation
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Date: 9/7/2010
Junior Farmhands Registration
Please note that Session 4: July 19-23 is now CLOSED.
Fee free to join the last session.
Please fill out this form. If you have any questions, please email David Rudin at
drudin@ppcf.org
or call 719.389.1251 x112. We will do our best to accommodate your request. Please allow a couple of days for us to get back to you.
Students First and Last Name
Age
Entering Grade
Address
City, State, Zip
Work Phone
Home Phone
Cell Phone
Email Address
Parent/Guardians Name
Relationship to Child
Please list any other adults that may pick up your child
Emergency Contact Name
Emergency Contact Phone
Health Information
Please list any allergies to plants, foods or insect stings; medical conditions; or physical limitations that the instructor should be aware of:
Health Info.
PLEASE SELECT FROM THE FOLLOWING SESSIONS:
*Note: If registering more than one child in the same family, please register separately
Sessions
Volunteer Opportunity
Please check here if you would like to volunteer on the farm while your child is in class.
Cooking Session
Please check if you would like to participate with your child in a cooking session on the last day of class from 12pm-2pm. The cost is an additional $20 for one parent and one child. (additional siblings and parents can be added for $10.00) Maximum 15 people.
Attendee Name(s) For Cooking Session
LIABILITY WAIVER - Junior Farmhands
To the fullest extent permitted by law, visiting guests shall indemnify and hold harmless Venetucci Ranch, LLC and the Pikes Peak Community Foundation, their officers, employees, and insurers from and against all claims, damages, losses and expenses and demands, including court costs, attorney’s fees and expenses, due to injuries, losses and damages arising out of, resulting from or in any manner connected with visitation to the Venetucci Ranch, LLC or the Pikes Peak Community Foundation.
Waiver
I have read and agree to the terms listed in the Volunteer Liability Waiver Form
Waiver (Children under 18)
I am the legal, responsible party for the Children listed above. I agree with the terms listed in the Junior Farmhands Liability Waiver Form.
Please Type your Name in the Box (Your typed name constitutes a legal signature)
Date
LIABILITY WAIVER - PHOTOGRAPHY/VIDEO
In order to promote Venetucci Farm’s programs, we sometimes need photographs and/or videos of students/volunteers/visitors in action on the farm. Please accept the waiver for your permission to use pictures and videos of you/your child to promote Venetucci Farm.
Waiver
I have read and agree to the terms listed in the Photography/Video Liability Waiver Form
Waiver (Under 18 years)
I am the legal, responsible party for the Children listed above. I agree with the terms listed in the Photography/Video Liability Waiver Form.
Please Type your Name in the Box (Your typed name constitutes a legal signature)
Date
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