Summer Camp Registration

The Holistic Earth-Ling, Inc

Summer Camp Registration

Earth-Ling Farm

23847 SW 147Ave, Redland Fl33032

Camp Start Date: June 23 – August 1, 2025

Age Group: 8-13 years

Schedule: Monday, Friday, 9AM-2PM

Making Payment: Zelle, Cash-App,

Venmo, Check or Cash

Before (7:30-9:30am) & After Care

(2:30-6:30) is available at $10 per hour

(a snack is included).

Camper Information

Student’s Full Name:________________________________________

Date of Birth:____ / ____ / ____

Preferred Name (if any):______________________________________

Gender (optional):_______________

Student’s Home Address:_____________________________

City, State, Zip:_____________________________________

Parent/Guardian Name:_________________________________

Parent/Guardian Telephone:______________________________

Parent/Guardian Email:__________________________________

Parent/ Guardian Home Address:__________________________

City, State, Zip:_________________________________

Emergency Contact Information (3 is required)

#1. Emergency Contact Name:

_________________________________

Relationship to Camper:

_________________________________

Phone Number:_____________________

#2. Emergency Contact Name:The Holistic Earth-Ling, Inc

_________________________________

Relationship to Camper:

_________________________________

Phone Number:_____________________

#3. Emergency Contact Name:

_________________________________

Relationship to Camper:

_________________________________

Phone Number:_____________________

Health & Wellness Information

Does your child have any allergies?

(Food, environmental, medication)

☐ Yes (Please specify):

________________________________________________________________________

__________________________________________

☐ No

Any medical conditions or special needs?

☐ Yes (Please describe):

_________________________________________________________

_________________________________________________________

☐ No

Dietary Preferences:

– ☐ Vegetarian

– ☐ Vegan

– ☐ Gluten-Free

– ☐ Pescatarian

– ☐ Other (Please specify):

_________________________________________________________

Nuts Allergies: List all known nut allergies:

________________________________________________________________________

__________________________________________

Medications taken regularly:

_________________________________________________________

Any activities your child should avoid due to health reasons?

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

Mindfulness & Learning Preferences

– Has your child participated in mindfulness, yoga, or nature-based learning before?

– ☐ Yes

– ☐ No

– What are their interests? (Check all that apply)

– ☐ Art & Creativity

– ☐ Nature Exploration

– ☐ Movement (Yoga, Dance, Sports)

– ☐ Music & Sound Healing

– ☐ Meditation & Mindfulness

– ☐ Team-building & Community Engagement

– ☐ Other:

________________________________________________________

Consents & Agreements

☐ I give consent for my child to participate in all camp activities, including outdoor

excursions

☐ I authorize the camp staff to administer basic first aid if necessary

☐ I give permission for my child’s photos to be used for camp promotional materials

(Optional)

☐ I confirm that all the information provided is accurate to the best of my knowledge

Additional Information Needed for Divergent (optional)

1. Does your child have any specific support needs we should be aware of? (e.g., sensory

preferences, communication style, mobility

considerations)__________________________________________________________________

________________________________________________________________________________

2. What strategies or accommodations help your child feel comfortable and engaged?

________________________________________________________________________________

3. Are there preferred methods of communication for your child? (Verbal, non-verbal,

assistive devices,

etc.)____________________________________________________________________________

________________________________________________________________________________

What to bring to camp:

PLEASE LABLE ALL YOUR CHILD’S BELONGINGS!

• Healthy lunch (NO processed foods, sodas, chips, candies, chocolate or high sugary

snacks)

• Hat

• Sunscreen

• Towel

• Swim wear Note: Children must already know how to swim. A waiver must be signed

before leaving the property..

• Bug repellent. We offer farm-made, organic repellent at $10 ea.

• Water in insulated bottle. NO SINGLE USE PLASTIC bottles please.

• Filtered water is provided at all times while at camp.

• Comfortable shoes (you may send extra sandals separately).

• A bag to hold all items.

• Large t-shirt for messy art and gardening. Please avoid sending your child in clothing

that is special or delicate, as they will be engaged in hands-on activities and messy

projects. A yoga mat will be provided, but your child is welcome to bring their own.

• Refrigerator is provided for your child’s lunch.

A Final Important Note To Parents

During camp the gate opens at 8:00 AM daily.

Parents must sign in their child upon arrival.

Parent/Guardian Signature:

_______________________________________________

Date: ____ / ____ / __