Registration Form 

To reserve your child(ren)’s spot:

1. Fill out our online registration form below.
2. Once you click “Submit”, you will be redirected to the page to purchase your camp(s).

**If you have multiple children attending, there will be a link to return to fill out this form again.**

Child's Name *

First

Last

Preferred Name (If different from above)

Date of Birth *

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Registering for the following camps: *

• Medicine Makers: June 9-11
• Earth Artists: June 16-18
• Wild at Heart: June 23-25
• Medicine Makers: July 7-9
• Earth Artists: July 14-16
• Wild at Heart: July 21-23
• Medicine Makers: July 28-30
• Earth Artists: August 4-6
• Wild at Heart: August 11-13
• Medicine Makers: August 18-20

Parent or Guardian's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Primary Phone Number *

Secondary Phone Number

Email *

Emergency Contact's Name *

First

Last

Emergency Contact's Phone Number *

Please share your child's strengths/passions:

Any physical and/or dietary restrictions?

Allergies (please specify):

Medications:

Any other physical, social, or emotional challenges we should be aware of:

PLEASE NOTE:

We spend a great deal of time curating each camp, mindfully dividing the kids up into small groups for a portion of the day and intentionally splitting up siblings and friends. This cultivates new connections at camp and helps facilitate the dynamic and flow of activities.

If you have extenuating circumstances (such as a cousin visiting to spend the week together at camp, or a very timid younger child who needs to be with their sibling), please state the name of the friend or relative below, as well as the circumstances:

Name of Relative or Friend:

RELEASE, INDEMNIFICATION AND WAIVER FORM: (This is a release – please read it carefully.) *

• I, the undersigned, hereby acknowledge that I have been advised and fully understand that certain elements of danger are inherent in the activities sponsored by Bluebird Hill Homestead which are beyond the control of the instructors, agents, officers, students, and employees of Bluebird Hill Homestead, and that participation in any program activities may entail unavoidable risk of personal injury, death, and loss of or damage to property. These risks include, but are not limited to insect and animal bites and stings, forces of nature such as but not limited to lightning, and unexpected extreme weather conditions, and any hazard present in the wilderness, such as but not limited to low lying branches, sharp objects, and slippery surfaces. I hereby assume all risks of injury and death to the participant and loss of or damage to property arising out of participation in such activity and I agree to indemnify, hold harmless Bluebird Hill Homestead, its officers, instructors, agents, and employees (“Releasees”) from and against all claims arising from any occurrence causing damage or injury to myself or to any party participating in said event or any third parties injured as a result of my actions. I further agree to repair or reimburse Bluebird Hill Homestead for any and all damages that I cause to Bluebird Hill Homestead property or the property at which a specific activity is held. Prior to signing below, I have read and understand the terms and conditions of this Release, Indemnification, and Waiver, understand by signing below I am waiving certain legal rights I may have against the Releasees, and I agree to subscribe to all the terms and conditions set out above.

PHOTO/VIDEO RELEASE:

• By checking this box, I hereby grant free permission for Bluebird Hill Homestead to use still or motion picture images of the person participating in their programs or events for outreach purposes, including but not limited to electronic or print materials, or print or broadcast media. (Please consider granting this release if at all possible, as this helps us greatly with sharing about our programs. We do not share names of participants publicly.)

ELECTRONIC SIGNATURE *

• By checking this box, I acknowledge that typing my name below constitutes my online signature and is as legally binding as such.

Please type your name as your signature: *

Submit

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Once you’ve submitted the above registration form, you will be redirected to the checkout page to purchase your camp(s). Both your registration form AND payment must be received to hold your spot.

Click Here if you need to navigate back to that checkout page.

Payment

You can pay online using a credit or debit card, or your Paypal account. If you prefer to pay by check, please mail it to:
Bluebird Hill Homestead
456 Old E East
Hudson, WI 54016

*Both the registration form and full payment must be received to reserve a spot for your child(ren).

Discounts

We offer a 10% discount for families with multiple siblings attending. If registering for more than one child, enter the coupon code SIBLINGS in the checkout cart.

We also have a sliding scale scholarship fund for all programs. Please do not let cost prevent your participation.  Contact us about your specific needs.

Cancellation Policy

Your tuition includes a 25% non-refundable deposit. If you need to cancel your reservation for any reason prior to 14 days before the camp start date, we will refund your tuition minus the deposit amount. Cancellations made 13 days or less prior to the first day of camp, are not refundable.

Questions?

Please contact us at Connect@BluebirdHillHomestead.com or (612)910-9756