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Henny Penny Farm

Ridgefield, CT

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Junior Farmer Registration Form

Junior Farmers are ages 5 to 8.

Please gather and have the following information to hand before you begin, unfortunately the form doesn’t allow for saving and completing later:

  • Childs date of last Tetanus vaccination/booster (DTP/DTap on immunization record)
  • If applicable, Childs medication details
  • Physicians Name and Phone number
  • Details for 2 emergency contacts

JUNIOR FARMER (5-8yr olds) – CAMP REGISTRATION FORM

Step 1 of 6

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  • CAMPER INFORMATION

    please select all that apply.
  • please list the best email to use for us to contact you with important camp updates.
    we ask this question as your child will be attending camp on a working farm and it is strongly advised to have an up to date tetanus shot.
  • this can be found on the Immunization Record Sheet, shown as DTP/DTap.
  • please state NONE if this question is not applicable to your child.
  • please state NONE if this question is not applicable to your child.
  • EMERGENCY CONTACT DETAILS

  • please provide the best number to reach the emergency contact on during DAYTIME hours.
  • please provide the best number to reach the emergency contact on during DAYTIME hours.
  • AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

  • I, the parent (or guardian) of the above-named camper, do hereby give permission to the Henny Penny Farm staff to secure medical treatment for my child if necessary. In the event of accident or injury, when parent, legal guardian or an emergency contact are not available, I give my permission to Henny Penny Farm to procure medical attention.
  • HOLD HARMLESS AGREEMENT

  • I understand that my child will come in contact with sheep, goats, chickens and other animals that will be at Henny Penny Farm. I understand the risks of injury/infection having close contact with large and small animals as well as the potential for injury associated with participation in on-farm programs.

    I also understand that an inherent risk of exposure to COVID-19 exists in any location where people are gathered/present and by participating in on-farm programs, you assume any and all risks related to exposure to COVID-19.

    I agree to waive any and all claims of liability, release and hold harmless Henny Penny Farm, its owners, employees and volunteers, in the event that such injury/infection may occur to my child.
  • PHOTO RELEASE

  • Subject: 2025 Henny Penny Farm Camps and Programs

    Location: Henny Penny Farm, 673 Ridgebury Rd, Ridgefield CT 06877

    I grant to Henny Penny Farm, its representatives and employees the right to take photographs of my child in connection with the above-identified subject. I authorize Henny Penny Farm, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Henny Penny Farm may use such photographs of my child with or without the child’s name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
  • Please enter your email address here if you would like to receive a copy of the submitted forms for your records!

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