Summer Camp Registration Form

Please complete the following form which will register your child for our Summer Farm Camp.

Complete payment either via:
*Paypal – you will automatically be taken to a PayPal page at the end of the form
*Credit Card by Phone – call our Office Manager 570-992-6161 to complete a credit card payment
*Mail – mail a check with participant name(s) in note section made payable to QVLHF to:

Quiet Valley Living Historical Farm
357 Quiet Valley Road
Stroudsburg, PA 18360

Costs are:
Nature Explorers (ages 5-9) $85 Non-members $60 Members
Farm Explorers (ages 10-14) $125 Non-members $100 Members
Historic Pastimes and Games (ages 11-14) $125 Non-members $100 Members

    Register Participant For:
    Farm ExplorersNature ExplorersQV Explorers

    Contact Info:

    Emergency Contact Info:

    Additional Info:

    List any concerns that we should be aware of (physical restrictions, emotional issues, allergies etc: :

    Medical Insurance Information (Company name, policy number and any other necessary information) :

    If you anticipate your child will be absent on any dates, please list:

    We authorize Quiet Valley to take photographs of my child, said images for sole use of Quiet Valley.

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