2022 Pono Grown Farm & Nature Camp Application Form

Camper's Name*

First Last

Camper's Birth Date*

This summer our camp is designed for 5.5 to 8 year old kids. If your camper is not within this age range, his or her application will likely be denied. Thanks for understanding our goal to create the best fit for the group as a whole.

Does camper have any allergies?*

Yes
No

Please list all allergies and describe camper's response to exposure.*

Does camper use an inhaler or epipen?*

Yes
No

Does camper have any health concerns or medical conditions?*

Yes
No

Please list all health concerns and medical conditions*

Also describe any necessary medications or treatments that may affect his/her participation at camp.

Does camper have any physical limitations?*

Yes
No

Please describe camper's physical limitations.*

Camper's Gender*

Anything else you want us to know?

Parent/Guardian's Name*

First Last

Relationship to camper*

Parent/Guardian's Phone Number*

Parent/Guardian's Email*

Preferred Communication Method*

Phone call
Text message
Email

We will contact you as little as possible, but want to make sure that when we do it's as easy as can be, so let us know how you prefer to be reached.

Additional Parent/Guardian's Name

First Last

Relationship to camper

Phone

Email

Emergency Contact Name*

First Last

Please name SOMEONE OTHER than parent(s)/guardian(s) listed above. Parent(s)/Guardian(s) will be contacted first in case of an emergency. This gives us additional adults to contact in case we cannot reach you for some reason.

Emergency Contact's Phone Number*

Emergency Contact's Relationship to Camper*

Camper Photo Release*

I agree to have photos/videos of my child's camp experience taken and shared in future promotional efforts online and/or in print for camp.

Yes
No
I agree to have camper photos taken, but not publically shared

Liability Waiver*

I give consent for my child to participate in Pono Grown camp activities, and execute the liability release described herein on his/her behalf. I agree to assume responsibility for all risks, injuries, damages (known or unknown) associated with my child's participation in Pono Grown camp activities. I also agree to inform the camp coordinator of any actions or movements, which I feel my child cannot safely perform. I will inform the camp coordinator of any limitations, medical conditions, or other special considerations that may affect my child's safety during these camp activities in Makawao, Hawaii. I discharge in advance Pono Grown LLC and all officers, employees, contractors, and volunteers from all liability related to my child's participation in and presence at camp. Furthermore, I forever waive any claim I, my heirs, or my legal representatives my have against the above mentioned persons and entities.

Camp Policies & Waiver*

PLEASE READ CAREFULLY. We reserve the right to update this waiver at any time with notice.
* Families are responsible for their children’s ability to comply with all health protocols before sending them to camp. * Campers may not attend camp if they, anyone in their household, or anyone with whom they  have been in contact exhibits any symptoms of COVID-19 or tests positive regardless of symptoms within 10 days of camp.  * Parents/Guardians are required to monitor campers for any symptoms of illness and to keep them home if they (or anyone in their home) have any of the following: chills, cough, shortness of breath, fatigue, runny nose, watery eyes, congestion, muscle aches, headache, loss of taste or smell, sore throat, skin rash, diarrhea, nausea, vomiting, and/or lice. * Campers with underlying health conditions are advised to consult with their doctor about the decision  to attend camp.   * While we will follow all CDC, state and county requirements to the best of our ability, and are implementing enhanced cleaning protocols, we are not able to guarantee the health of your child or family.  * In checking the box below, you consent to have thoroughly read and voluntarily agree to the participation terms and health protocols listed above.  * ASSUMPTION OF RISK: I assume the risk that my child, myself, and other family members may be exposed to or infected by COVID-19 or any other contagious condition by attending any camps and activities at Pono Grown, and that such exposure or infection may result in personal injury, illness, permanent disability or death. I hereby choose to accept these risks in order to enroll my child in Pono Grown Farm & Nature Camp. * WAIVER OF LAWSUIT/LIABILITY: I understand that the risk of becoming exposed to or infected by COVID-19 at Pono Grown Farm & Nature Camp may result from actions, omissions, or negligence of myself, my child and others, including, but not limited to, Pono Grown LLC employees, contractors, volunteers, or other campers and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injuries to my child, myself, and other family members (including, but not limited to, personal injury, disability or death), illnesses, damages, losses, claims, liability, costs or expenses, of any kind (collectively, “Claims”), that I, my child and our family may experience or incur in connection with my child’s attendance at Pono Grown Farm & Nature Camp. I hereby forever release and waive my right to bring suit against Pono Grown LLC and its agents and employees, contractors, volunteers, and other representatives in connection with exposure, infection and/or spread of COVID-19 related to utilizing Pono Grown’s services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages whether known or unknown, foreseen or unforeseen.

I agree to the camp policies in the waiver above

Consent for Treatment*

I give consent to have my child treated by emergency medical personnel, a physician, or surgeon in the case of sudden illness or injury while participating in Pono Grown Camp activities. I understand that any necessary medical treatments will be my expense.

Electronic Signature*

I have read the above parental consent form, waivers of liability, and COVID policies. I fully understand their contents, and agree to all of their terms and conditions. I agree that all the information contained in this application is accurate and will notify camp coordinator immediately with any changes.

My name entered here serves as my electronic signature*

Date*

Pono Grown Camp Options*

1 week $325

Camp Week Selection*

Select All
Week 1: June 7 - 10, 2022 (FULL)
Week 2: June 14 - 17, 2022 (FULL)
Week 3: June 21 - 24, 2022 (FULL)
Week 4: June 28 - July 1, 2022 (FULL)
Week 5: July 5 - 8, 2022 (FULL)
Week 6: July 12 - 15, 2022 (FULL)
Week 7: July 19 - 22, 2022 (FULL)
Week 8: July 26 - 29, 2022 (FULL join waitlist)

Siblings*

Does your camper have a brother or sister who is also attending Pono Grown camp this summer?

No
Yes

Sibling Discount

Price: $0.00

How did you hear about our camp?*

CAPTCHA

Payment Options*

$100 PER WEEK DEPOSIT is required to hold your camper's spot. We will hold your child's spot for 5 days after application is received. If payment has not been made within 5 days, their spot will no longer be reserved. Once spot is confirmed, the remainder of your balance will be due 1 month before your camper's start date. The deposit is non-refundable except if the camp week(s) you've selected are canceled by Pono Grown. No deposit is required to join the waitlist if a week is already full. For payment, I will

Mail a check to Pono Grown at 677 Olinda Road, Makawao, HI 96768
Arrange to drop off cash or make payment via a phone app
Pay by credit card with an additional 3% processing fee
Join the waitlist (no deposit or payment required unless a spot opens for your camper)

Credit Card Processing Fee*

Price: $0.00

Total

$0.00

Credit Card

Card Details

Cardholder Name