Pamplin Historical Park will offer a history camp, Farm Fields and Battlefields: Exploring Life During the Civil War,on the following dates: June 22-24, July 13-15, July 20-22, July 27-29, August 10-12. The camp is designed for children between 8 years of age (must be 8 on day of camp visit) and 12 years of age (or entering 7th grade), and will last from 9:00 a.m. to 4:30 p.m. The cost is $100.00 for the three-day session. The payment covers registration, materials, crafts, and snacks.
In signing this form, I hereby indicate my permission for the following named child, for whom I am the legal guardian, to participate in the Pamplin Historical Park history camp program. In permitting my child’s participation in the history camp, I hereby agree and hold harmless Pamplin Historical Park, its officers, employees, and agents from any and all liability.
I also agree to hold harmless Pamplin Historical Park and its agents from any and all liability arising from my child’s participation in the firing of the reproduction Civil War musket. Please select one of the following:
I acknowledge that I have received and understand the terms of firing the reproduction Civil War musket and by signing below, I authorize my child to participate.
I do not authorize my child to fire a reproduction Civil War musket.
I further state that the child does not suffer from any medical condition or disability that may require special attention or care, unless indicated on the attached application and arrangements have been made to provide the necessary care. I also understand that Pamplin Historical Park reserves the right to remove a repeatedly disruptive child from the program, and that the admission fees are non-refundable.
Name of Child
Child’s Birthdate
Name of Legal Guardian
Address of Guardian
City, State Zip
Daytime Phone Number of Guardian
Email Address
Emergency Contact (other than Guardian)
Phone
Signature of Legal Guardian_______________________________________________________
Date of History Camp
June 22-24
July 27-29
July 13-15
August 10-12
July 20-22
Is this your first camp? Y
N
If no, how many camps have you attended?