ORKESTAI FARM

Name (of participant) *

First Name

Last Name

Address (participant)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth (participant) *

MM

DD

YYYY

Preferred contact person *

First Name

Last Name

Contact's phone *

(###)

###

####

Name of parent / guardian (if different than participant)

First Name

Last Name

Participation days *

check as many or as few as desired, however weekly participation is expected unless otherwise arranged

Mondays : 9:30am-12pm

Wednesdays : 9:30am-12pm

Fridays : 9:30am-12pm

First Saturdays : 9:30am -12pm (May-Oct)