Summer Clinic

2024 Tally Ho Farm Summer Clinic Sign-Up

By signing this form you acknowledge you have read and agree to all terms!

Student's First Name: *

Student's Last Name *

Date: * +

T-Shirt Size *

As a worker, you have been selected to participate in a special afternoon session of clinic. Do you wish to accept this invitation? *

Yes - week 1

Yes - week 2

No

If the above choice was not available when you originally filled out the form, then it does not apply for you. It is only for students that have applied to be volunteers during Clinic.

Week 1

Week 2

The price for Clinic is $500 per week. Each Session requires a $250 deposit. The deposit is NON-REFUNDABLE, except in the case where space is not available. The balance, $250, will be billed on your June invoice. Failure to pay your June invoice by June 1st is a forfeit of your Clinic deposit and your spot in Clinic.

As a parent, signing my child up for Summer Clinic at Tally Ho Farm, I understand the deposit given to hold my child’s position is NON-REFUNDABLE, if I should choose to back out of participating in the Clinic. Circumstances where the child becomes injured and can not participate will be given consideration. All other excuses shall not be a reason for refund.

Students must sign up by May 15th in order to receive a shirt.

Parent Signature *

clear

Type the Name of the above signature *

Email confirmation *

The field trip will most likely be on Thursday of the week your child is in Clinic. Please answer below on your driving status.

Can you drive for
the field trip on
the Thursday? *

How many people,
besides the driver,
does your car carry? *

Since parent's are not allowed to stay to watch clinic, we offer to take pictures of the students. These pictures come on a custom THF flash drive. Would you like to purchase a flash drive? Cost of a flash drive is $10 a week or $15 for both week. This charge will be added to your June Invoice when the remaining balance of clinic is due. *

Yes

No

The Friday of each week we have a party and ask each student to bring something to share with the others. Please sign up below with what you would like to bring. Please understand that this choice could be changed the first day of clinic.

What would you like to sign up to bring week 1 AM to the party? * 🛈

What would you like to sign up to bring week 2 AM to the party? * 🛈

Please list an actual item. NOT "whatever is needed" or "anything".

For your other choice, what would you like to bring? It can not be something that has already been listed above. * 🛈

Payment Method for Deposit *

Check (To be Dropped off within Three days of submitting)

Auto Draft (Will be applied to next month's invoice)