Elementary Art Summer Camp Registration Form

2013 Elementary Art Camp Registration Form

Please note that all fields followed by an asterisk must be filled in.

Parent/Guardian First Name*

Parent/Guardian Last Name*

E-Mail Address*

Street Address*

City*

State/Prov*

Zip/Postal Code*

Home Phone*

Student's Name*

Grade*

School

Please list ADA Accommodations needed

Please check any/all weeks you wish to participate:*

	June 10th-June 13th
	June 17th-June 20th
	June 24th-June 27th
	July 8th-July 11th

Transportation To and From Camp*

Before & After Care (8:00am-4:30pm)

Total Registration Fees *

Payment in full by June 1st Payment Type

	Check
	Cash
	Online

Statement of Understanding*

By checking this box I accept and understand that this is a 4 day camp (Mon-Thurs only) from 9:00am-3:00pm. Any portion of the camp that my child can not attend shall be forfeited without refund or credit. I also understand that I am responsible for picking up my child from camp on time unless they are a walker. If I am more than 10 minutes late, I accept and understand that fees will be applied.

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2013 Elementary Art Camp Registration Form

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