The Neon Museum Summer Camp Registration
Camper Information
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Age
*
Grade
*
T-Shirt Size
*
Any allergies (food, environmental, etc.)?
Any special needs or accommodations required for the camper?
Do you qualify for Museums for All (information can be found here)? If so, you may qualify for a scholarship for this Summer Camp
*
Yes
No
Parent/Guardian Information
Parent/Guardian 1 Full Name
*
First Name
Last Name
Parent/Guardian 2 Full Name
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Additional Contact Number
Email
*
example@example.com
Additional Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Demographic Information
Race/Ethnicity
School student attends
Language(s) spoken at home
Primary Emergency Contact
Full Name
*
First Name
Last Name
Relationship to Camper
*
Contact Number
*
Secondary Emergency Contact
Full Name
*
First Name
Last Name
Relationship to Camper
*
Contact Number
*
Terms of Understanding
*
I understand that portions of this camp occur outside in the Neon Boneyard at the museum and will send my student with the proper materials for outdoor activities.
*
I understand that my student will be utilizing technology to explore the art of animation during the camp.
*
I understand that filling out this form does not secure my student a spot at this camp. Attendance will be confirmed once registration is closed.
Authorization and Media Consent
I, [Parent/Guardian's Name], grant permission for [Camper's Name] to be photographed or recorded during activities at The Neon Museum Summer Camp. I understand that these photos or recordings may be used for promotional materials, social media, or other camp-related purposes.
*
Yes, I grant permission.
No, I do not grant permission.
*
I understand that this consent is voluntary, and I may revoke it at any time by contacting the camp organizers in writing.
Parent/Guardian's Signature
*
Pick-Up/Drop-Off Information
Name(s) of Authorized Individuals
*
Special instructions for drop-off and pick-up?
Additional Comments/Notes
Any additional information or special requests?
Submit
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