Potomac Ages 7-12 Summer Camp Form

Step 1: Select quantity to add number of campers per week to your cart.

Campers per week?*

June 21-25 total

June 28-July 2 total

July 5-9 total

July 12-16 total

July 19-23 total

July 26-30 total

August 2-6 total

August 9-13 total

August 16-20 total

August 23-27 total

FULL TOTAL

Step 2: Select how many campers you are signing up. This will populate a form for each camper.

How many campers are you signing up? *

Step 3: Fill out each camper form and allocate the camp week in your cart to each individual camper.

Child Name *

First Name Last Name

Birth Date *

Month Day Year

Grade *

Allergies/Special Needs *

NA if none

School Attending *

Camper One Week(s) *

Camper 1 add on total

Child Name *

First Name Last Name

Birth Date *

Month Day Year

Grade *

Allergies/Special Needs *

NA if none

School Attending *

Camper Two Week(s) *

Camper 2 add on total

Child Name *

First Name Last Name

Birth Date *

Month Day Year

Grade *

Allergies/Special Needs *

NA if none

School Attending *

Camper Three Week(s) *

Camper 3 add on total

Parent/Guardian Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Emergency Contact *

First Name Last Name

Emergency Number *

Area Code Phone Number

E-mail *

example@example.com

Comments+Friend Request

I understand Artworks photographs students and artwork for possible use in its publications and/or website. I acknowledge that no compensation is provided to individuals who appear in photographs or videotapes. In an effort to protect my child’s privacy, I understand that names will not be used with any publication. If I am concerned with this policy, I understand it is my responsibility to contact Artworks with my concerns.

Policies *

I agree

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that Artworks Fine Art Studio INC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that Artworks Fine Art Studio INC can not guarantee that I or my child will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself, my child and others, including, but not limited to, studio staff, and other studio clients and their families.
I voluntarily seek services provided by Artworks Fine Art Studio INC and acknowledge that I am increasing the risk to exposure to the Coronavirus/COVID-19. I acknowledge that I or my child must comply with all set procedures to reduce the spread while attending our appointment.
I attest that:
* I (or my child) am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I (or my child) have not traveled internationally within the last 14 days.
* I (or my child) have not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I (or my child) have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I (or my child) have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.
* I (or my child) am following all CDC recommended guidelines as much as possible and limiting my (or my child) exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold Artworks Fine Art Studio INC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the studio, or that may otherwise arise in any way in connection with any services received from Artworks Fine Art Studio INC. I understand that this release discharges Artworks Fine Art Studio INC from any liability or claim that I, my heirs, or any personal representatives may have against the studio with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Artworks Fine Art Studio INC. This liability waiver and release extends to the studio together with all owners, partners, and employees.

Signature *

Clear

Total *

USD Description

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

By submitting this form I indicate that I have read and agree to the registration, tuition, and fees. No adjustments will be made for camper absences. Although every effort will be made to provide a safe environment, accidents can occur. I agree to be responsible for any medical bills incurred resulting from illness, or injury during my child's participation at Artworks Fine Art Studio. If necessary, I authorize Artworks to administer first aid/and or authorize medical treatment of my child. A 70% refund will be made up until May 15th. After May 15th there are no refunds or switching camp weeks.

Agreement *

I agree

Potomac Ages 7-12 Summer Camp Registration 2021

Camper 1:

Camper 2:

Camper 3:

PARENT/GUARDIAN INFORMATION:

Policies

COVID-19 Liability Waiver

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