Summer Readiness Registration Form.Pay What You Can

Summer Readiness Application

Pay What You Can
PLEASE FILL OUT THIS FORM IF YOU ARE SEEKING OUR PAY WHAT YOU CAN OPTION FOR 2021 IN PERSON SUMMER CAMP:

ART Inc provides educational and creative opportunities for all children, regardless of their income level. Information listed on the scholarship application is strictly confidential.

The Pay What You Can option is available for children that receive free or reduced lunch at school, and are 5 -13 years old.

Students are expected to be on time and attend each day of camp. Students with excessive absences will not be considered for future scholarships.

We use the honor system for scholarships, and ask you to request the amount you need.

The camp schedule is 100% yours to create the perfect summer based on your child's artistic interests and the session that best fits your schedule:

Morning Session: 9am-12pm
Afternoon Session: 1:30-4:30pm

Please begin the application form on the next page by pressing the next button below.

Personal Information of Camper
Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
Gender *

Male Female
Where does this student attend school? *
Student Grade (2021-2022 School Year) *

Parental Information and Submission
Name of Parent *

First Name Last Name
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How did you hear about our camp?

A flyer Social Media Newsletter Peoria Public Schools Attended previously Other
AUTHORIZED PICK-UP: Please list the First and Last Names of persons you give permission to pick up camper up.
Anyone picking-up a child must show valid ID and be listed as an approved individual at the time of pick-up
Please list any emergency contacts, their relationship to camper, best phone numbers or other contact information that will be helpful in an emergency.
I, hereby grant ART Inc Staff permission to authorize medical, dental, and/or hospital attention to your child. You understand that matters of any severity will be discussed as reasonably as possible after the initial incident. ART Inc and its staff cannot be held responsible for any repercussions caused as the result of treatment. I also grant permission for images of my child to be used for either Promotional Materials and/or Digital Camp Showcase. By granting permission, I am agreeing to:
- Promotional Materials – I hereby grant permission for images of my child, captured through video, photo, and digital camera, to be used solely for the purposes of educational and promotional material, publication in print, ART Inc's website, ART Inc's social media sites. I hereby wave my rights to inspect and approve the finished product or copy that may be used in connection with an image and of compensation or ownership thereto.
Electronic Signature: By entering my name below, I accept the above conditions and releases. (You must be 18 years old or over to sign below.) * *

First Name Last Name
Relationship to registered camper: *
Current date *

Month Day Year
Date
Should be Empty:

Summer Readiness Application

Personal Information of Camper

Which class will your camper to attend?

Pay What You Can

Parental Information and Submission