Summer 2022 Camp Registration Form
One form per child please
Name
First Name
Last Name
Student Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Name
First Name
Last Name
Parents Cell Phone
Please enter a valid phone number.
Parents Work Phone
Please enter a valid phone number.
Parents Email
example@example.com
Does your child have any food allergies as some classes may have food as part of their activities? If so please give us details below
Does your child take any medications? please list them here and what they are prescribed for.
Do we need to administer any of these medications while the child will be in a camp situation? Please answer below
PARENT RELEASE FORM FOR MEDIA RECORDINGS. I give or deny permission to the Cultural Arts Center to use the image of my child named above in the manner stated below for media recordings while at summer camps. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that may include but not be limited to, printed materials such as brochures, newsletters, videos for the Center's website, digital images for marketing of the CAC Classes and activities for children. At NOT TIME do we release a child's name in conjunction with an image. AS SUCH I choose the following option related to Media Recordings: (check one box)
NO YOU CANNOT TAKRE ANY IMAGES OF MY CHILD FOR ANY REASON
You CAN TAKE IMAGES of my child for EDUCATIONAL PURPOSE ONLY but not for marketing, Facebook, Instagram, Newsletters, Brochures, Website, etc. You can only use the image if you are showing my child in a class setting and you are teaching something about that class to others.
You CAN USE MY CHILDS IMAGES FOR PRINTED MATERIAL ONLY ( such as brochures, flyers, etc) but not for digital use as on a website, digital newsletter, emails, Facebook, Instagram, etc.
YOU HAVE UNRESTRICTED USE OF MY CHILDS IMAGES for use in a variety of purposes without further notification
Parents Please Sign Here:
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Date
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Month
-
Day
Year
Date
SUMMER CAMPS WE OFFER: click the box to register for that camp, register as many as you like for this one student!!!!!
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WOOD U WOODLE ME WOOD CRAFT CAMP, 1st/2nd graders , June 6-10
$
28.00
CERAMICS & CANVAS, 3rd/4th graders, June 6-10
$
42.00
CERAMICS & CANVAS, 5th/6th graders, June 6-10
$
42.00
SUN, SAND, & SEA CAMP, 4th-6th graders, June 13-17
$
79.00
WOOD U WOODLE ME WOOD CRAFT CAMP, 2nd/3rd graders, June 13-16
$
28.00
BEGINNER STRINGS CAMP, 3rd graders & up, June 20-23
$
53.00
DISNEY UKULELE CAMP, for students who have been taking Ukulele for the last year at the center, JUNE 20-23
$
48.00
PRINCESS CAMP, 2nd/3rd graders, June 20-23
$
105.00
STEAM & CHEMSITRY 101 CAMP, 4th-6th graders, June 20-23
$
105.00
MAKE & PLAY CAMP, Pre K 4 and K 5, June 27-30
$
48.00
TIE DYE & TEXTILE CAMP, 4th-6th graders, June 27-30
$
105.00
WORLD OF DISNEY ART CAMP, 2nd/3rd graders, June 27-30
$
53.00
LETS GET MESSY CAMP, 4th-6th graders, July 11-15
$
105.00
STORYLAND ART, 2nd/3rd graders, July 11-14
$
53.00
DRUM CAMP, 2nd-4th graders, July 11-14
$
22.00
BEGINNER UKULELE CAMP, 2nd/3rd graders, July 11-14
$
48.00
BEGINNER UKULELE CAMP, 4th-6th graders, July 11-14
$
Free
STORY HOUR ART, Pre k 4 & K 5, July 18-22
$
28.00
CLAY ART CAMP, 1st/2nd graders, July 18-22
$
42.00
COME PAINT WITH ME CANVAS ART CAMP, 4th-6th graders, July 25-28
$
53.00
CERAMICS & CANVAS CAMP, 1st/2nd graders, July 25-28
$
48.00
Payment Methods
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Last Name
Credit Card Number
Security Code
Card Expiration
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the form.
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