2022 Summer Arts Camp Registration Form

Summer Arts Camp Registration Form
< Back to Summer Arts Camp Main Page
Parent/Guardian
Address

Street Address

Apt./Unit No.

CityState

Zip Code
Phone Number

Area CodePhone Number
Alternate Phone

Area CodePhone Number
Email
example@example.com
If you were referred, by whom?

* No camp on Monday, July 4th.

* Broadway Actors Only - No Camp Monday, July 18th.
Agreement

A deposit of roughly half of the total amount due is required to secure your space in Summer Art Camp. $425 for Broadway, $225 for Artistic Adventures and YAYA. Participant is registered only upon receipt of registration form and full payment. All returned checks and denied credit cards will incur a $50 service fee. We cannot prorate sessions or issue refunds unless sessions are canceled, rescheduled, or the content of the program is considerably altered by the Art and Culture Center/Hollywood.

As the parent or legal guardian of the aforementioned child, I certify that I hold harmless and release the Art and Culture Center/Hollywood, its employees, and agents from any liability, claim, right of action, of any kind or nature which I, my child, or legal representative may have as a result of injury, illness, or damage. I authorize the Art and Culture Center/Hollywood to seek urgent medical care in the event of an emergency.

I hereby allow the Art and Culture Center/Hollywood to take photographs or videotape of me/my child during participation in its programs. The photos or video may be used for the sole purpose of promoting the Art and Culture Center/Hollywood.

I have read and understand all of the above.
Signature
Date

MonthDayYear
Date
Please remember to select the camp program and
quantity of children attending.
(One deposit per child per session)

My Products

Artistic Adventurers Summer Arts Camp Deposit $225.00

A deposit of roughly half of the total amount due is required to secure your space in Summer Art Camp.

Session	Quantity
Session 2: July 5 – July 15 (No Camp Monday, July 4 )
Session 3: July 18 – July 29
Session 4: August 1 – August 12

Item subtotal:

YAYA Summer Arts Camp Deposit $225.00

A deposit of roughly half of the total amount due is required to secure your space in Summer Art Camp.

	Quantity
Session 3: July 18 – July 29
Session 4: August 1 – August 12

Broadway Actors Summer Arts Camp Deposit $425.00

A deposit of roughly half of the total amount due is required to secure your space in Summer Art Camp.

	Quantity
Session 1: June 20 – July 15 (No Camp Monday, July 4 )
Session 2: July 19 – August 12 (No Camp Monday, July 18)

Family Membership. Individual-level benefits for two adults and up to four children or grandchildren under the age of 18 residing at the same addressPersonalized membership card allowing free gallery admission year-roundFree admission to all of our events, such as opening receptions, artist talks, and panel discussionsMembers eventDiscounts on workshops and classes for adults10% discount on Center merchandiseEmail alerts informing you about the Center’s innovative, critically acclaimed programmingPlus, discounts on private lessons, after-school classes/programs and camps for children

Family Membership$75.00

Individual-level benefits for two adults and up to four children or grandchildren under the age of 18 residing at the same addressPersonalized membership card allowing free gallery admission year-roundFree admission to all of our events, such as opening receptions, artist talks, and panel discussionsMembers eventDiscounts on workshops and classes for adults10% discount on Center merchandiseEmail alerts informing you about the Center’s innovative, critically acclaimed programmingPlus, discounts on private lessons, after-school classes/programs and camps for children

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please verify that you are human
< Back to Summer Arts Camp Main Page
Should be Empty:

Summer Arts Camp Registration Form

Select Programs

Select Programs

Select Programs

Select Programs

My Products