2022 Summer Arts Camp Registration Form

Summer Arts Camp Registration Form
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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:$0.00

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$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
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Summer Arts Camp Registration Form

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