Spring Break Art Camp

Spring Break Art Camp Registration

Please select your desired age group below.
Age Group*

8-1011-14
Are you an AGB Museum Member?*

YesNoNo, but sign me up! (+$80 Family Membership)
How would you like your name to appear on your membership card, mailings, and in the AGB magazine?*
(ex. Dr. John and Ms. Jane Doe, Mr. and Mrs. John Doe, John and Jane Doe, etc)
Member Number*
More information about membership at The AGB available here.
Promo Code

Registration Ages 8 to 10

Please select your desired class(es) from the dropdown menus below.

Spring Break Camp (March 16 to 20)
9am-4pm (March 13 to 17)
9am-4pm (March 11 to 15)
9am-4pm (March 17 to 21)
9am-4pm (March 16 to 20)
S1 9-11 Counter

+ New Membership Fee
+ Late Registration Fee
+ Class Fee
- Membership Discount
Subtotal
YOUR REGISTRATION IS NOT COMPLETE YET.
Please take a moment to ensure that all desired classes have been selected.*

I have selected all of the classes I want to register for. The green check mark is visible next to the classes I selected.I am having difficulty selecting classes.
Please contact Megan Carpenter - mcarpenter@agbmuseum.org or call 863-688-7743 ext.5423

Registration Ages 11-14

Please select your desired class(es) from the dropdown menus below.

Spring Break Camp (March 16 to 20)
9am-4pm (March 13 to 17)
9am-4pm (March 11 to 15)
9am-4pm (March 17 to 21)
9am-4pm (March 16 to 20)
S1.1 9-11 Counter

+ New Membership Fee
+ Late Registration Fee
+ Class Fee
- Membership Discount
Subtotal
YOUR REGISTRATION IS NOT COMPLETE YET.
Please take a moment to ensure that all desired classes have been selected.*

I have selected all of the classes I want to register for. The green check mark is visible next to the classes I selected.I am having difficulty selecting classes.
Please contact Megan Carpenter - mcarpenter@agbmuseum.org or call 863-688-7743 ext.5423

Student Information
Student Name*

First NameLast Name
Grade*
Birth Date*

MonthDayYear
Children under the age of 7 who have not completed 1st grade cannot be accommodated due to the Spring Break Camp curriculum level. If you have any questions, please contact the Education Department at 863-688-5423.
Emergency Contact's Name*

First NameLast Name
Relationship*
Emergency Contact Phone Number*
Alt. Phone Number

Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Name (2)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone Number*
Secondary Phone Number
E-mail*
Please provide an email address used often. NOTE: All important camp material is sent via email.
Adults Allowed to Pick up Child

Security Pin Number
Create a 7 digit numerical security code to be used for your child's secure check-in and
check-out process for camp. If you have more than one child registering for a class,
please use the same code. Please note that the security code cannot start with 0.
Security Pin cannot start with 0. Please try another number.
Security Pin*

Payment
Join as a Member Fee
Membership Discount
Number of Classes Counter
Class x Discount
Class Cost by Number of Classes
Class Cost
Total Class Fee
Date

MonthDayYear
Date
Late Fee
Teacher Kid Discount
Total
Payer Name*

First NameLast Name
Payer Email*
example@example.com
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
+ New Membership Fee
+ Late Registration Fee
+ Class Fee
- Membership Discount
Camp is FREE for AGB Staff and Teacher kids, as long as the class does not fill. We will inform you should the free seat no longer be available.

Please check the Confirmation box below and press "Submit" to complete your registration.
Please check the Confirmation box below and press "Submit" to complete your registration.

Confirmation*

BY ACKNOWLEDGING AND CLICKING "SUBMIT" BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Should be Empty: