Creative Art Start - Summer Art and Maker Camp.
Registration - Credit Card
Campers Name
*
First Name
Last Name
Date of birth of Camper
*
School and Grade as of September 2023
*
Parent/Guardian Name # 1
*
First Name
Last Name
Parents/Guardian Name # 2 (if applicable)
First Name
Last Name
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home phone:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency contact name and phone:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Doctor/phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Caretakers name and phone if applicable:
Any special needs or additional information?
Please check which week/s camper will be participating:
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Week 1: June 20th to 23rd. 9:00am to 3:00pm (Tues - Thurs) 9:00am - 1:00 pm (Fri) - $850
$
850.00
Week 4: July 10th - July 14th (Mon - Fri) 9:00am to 3:00pm (Mon - Thurs). 9:00am - 1:00 pm (Fri) - $950
$
950.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
BY ACKNOWLEDGING AND SIGNING 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.
*
First Name
Last Name
Please verify that you are human
*
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