Summer Camp Emergency Contact Form

Emergency Contact Form

SAS Summer Art Academy 2023
Registration payment per session, per child must be submitted seperately on our website only. Thank you!
Camper's Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
MaleFemale
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Mobile Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
"Outside the Lines" (ages 12-16) - June 26-30, 1pm-4pm"Mixed Media Mania" (ages 6-11) - July 10-14, 1pm-4pm"Summer Sculpt" (ages 5-8) - July 10-14, 9am-12pm"Summer Sculpt" (ages 9-13) - July 17-21, 9am-12pm

Medical Information
Does the camper have allergies including asthma?
Please explain on the field provided including any food the camper is allergic to
Is the camper currently under medication?
Please provide the details, the name of the medication and period of intake
Does the camper have any special needs or require accomidations?
Please share any special needs or sensory/tactile sensitivities, and list any accommodations may need at camp

Emergency Contact Form