SUMMER ART CAMP!

SUMMER ART CAMP!

Get your artsy fartsy on with The Blank Canvas Splattered!
Name

First NameLast Name
Age
Gender
Parent Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
First Camp Choice

MonthDayYear
Date
Second Camp Date Choice

MonthDayYear
Date
Destination Art Camp Date Choices

MonthDayYear
Date
Payment Options
PAYMENT: $315/entire week ($50/sibling discount per week); $550/2 full weeks; $65/individual day; $175/half day full week (for younger campers)
Destination Art Camp: $60 (May 26: Somerdale) / $70 (May 27: Crystal Springs) / $70 (May 28: OC Beach)
Studio/Camp/Mailing Location:

The Blank Canvas Splattered!
128 West Maiden Lane
Somerdale, NJ 08083
Food Allergies (popsicles/ice-cream provided each day):
Medications/Special treatment/needs:
Media Release Form:
I hereby give consent to use all photos, artowrk and/or video recordings taken of my minor child on printed medio and/or our website, www.NicoleBlankArt.com.
Parent Signature
Parental Declaration:
In the event of an accident or an illness during camp hours that needs immediate attention, I agree to my son/daughter receiving first aid & medical treatment from qualified persons, including life-saving treatments, as may be considered necessary by a licensed medical personnel. I understand that medical insurance coverage is primarily provided by my personal health insurance coverage as The Blank Canvas Splattered does not provide insurance coverage, nor do the owners of the property on which camp is run (Nicole & Robert Blank).
Parent Signature
CAMPER DECLARATION:
I will fully cooperate with staff, rules and program activities as to not discredit my parents, my morals or myself. I will respect & honor my peers' sensitivities while constructively critiquing art work & during daytime interactions.
Camper Signature
Should be Empty: