MOLAA 2026 Bilingual Arts and Summer Camp Payment and Emergency Form

2026 Bilingual Arts and Summer Camp Emergency Contact Form

SKIP THIS PAGE IF YOU ARE NOT A WAITLISTED PARENT. CONTINUE BY CLICKING NEXT
Membership Email
Enter your registered MOLAA membership email above. Discounted pricing only applicable to museum members.
SUMMER CAMP WAITLIST PAYMENT: THIS PAGE IS RESERVED FOR WAITLISTED PARENTS ONLY.

You must submit one form per student. Please select the week(s) of camp below and continue to complete the Emergency Contact Form. Payment information will be collected at the end of the form.
Summer Camp Products for Waitlisted Parents
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Week 1 (Regular Pricing)(STEAM Week: Monday, July 6 – Friday, July 10, 2026)
$350.00 Quantity



Week 2 (Regular Pricing) (Community Week: Monday, July 13 – Friday, July 17, 2026)
$350.00 Quantity



Week 3 (Regular Pricing) (Artivism Week: Monday, July 20 – Friday, July 24, 2026)
$350.00 Quantity



Total

$0.00
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The payment is ready! It will be completed once you submit the form.

MOLAA Art Camp Emergency Contact Form

Please fill out all listed information. All information you provide is completely confidential.
Child's name *

First NameLast NameGender/Pronouns
Date of Birth

MonthDayYear
Date
Age*
What week(s) is your child registered for? Select all that apply.*

STEAM Week (July 6th - 10th)Community Week (July 13th - 17th)Artivism Week (July 20st - 24th)
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email *
example@example.com
Parent/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Main Phone *
Please enter a valid phone number.
Parent/Guardian Emergency Phone *
Please enter a valid phone number.
Emergency Contact *

First NameLast Name
Emergency Contact Home Phone*
Please enter a valid phone number.
Emergency Contact Cell Phone*
Please enter a valid phone number.

Medical Information
Medical alerts (medication, allergies, asthma, etc)
Please fill in -all necessary protocol, including use of an EPI pen, if applicable.
Physical Activity Limitation
Doctor's name
Doctor's Contact Number
Please enter a valid phone number.
Insurance Company
Preferred Hospital

Sign in/ Sign out Authorizatin

Please list the parent, guardian, or individual(s) that you authorize to pick up your camper. A photo ID must be presented to camp staff at the time of drop-off and/or pick up.
Authorized Person #1

First NameLast Name
Relationship to Child
AP (1) Cell Phone
Please enter a valid phone number.
AP (1) Work Phone
Please enter a valid phone number.
Authorized Person #2

First NameLast Name
Relationship to Child
AP (2) Cell Phone
Please enter a valid phone number.
AP (2) Work Phone
Please enter a valid phone number.
Authorized Person #3

First NameLast Name
Relationship to Child
AP (3) Cell Phone
Please enter a valid phone number.
AP (3) Work Phone
Please enter a valid phone number.

Waiver & Release of all Claims
Please read this form and be aware that, in signing up and allowing your child to participate in this camp, you will be waiving and releasing all claims and injuries your child might sustain arising from this camp.

ACKNOWLEDGEMENT OF THE RISK OF INJURY:
Through my child’s participation in this class, I recognize that there are certain risks of physical injury and I agree to assume the full risk of any injuries, including death, damages or loss, which my child may sustain as a result of participating in any and all activities connected with or associated with said camp.

WAIVER OR CLAIM FOR INJURY:
I agree to waiver and relinquish all claims against the Museum of Latin American, its volunteer staff, directors, agents and employees, as a result of my child’s participation in summer camp.

RELEASE FROM LIABILITY:
I do hereby fully release and discharge the Museum of Latin American Art, and its volunteer staff, directors, agents, and employees, from any and all claims from injuries, including death, damages and losses sustained by and arising out of, connected with, or in any way associated with the activities of the summer camp, or my child’s

participation in the camp.

INDEMNITY AND DEFENSE:
I further agree to indemnify and hold harmless and defend the Museum of Latin American Art, its volunteer staff, directors, agents and employees from any and all claims resulting from injuries, including death, damages and losses sustained by and arising out of, connected with, or in any way associated with the activities of the summer camp, or my child’s participation in the camp.

I have read, understand, and agree to the policies and rules of the Museum of Latin American Art Summer Camp Program. I hereby give my permission for the MOLAA staff to seek emergency medical treatment in the event I am unavailable. I accept financial responsibility for any medical emergency treatment given to my child.

I also understand that MOLAA takes photographs of children and their artwork in class - both individual and group - and projects for promotional materials, social media, ads and email communications. Please contact us at education@molaa.org if you object to your child being photographed.
Name of Parent/Guardian *

First NameLast Name
I plan on attending the Summer Camp Culmination Event on Sunday July 27th from 3PM to 4:30PM in MOLAA’s Viva Events Center! (Light refreshments and opportunities to purchase keepsakes designed by your child will be provided).*

YesNo
Date Signed *

MonthDayYear
Date
Should be Empty:

2026 Bilingual Arts and Summer Camp Emergency Contact Form

SUMMER CAMP WAITLIST PAYMENT: THIS PAGE IS RESERVED FOR WAITLISTED PARENTS ONLY.

MOLAA Art Camp Emergency Contact Form

Medical Information

Sign in/ Sign out Authorizatin

Waiver & Release of all Claims