NESA Camp Registration

NESA Fall Course Registration

We are so excited to welcome you to our second year of NESA Afterschool programming! Please fill out the registration form below and complete the instructions for payment at the end of the form. You will receive a confirmation email upon completion of both registration and payment. Please email jenniferchambers@nesarts.org with any questions.
Participant Name*

First NameLast Name
Camper Gender*

FemaleMaleNon-BinaryTransgenderOther
Preferred Pronouns*
School attending if applicable
Birthdate*

MonthDayYear
Date

Parent/Guardian #1 Information

These fields are required for students under 18 years of age.
Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone Number

Area CodePhone Number
Email
example@example.com
Occupation
Employer*
Do you wish to add information for a second parent/guardian?

YesNo

Alternate Pickup/Release

Please share the name and contact information of the individual(s) in addition to parents/guardians permitted to pick up your child.
Individual #1

First NameLast Name
Phone Number

Area CodePhone Number
Relation to child
Individual #2

First NameLast Name
Phone Number

Area CodePhone Number
Relation to child
Individual #3

First NameLast Name
Phone Number

Area CodePhone Number
Relation to child

Medical Release Information

Please share your medical and health insurance information in case of emergency.
Health Insurance Provider*
Health Insurance Policy Number*
Primary Physician*
Physician Address*
Physician Phone Number*

Area CodePhone Number
Hospital Preference*
Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures), required treatment, and need for paramedic in case of emergency*
Are you presently being treated for any injury or sickness, or taking any form of medication for any reason?*

YesNo
If yes, explain:
Are you allergic to any type of food or medication?*

YesNo
If yes, explain:
If yes, explain:

Terms of Agreement

New England School of the Arts and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. Children’s photos and quotes may be used for publicity purposes. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, FirstResponder, and/or Physician).
Parent/Guardian Name or Your Name if 18 or older*

First NameLast Name
Date*

MonthDayYear
Date
By typing your name below, you digitally sign agreement to the above language*
Photo Release

I hereby give permission for my child to be photographed and during the New England School of the Arts Summer Camp. I understand the photos and videos will be used to keep a journal of activities, to share during power point presentations and/or reports and for promotional purposes including flyers, brochures, newspaper, social media and on the internet. I understand that although my child’s photograph and video may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos/videos are the property of New England School of the Arts and its affiliates.
By typing your name below, you digitally sign agreement to the above language*

Participation Consent Form

I, the undersigned*, herby release discharge, indemnify, hold harmless and defend New England School of the Arts (NESA), its officers, employees and servants from any and all liability (claims, demands, losses, causes of action, suits, judgements) of any kind that I or my family may have against NESA due to death, personal injury or illness, loss or damage to property, or future causes that occur during the 2024 New England School of the Arts Fall Afterschool program. In the event of any medical emergency, I authorize and consent for NESA to act on behalf for medical care deemed necessary for the participant.
Name of Participant*

First NameLast Name
Name of Parent if 18 years or younger

First NameLast Name
By typing your name below, you digitally sign agreement to the above language*
Date*

MonthDayYear
Date

Thank You!

Thank you for completing registration for NESA Fall Afterschool Programming. You will receive an email confirming your registration shortly. Please email jenniferchambers@nesarts.org with any questions.
Full tuition is due at the time of registration.

Cancellations: It may be necessary for a parent or enrolled adult to cancel their registration after full tuition has been paid. If cancellation is due to a serious illness or injury that prevents participation in NESA activities, New England School of the Arts will refund the paid tuition provided that a doctor’s note certifying the illness or injury is submitted in writing. Any cancellations for other reasons are not subject to refunds.

Waitlists: Once we reach capacity for a session, we will start a waitlist. There is no deposit required to be placed on the waitlist.
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NESA Fall Course Registration