ARTx3 Summer Camp Registration

ARTx3 Summer Camp Registration

Please complete this form before your child attends camp at the ARTx3 Campus.
Today's Date*

MonthDayYear
Date
Camper Information
Camper Name*

First NameLast Name
School District*
School Name*
Age*
Date of Birth*

MonthDayYear
Date
Grade this August*
Camper's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Camper's Phone Number
Please enter a valid phone number.
Camper's Email
example@example.com
Parent / Guardian Information
Parent / Guardian Name*

First NameLast Name
Parent or Guardian Cell Phone*
Please enter a valid phone number.
Parent or Guardian Work Phone*
Please enter a valid phone number.
Parent or Guardian Email
example@example.com
Kid Code
Please enter a word that the person(s) picking up your child must give to staff members.
Emergency Contact Information

This person will be allowed to pick up your child in case of an emergency.
Emergency Contact Name (other than parent/guardian)*

First NameLast Name
Relation to Camper*
Emergency Contact Cell Number*
Please enter a valid phone number.
Emergency Contact Home Number
Please enter a valid phone number.
Emergency Contact Work Number
Please enter a valid phone number.
Authorized Individuals

You may list additional people who may pick up your child (they will be asked to show their driver’s license). If anyone other than the people listed below is going to be picking up your child, you must send a note. If you have changes to this list (additions or deletions) anytime during the camp, you must notify the ASC Education Programs Manager or ASC Theater Programs Manager.
Individual #1

First NameLast Name
Individual #2

First NameLast Name
Individual #3

First NameLast Name
Individual #4

First NameLast Name
Health / Medication Information
Please list any information we should know about your child (medication, allergies, etc.). Include food allergies, insect bites, etc.*
Permission to Administer Physician-Prescribed Medication

We encourage all parents/guardians to administer all physician-prescribed medication(s) to their children before or after an ARTx3-sponsored program. We understand that an unusual case may arise and a member of ARTx3 Campus' staff may be requested to administer medication. By completing the information below we will, in some circumstances, authorize a member of staff to administer physician-prescribed medication(s) that are stored in current prescription bottle(s).
Camper's Name

First NameLast Name
Name of medication
Dosage
Times to be given
Physician's Name
Physician's Phone Number
Please enter a valid phone number.
Specifications for Medication
Liability Waiver / Release
While participating in an ARTx3 program/event, it is understood that the program participant is aware of all rules and regulations listed below:
- I agree to accept and abide by the rules and regulations of the program as established by the ARTx3 Campus and to obey the direction of ARTx3 staff and representatives.
- I agree to uphold all safety precautions while participating to ensure my safety and the safety of others.
- I acknowledge that I will be held responsible in the event of substantial damage to ARTx3 property or building structure.
- I acknowledge that my participation may involve the risk of contracting or the actual or alleged contracting of COVID-19 or any other communicable disease or illness. I agree to release ARTx3, and its affiliates, from all responsibility and hold them harmless if I am exposed to bacterial or viral infection while participating in ARTx3 activities and will adhere to all endemic, epidemic, and pandemic guidelines set by ARTx3 at the time of participation.
- I acknowledge that my participation may involve the risk of injury. Further, I understand ARTx3 does not maintain any type of medical insurance that would cover any injuries sustained while participating, whether in ASC, the ARTSpace, the ARTWORKS, or on the grounds of any ARTx3-owned facility.
- I, the undersigned participant, or parent/guardian if the participant is under the age of 18, agree to the rules and regulations set forth by ARTx3 during my, or my dependant's, participation. With my signature, I agree to the terms listed above, as well as release the ARTx3 Campus from all responsibility and hold them harmless in the event that I become ill or am injured.
Photo / Video Release
I grant the ARTx3 Campus permission to take photographs and videos of me and/or my children. I authorize ARTx3, its assignees, and transfers, to copyright, use, and publish my likeness in print and/or electronically. I understand and agree that ARTx3 may use such photographs of me with or without my name and for any lawful purpose, including for such purposes as publicity, illustration, advertising, social media websites, web content, and other communications related to ARTx3’s mission.I DO NOT grant the ARTx3 Campus permission to take photographs and videos of me and/or my children.
Camper Name*

First NameLast Name
Parent / Guardian Name*

First NameLast Name
Signature*

Powered by Jotform SignClear
This signature covers the (1) Camp Registration Form, (2) Permission to Administer Physician-Prescribed Medication Form, (3) Liability Waiver / Release, and (4) Photo / Video Release.
Today's Date

MonthDayYear
Date
Agreement*

I have read the 2025 ARTx3 Summer Camp Manual and understand the rules and regulations.
Read the summer manual here.
Should be Empty:

ARTx3 Summer Camp Registration

Camper Information

Parent / Guardian Information

Kid Code

Emergency Contact Information

Authorized Individuals

Health / Medication Information

Permission to Administer Physician-Prescribed Medication

Liability Waiver / Release

Photo / Video Release