Summer 2026 Youth Registration Form

2026 Youth Registration Form

Programs for grades 6 - 9
Student Information
Student's Name*

First NameLast Name
Student's preferred name*
Birth Date*

MonthDayYear
Is this your first enrollment at Purchase?*

YesNo
Grade (for fall 2026)*
Gender*

MaleFemaleNon-binaryOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's email address*
Parent/Guardian Information
Name*

First NameLast Name
Home Number*
Cell Number*
E-mail (all correspondence will be sent to this email.)*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number*
Program selection

Registration Discount Applied
Please select your discount type. Must be paid in full by

Early registration (must be paid in full by May 1)Second registration in the familyPurchase College employee or alumniPepsiCo employeesBroadview Families
Please select your program(s)*

Young Vocalists $540Young Artists $1080Young Writers $1080Young Filmmakers $1080
Tuition plus $25 registration fee
Payment Options
Choose your payment

Payment in fullPay a deposit (A deposits is required for EACH program.)
Pay a deposit for a 1 week program (Young Vocalists.)

Deposit for 1 program
Pay deposit for 2 week programs (Young Artists, Writers or Filmmakers)

Deposit for 1 programDeposit for 2 programsDeposit for 3 programs
Nonrefundable deposits include the nonrefundable $25 registration fee.
Amount paid today
Balance Due by May 1, 2026 (to retain early registration discount)
To submit you payment.
1. Download the Credit Card Authorization Form
2. Complete the form and save to your computer
3. Upload completed form using this Secure Upload Link
You may also print the Credit Card Authorization form and mail or deliver the form in person to the Continuing Education office.

Youth and Precollege Programs in the Arts
Purchase College, State University of New York
School of Continuing Education
Music Building, Suite 0089
735 Anderson Hill Road
Purchase, NY 10577

Payment by check, made payable to Purchase College, is also accepted. Please include the students name and program on the check.
Liability/Photo Releases
Liability Release

The parent/guardian/student does hereby waive, release, absolve, forever discharge, and do further agree to indemnify and hold Purchase College, SUNY, its employees, trustees, officers, volunteers, and agents harmless from any and all claims, damages, losses and/or expenses arising out of participation in summer Youth and Precollege Programs in the Arts at Purchase College. The parent/guardian/student assumes all liability for any and all personal injury, bodily injury, illness or property damage that occurs as a result of participation in such activities. The parent/guardian/student also agrees not to bring any lawsuits nor make any demands nor pursue any complaints against Purchase College as a result of participation in summer Youth and Precollege Programs in the Arts. Agreement to this Release also warrants that participation in these activities is voluntary and the parent/guardian/student has read and understands the inherent risks involved in the activities. The parent/guardian/student understands that these risks exist despite the safety precautions and procedures implemented by summer Youth and Precollege Programs in the Arts at Purchase College. The student agrees to obey all rules and policies mandated by summer Youth and Precollege Programs in the Arts staff as well as those outlined in the Code of Conduct. The parent/guardian warrants there is and will be adequate health insurance coverage in force for the term of the student’s attendance. The parent/guardian further verifies that the health insurance covers any and all accidents, injuries, or illnesses that may result from participation in summer Youth and Precollege Programs in the Arts at Purchase College.
I acknowledge I have read and agree to the terms of the Liability Release*

Yes
PHOTO, MEDIA, AND COPYRIGHT RELEASE

As parent/guardian of the student named below I grant permission for Purchase College to photograph, videotape and/or audiotape my student during activities at Purchase College. These photographs/videos/audios will remain the property of Purchase College and may be used in advertising or marketing campaigns on the Purchase College website, social media websites, and for promotional and informational material including, but not limited to, flyers, brochures, newsletters, emails, advertisements, newspaper articles, TV or cable interviews/promotions. I understand my student’s last name will not be used unless I give my express permission. I hereby waive and release any rights to compensation for, or ownership of, such images and/or sounds.
I acknowledge and agree to the terms of the Photo, Media and Copyright Release*

YesNo
Pick Up Procedures

My student can be released to the following individual(s) at the end of each program day. The individual picking up must follow the sign out procedures and sign out the student at the program sign out location.
Authorized to Pick Up*

First NameLast Name
Authorized to Pick Up

First NameLast Name
Authorized to Pick Up

First NameLast Name
My student can sign themselves out (only if 14 years or older)

YesNo
I acknowledge I agree to the terms of the Pick Up Procedures*

Yes
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
How did you hear about our programs?*

Brochure/PostcardWestchester MagazinePatchFamily/FriendWestchester MagazineSocial Mediaother
describe "other"
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

2026 Youth Registration Form

Student Information

Parent/Guardian Information

Emergency Information

Program selection

Payment Options

Liability/Photo Releases

Pick Up Procedures