Summer Camp Registration Form

New Moon Art Studio Summer Camp Registration Form

Register your child for our summer camp (ages 5–13). Please complete all required sections. Contact us with any questions.
Camper Information

Please provide details about the camper.
Camper Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
MaleFemale
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
T-shirt Size*
Parent/Guardian Information

Primary contact for the camper.
Primary Parent/Guardian Full Name*

First NameLast Name
Mobile Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Emergency Contact

Contact in case of emergency (other than parent/guardian).
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number(s)*
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information

Provide relevant health information to ensure camper safety.
YesNo
Allergies (please list all known allergies)
YesNo
Medical Conditions (please describe any conditions)
YesNo
Medications Currently Taken
Physician Name

First NameLast Name
Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Health Insurance Provider
Policy Number
Permissions and Waivers

Please review and provide your permissions for New Moon Art Studio.
Transportation

Specify pickup and drop-off arrangements.
Parent/Guardian PickupAuthorized Adult
Names of Authorized Pickup Persons (if applicable)
Payment Details

Review camp fees and select your payment method.

Camp Fees and Payment*

Summer Art Camp

June 15 - Jun19

$529.00

Summer Art Camp

June 22 - June 26

$529.00

Summer Art Camp

July 6 - July 10

$529.00

Summer Art Camp

July 13 - July 17

$529.00

Summer Art Camp

July 20 - July 24

$529.00

Summer Art Camp

July 27 - July 31

$529.00

Summer Art Camp

August 3 - August 7

$529.00

Enter coupon

Total

$0.00

Credit Card

All payments are non-refundable.
I understand that all payments are non-refundable.
Signatures

Parent or guardian signature is required to complete registration.
Parent/Guardian E-Signature*

Powered by Jotform SignClear
Date Signed*

MonthDayYear
Date
Should be Empty:

New Moon Art Studio Summer Camp Registration Form

Camper Information

Parent/Guardian Information

Emergency Contact

Medical Information

Permissions and Waivers

Transportation

Payment Details

Credit Card

Signatures