Mt Airy Art Camp Registration Form

Mt Airy Art Camp Registration Form
4th Annual Mt Airy Art Camp

Workshop Title: Entering the 3rd Dimension: PAPER SCULPTURE, POP UP BOOKS and PUPPETS
With: Aaron Birk, Art Instructor and Professional Artist, Please note: There will always be at least two adults in the room during camp hours
Location: Aquaria Studio, Studio 306, 4100 Main Street, Studio 306, The Lincoln Mill Building, Manayunk, Philadelphia, PA 19127
Ages: 8-14yrs
Dates: This year we are thrilled to offer four independent art camp sessions: July 6-10, July 13-17, July 20-24, July 27-August 1
Days/Times: Camp Sessions will be Monday-Friday, 9am-2pm (5 hours/day) + Friday 6pm Final Exhibition
Rates: $399/week, (27 class hours includes exhibition party and all art materials. Take $50 off for each additional week registered.
More info: aaronbirk.com
Contact info: dancinglaughingking@gmail.com, (215) 724-6839
- July 6-10July 13-17July 20-24July 27-Aug 1
- Child's Full Name*
- Preferred Name (if different)
- Pronouns
- Date of Birth*
  
  MonthDayYear
- Age*
- Parent/Guardian 1 - Full Name*
- Relationship to Child*
- Email Address*
  example@example.com
- Phone Number*
  Format: (000) 000-0000.
- Parent/Guardian 2 - Full Name
- Relationship to Child
- Email Address
  example@example.com
- Phone Number
  Format: (000) 000-0000.
- Emergency Contact Name (1)*
- Contact Phone*
  Format: (000) 000-0000.
- Emergency Contact Name (2)
- Contact Phone
  Format: (000) 000-0000.
- Authorized Pick Up Person 1*
- Phone number*
  Format: (000) 000-0000.
- Authorized Pickup Person 2
- Phone Number
  Format: (000) 000-0000.
- Authorized Pickup Person 3
- Phone number
  Format: (000) 000-0000.
- YesNo
- If yes, please describe (food, environment, etc.)
- YesNo
- If yes, please describe what medications are for.
- YesNo
- If yes, please describe type of accommodations or support is needed.
- Is there anything you'd like us to know to help your child have a great experience? (e.g., personality, learning style, triggers, strengths)
- Physician's Name
  
  First NameLast Name
- Physician's Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- All skill levels and abilities are invited. Each student will be absorbed in their own practice and supported at their level.
- Please share a few words about your child's artistic interests.*
- I give permission for my child to be photographed for promotional use (Yes/No)
- I give permission for my child to go on walks during camp.
- I give permission for staff of Aquaria Studio to perform basic first aid for my child if needed.
- Liability Waiver Agreement
  By signing this Waiver and Release of Liability, with full appreciation of the risk involved, on my own behalf and on behalf of my child(ren), I hereby voluntarily release and forever discharge Aaron Birk and Aquaria Studio, its trustees, officers, employees, agents, insurers and contractors from any and all legal or financial responsibility for any personal injury, disability, illness, damage, medical expense or death, arising from or related to my child(ren)'s participation in Mt Airy Art Camp. I agree, for myself and my child(ren), not to make any type of legal or equitable claim on Aaron Birk and Aquaria Studio, or any of its trustees, officers, employees, agents, insurers or contractors with respect to any injury I or my child(ren) may suffer, whether or not it arises through the negligence, omission, default or other action of anyone affiliated with the Aaron Birk and Aquaria Studio, including other campers. I further agree that if any such claim is made, I will indemnify and defend the School with respect to any such claim, injury or damage.
- I agree with the Liability Waiver Agreement.
- Parent/Legal Guardian Full Name:*
- Date:*
  
  MonthDayYear
  Date
- 1) Drop-off and pick-up time Policy
  
  • Drop-off time is 9am
  • Pick-up time is 2pm
  • if you are more than 15 minutes early or 15 minutes late, there is a $1 per minute charge.
- Parent Initials*
  Please initial to acknowledge the above policy.
- 2) Refund/Cancellation Policy
  
  • If cancelling more than a week from the start of camp, a full refund will be given.
  • If cancelling 3-6 day before the start of camp, a refund will be given minus a $100 fee.
  • If cancelling less than 48 before the start of camp, no refund will be given.
  • If student is asked to leave because of continuous disruptive behavior, no refund will be given.
- Parent Initials*
  Please initial to acknowledge the above policy.
- 3) Emotional and Physical Safety Policy
  
  Everyone has a bad day sometimes and we have a special corner with colorful cushions to crash out or take a break if needed. We value emotional and physical safety and mutual respect in the classroom; a peaceful workspace and an experience of belonging and connection. We always try to resolve friction and differences with our words. Aaron is trained in the Nonviolent Communication Method and is here to support resolution and repair. If a student becomes violent or destructive the camp reserves the right to send them home. If a student remains too dysregulated to continue with the group, they may be asked to leave the camp without a refund.
- Parent Initials*
  Please initial to acknowledge the above policy.
- Please make your payment now - Your registration only will only be complete once payment is received. If registration is at capacity (15 student limit) your child's name will be added to a waitlist.
  
  ----------------------------------------------------------------------
  
  Rates: $399/per camp week. Includes 27 hours of class including an exhibition party. All art materials provided.
  
  Discounts: Take $50 off for each additional week.
  
  ----------------------------------------------------------------------
- Payment Methods
- - Venmo - Venmo ID @AaronBirk
  - Check - Please make check payable to Aaron Birk
  - Apple Pay for iPhone - Text payment to (215) 724-6839
- Note: For financial needs please contact us.
- I am aware that I need to make the camp payment in order for my child's registration to be finalized*
  Please initial to acknowledge the above policy.
- FlyerSocial MediaAaronBirk.comEmailFriend / Word of mouthSchoolOther
- Is there anything you would like to ask or let us know about?
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Mt Airy Art Camp Registration Form

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