Harthaven Art Summer Kid's Camp 2018

Harthaven Art Summer Kid's Camp 2018
https://rebarn64.wixsite.com/website
Name of Student

First NameLast Name
Class A or Class B: June 18th-21st,2018 and/or June 25th-28th, 2018

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Alternate Phone

Area CodePhone Number
Grade Level This Fall
Emergency Contact and Phone Number
Any Medical Conditions or Allergies?
Name of Physician and Phone Number
I have read, understand, and agree to the following:

Medical consent and release: In the event of an emergency, I give my authorization for the transport of my child to a hospital or emergency care facility for treatment if needed. In the event that I cannot be reached, I consent to medical and/or hospital care as deemed necessary by a licensed physician to be given to my child in order to protect my child's health. I assume all financial responsibility for any said transport or treatment. I understand that every attempt to reach me as soon as possible will be made. I grant this authorization to be in effect only after reasonable attempts to reach me have been made, without success, by the attending physician.
I have read, understand, and agree to the following:

I hereby give my informed consent and approval for my child's participation in the above Art Camp, June 18-21, 2018 and/or June 25-28, 2018. By signing below, I assume any risk of harm or injury which might occur to my child (who is listed above). I release, absolve and hold harmless and waive all claims against Sylvia Barnhart, her family, any helpers or representatives, as well as the Barnhart property (16990 Pine Oaks Drive, Redding, CA, 96003) from any and all liability, costs and damages which might arise from participation in the above named Art Camp..
Parent of Guardian Signature:
Please email Harthavenart@gmail.com once you have filled out this form. Space for each Art Camp is limited, so please email me to confirm your spot. Payment can be made by check, Square Cash, or cash and can be made on the first day of Camp.

Thank you!

~Sylvia
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Harthaven Art Summer Kid's Camp 2018

https://rebarn64.wixsite.com/website