Camp 2025

Thank you for your interest in the Art of Nature Summer Camp program! You will be able to register all children in one household with a single registration form, even if the campers are attending different camp dates.

Half day camps for 6-8 year olds will be June 23-27 and Aug 11-15 and are $85 per camper. The full day camp for 9-12 year olds is July 14-18 and is $165 per camper.

All information gathered during this process will be handled confidentially, sharing with our staff only what is required to process registration and maintain the safety of your campers.

Vicksburg Arts is dedicated to providing access to extraordinary arts programming for the communities it serves. We provide a limited number of scholarships to students in need. If you need financial assistance, follow directions at the end of this registration form.

If you have any questions or difficulty completing this registration form, please contact us at admin@vicksburgarts.org.
Parent or Guardian Name*

First NameLast Name
Parent or Guardian E-mail*
example@example.com
Parent or Guardian Primary Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Address*

Street Address

Apt or Bldg

CityState

Zip Code
Preferred method of contact:*

EmailPhoneTextAny of these methods
Emergency Contact*

First NameLast Name
Emergency Phone *

Area CodePhone Number
Who has permission to pick up your camper? Please include full name and relation to child.
Pick Up Auth*
We will make every attempt to accomodate special requests such as keeping siblings together or friends in the same class. Please indicate any special requests below.
Spcl Requests

Informed Consent and Liability Release

I hereby give my approval for my child’s participation in any and all activities prepared by Vicksburg Arts during the Summer Camps. In exchange, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Vicksburg Arts and all its respective officers, agents, and representatives from any and all liability for injuries to my child arising from participation in the camp. In case of injury to my child, I hereby waive all claims against Vicksburg Arts, including all teachers, participants, sponsoring agencies, advertisers, and owners and lessors of premises used to conduct the event.

Medical Release and Authorization

As Parent and/or Guardian of the named camper(s), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional of the minor child(ren) in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper(s). In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Vicksburg Arts and its affiliates including Directors, Instructors, and trained volunteers to provide the needed emergency treatment prior to my child’s admission to the medical facility. Release authorization is for the dates and/or duration of the Summer Camps. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Photograph/Video Authorization and Release

Vicksburg Arts and its authorized representatives will take photographs and videos during activities surrounding the Summer Camps. Please indicate your preference on permission to publish photographs and videos taken of your camper. If you grant permission for us to use photographs and videos of your camper, you will be waiving any right to compensation for their use. Your camper's likeness may be used on the Vicksburg Arts website, newsprint and social media.
Do you grant Vicksburg Arts authorization to use photos and videos of your camper as described in the paragraph above?
Photo Auth*

YesNo
Confirmation

BY PRESSING THE SUBMIT BUTTON AT THE END OF THIS REGISTRATION FORM, YOU ARE 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.

(You will be able to print the entire camp application just prior to submitting this form at the end.)

Camper #1 Information
Name #1*

First NameLast Name
Grade #1*
This is the grade the camper will be September 2025
Birth Date #1*

MonthDayYear
Session for #1*

Half Day Camp (6-8 years old) June 23 - 27Half Day Camp (6-8 years old) Aug 11 - 15Full Day Camp (9-12 years old) Jul 14 to Jul 18
Amt #1
T-Shirt Size #1*
Camper #1 . Please list any allergies, chronic illness, or medical conditions. If none, please type none or none known.
Med #1*
Another Camper?

YESNO

Camper #2 Information
Name #2*

First NameLast Name
Grade #2*
This is the grade the camper will be September 2025
Birth Date #2*

MonthDayYear
Session for #2*

Half Day Camp (6-8 years old) June 23 - 27Half Day Camp (6-8 years old) Aug 11 - 15Full Day Camp (9-12 years old) Jul 14 to Jul 18
Amt #2
T-Shirt Size #2*
Does Camper #2 have any allergies, chronic illness, medical conditions or special support needed? If yes, please describe below.
Med #2*
Another Camper?

YESNO

Camper #3 Information
Name #3*

First NameLast Name
Grade #3*
This is the grade the camper will be September 2025
Birth Date #3*

MonthDayYear
Session for #3*

Half Day Camp (6-8 years old) June 23 - 27Half Day Camp (6-8 years old) Aug 11 - 15Full Day Camp (9-12 years old) Jul 14 to Jul 18
Amt #3
T-Shirt Size #3*
Does Camper #3 have any allergies, chronic illness, medical conditions or special support needed? If yes, please describe.
Med #3*
Another Camper?

YESNO

Camper #4 Information
Name #4*

First NameLast Name
Grade #4*
This is the grade the camper will be September 2025
Birth Date #4*

MonthDayYear
Session for #4*

Half Day Camp (6-8 years old) June 23 - 27Half Day Camp (6-8 years old) Aug 11 - 15Full Day Camp (9-12 years old) Jul 14 to Jul 18
Amt #4
T-Shirt Size #4*
Does Camper #4 have any allergies, chronic illness, medical conditions or special support needed? If yes, please describe.
Med #4*
Another Camper?

YESNO

Camper #5 Information
Name #5

First NameLast Name
Grade #5*
This is the grade the camper will be September 2025
Birth Date #5*

MonthDayYear
Session for #5*

Half Day Camp (6-8 years old) June 23 - 27Half Day Camp (6-8 years old) Aug 11 - 15Full Day Camp (9-12 years old) Jul 14 to Jul 18
Amt #5
T-Shirt Size #5*
Med #5*

Do you need financial assistance to attend the summer camp?*

YesNo

Financial support for summer camp is awarded based on need. Please explain any special circumstances.*
Select all that apply*

Receive support from Generous Hands, Inc (GHI)Receive support from South County Community Services (SCCS)Receive WIC/EBT or other similar supportNone of these
The normal registration fee for the Junior camp is $85 and the Kids Camp is $165. To provide access to as many children as possible, we ask you to contribute what you can to the registration fee. What total amount can you contribute towards the registration fees for your camper(s)?
Amt to Contribute*
Scholarship Amount*

Just one more question! How did you hear about the Summer Camps program?
Facebook or InstagramSouth County NewsGoogle AdE-newsletterMy child's schoolDirect email from Vicksburg ArtsWord of mouthPrinted flyer

Payment
Total
To print a copy of this entire application, click the PRINT button below prior to clicking on the SUBMIT button.
Amount Due

prevnext( X )
USDCamp

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Camper #1 Information

Camper #2 Information

Camper #3 Information

Camper #4 Information

Camper #5 Information

Payment