Summer Camp Week 3 – Age 5-8

Summer Camp Week 3 - Age 5-8

Camper's Information:

First Name

Last Name

Date of Birth

Age

T-Shirt Size

Parent's Information:

First Name

Last Name

Address

City

State

Zip Code

County

Home Phone

Day Phone

Emergency Contact

Relationship

Emergency Contact Phone

Acknowledgement of Responsibility

I agree to sign my child(ren) in to camp each morning and out at the end of each day. I agree to pay a penalty if I am late picking up my child(ren) from camp. Late fees are accessed when I pick my child(ren) up past 6:00 p.m. Fees are $5 for every 15 minutes past 6:00 p.m. and are payable directly to the facilitator

Does your child have any allergies? If yes, please list them.

Does your child have any special dietary needs? if yes, describe in detail below

Please describe any behavioral, developmental, or learning disabilities your child may have.

List all prescription medications ART Station may/will be required to administer, along with the correct dosages and times scheduled.

What phone number is the best & fastest way to reach you during the time period of 8 a.m. to 6 p.m.?

Name of Physician/Pediatrician:

Phone Number

Authorization to treat

I hereby authorize the ART Station camp staff to act on my behalf in the event of a medical emergency involving my child, and to call Emergency Service (911).

Child's Name

Age

Parents' Names

Daytime Phone Number

The following people may pick up my child/children from Youth Performance Company or Youth Arts Camp:

Name

Relationship to child

Phone Number

Name

Relationship to child

Phone Number

Name

Relationship to child

Phone Number

Please list all emergency contacts, including name and phone numbers

Publicity Acknowledgement

I understand that photos taken of my child in ART Station Summer Camp Activities and Performances may be used for publicity purposes.

By entering my full name, I hereby agree to all ART Station policies and I confirm that all the information I've entered is accurate.

After submitting the registration forms, click the button below to pay for your registration

If you’d like to pay a deposit of $75 now and pay the balance prior to the beginning of the camp, please contact the Box Office at (770) 469-1105 or by email at boxoffice@artstation.org.

5384 Manor Drive

(770) 469-1105

Tue-Fri 10a-5p Sat 1a-5p