Summer Art Camp Registration

Please provide the following information:

    Camper's Name:     

     Parent's Name:      

                Address:          

                       City:      State:  Zip:         

              Work Phone:      Home Phone: 

                       Email:   

    Camper's Birth Date:   

    Select your desired Camp Session for the appropriate age level:

          Ages 6 - 8  Session                                   Ages 9 - 13 Session

    August 2nd-6th                                         July 12th - 16th

    August 16th - 20th                                    July 26th - 30th

                                                                           August 9th - 13th

                                                                            August 23rd - 27th

Please provide the following EMERGENCY CONTACT during camp session:

    Name:      Emergency Phone: 

Please let us know of any food or drug allergies the camper may have in the space provided.  We have a snack time each day, so please be sure to inform us if your camper has any food allergies.  In the past, parents have sent a special snack with those campers with special dietary needs.