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Mrs. Roam's Art Camp Registration 2019
Email address *
Secondary email address *
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Student Name *
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Student Age *
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Student School *
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Parent Name *
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Secondary Parent or Guardian Name *
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Parent Cell Phone *
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Secondary Parent or Guardian Cell Phone *
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Emergency Contact Name and Cell Phone *
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Which session(s) will your student be attending?
Please check all applicable boxes below:
June 10 - 14 Sessions
June 17 - 21 Sessions
July 22 - 26 Sessions
July 29 - Aug 2 Sessions
I give my permission for my child's photo to be used on Facebook/website page. *
TERMS & CONDITIONS: My family and I hereby waive and release Rebecca Roam, Mrs. Roam's Art Camp, the University City School District and their agents from claims for damages and/or injuries incurred while participating in or as a spectator of Mrs. Roam's Art Camp. Please sign below by typing your name. *
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A copy of your responses will be emailed to the address you provided.
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