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Bottle Works Arts Academy Summer Program 2022 - Enrollment Form
Enrollment Form
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* Indicates required question
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Student's age at start of Academy (must be at least 9 years old)
*
Your answer
Student's Birthday- (note: student must 9 years-old or older by June 15, 2022
*
MM
/
DD
/
YYYY
Student's Grade Entering in Fall
*
Your answer
Student's School District
Your answer
Have you attended a Bottle Works Arts Academy in the past
Yes
No
Clear selection
Have you attended Camp BW in the past
Yes
No
Clear selection
Student's T-shirt Size
*
Your answer
Parent/ Guardian's Name
*
Your answer
Parent/ Guardian's email address
*
Your answer
Parent/ Guardian's phone number
*
Your answer
Parent/ Guardian's Address
*
Your answer
Secondary emergency contact
*
Name/ Relationship/ Phone number
Your answer
Additional emergency contact person
Name/ Relationship/ Phone number
Your answer
I give my Child/ Children permission to go on short walks around the Bottle Works, the Cambria City neighborhood, and the Honan Trail.
*
Yes
Required
Please list the adults who are allowed to drop off and/or pick up the student during the week of the academy
*
Your answer
Any additional information we should know about the student ?
Your answer
How did you hear about Bottle Works Summer Camp
Bottle Works Website
Facebook Post
Instagram
Email from Bottle Works
From A Friend
Other
Other:
Clear selection
If the camp week includes a field trip, do you give your child permission to attend? Please select yes or no. If you select yes, you the agree to the means of transportation and trip location.
Yes
No
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