Multi-Arts Winter Camp,  2019                        
February 18-22
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Email *
Register for: *
Register for *
Number of Days of Attendance *
Specify Days of Attendance *
Required
Child's First Name *
Child's Last Name *
Age *
Date of birth *
Sex *
Parent / guardian name *
E-mail address *
Cell phone *
Home phone
Optional, Work phone
Town-address *
Best way to contact you in an emergency *
Emergency Contact name and phone number *
Does child has any life threatening allergies? *
How did you learn about this program: *
“I give the Director and staff of the Multi-Arts Program permission to administer minor first aid to my child. Should more than a minor injury occurs, requiring emergency treatment, I give permission to the Director and staff to acquire emergency medical treatment (i.e. ambulance)”. *
I give permission to Multi-Arts to take photographs and/ or videotapes of my children that may be used in future brochures/ publicity materials and on the Multi-Arts website.  No profit will be made from these recordings, and the names of the children will not appear next to the images. *
Payment Method *
You can either mail in a check or pay online via Paypal  http://www.multi-arts.org/payment.html
Payment Confirmation *
Please write the check number or Paypal  email used below.
I will pay the amount of: *
Submit and pay online or send check to Multi-Arts - PO Box 108 - Hadley, MA 01035. If sending check, please email to info@multi-arts.org notice of registration.
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