Summer Art Camp 2019 - Camper Information Form
Thank you for signing up for a Summer Art Camp at The Westmoreland Museum of American Art!

Please complete this form at least one week prior to the beginning of the camp.

Contact Ann Gravelle at agravelle@thewestmoreland.org with questions.

Please check the camp session(s) that you registered for: *
Required
Camper Information
Name of Child *
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Parents' Names *
Your answer
Home Phone *
Your answer
Alternate Phone - Mother
Your answer
Alternate Phone - Father
Your answer
Email *
Your answer
Allergies/Special Needs/Behavior Diagnoses/Additional Comments
Your answer
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