Registration Form Summer Art Camps 2020
Please fill out our registration form in it's entirety. Asterisk fields are required. Please give us as much information as you can so that we may help you child have the best experience at camp. At the end is our Parental Consent, Waiver and Release.
We're very happy to have you with us!
Child/Student
first name *
last name *
birthdate *
Parent/Guardian 1
first name *
last name *
email address *
home phone *
work phone *
cell phone *
Parent/Guardian 2
first name
last name
email address
home phone
work phone
cell phone
Address
street *
city *
state *
zip code *
The following individuals are authorized to pick-up my child at the end of the day:
first name *
last name *
relationship *
phone number *
first name
last name
relationship
phone number
Winter Holiday Art Camp: Please check the box below.
President's Week Art Camp: Please check the box below.
Spring Art Camp: Please indicate the week(s) you would like to register for:
Summer Art Camp: Please indicate the week(s) you would like to register for:
*
Required
Clear selection
requested Drop-In Day date(s)
Registration Fees
*
Before camp (8-9am)
Please note: we require 24 hrs notice to reserve before and aftercare.
*
After camp (3-5pm)
Please note: we require 24 hrs notice to reserve before camp and after camp.
*
If you would like to sign your child up for After camp, what time do you expect to pick your child up each day?
In case of emergency, please contact
(Parent/Guardian(s) will always be contacted first. Please provide contacts other than the parent/guardian(s) listed above.)
first name *
last name *
relationship *
phone number *
first name
phone number
last name
relationship
Child's doctor
first name *
last name *
phone number *
Allergies/Physical Limitations
Please let us know if your child has any allergies. We travel to the park or the Vivarium several times each week, a 20 minute walk each way, and expect that your child will be able to participate in this activity on his or her own, walking with our staff.
*
Learning Difficulties/ Special Needs
Does your child have any special needs or disabilities that it would be helpful for us to know about? If so, please let us know how we can best meet the needs of your child. *
Has your child had any educational counseling or testing that it would be helpful for us to know about? If so, please let us know how we can best meet the needs of your child. *
Has your child had any change in family situation or an illness that it would be helpful for us to know about? If so, please let us know how we can best meet the needs of your child. *
first name *
Parental Consent, Waiver, and Release
Please read carefully, as this electronic signature is a binding agreement between you and Beth Hird/Dancing Paintbrush Studio. I hereby give permission for my child, _____________________, to participate in Dancing Paintbrush Studio Summer Art Camp, and I hereby execute the Agreement, Waiver, and Release, below, on his/her behalf.

1) I state that said minor is physically able to participate in said activity. If our staff finds that full disclosure of information about their camper has not been made, we reserve the right to contact the parent, inform the parent that the camper may not return to camp, and no tuition refund will be made.

2) I am aware that Dancing Paintbrush Studio teachers and staff will be driving my child to field trip locations using private vehicles.

3) In the event of an accident or illness, I understand that every reasonable effort will be made to contact the parent / guardian immediately. However, if I am not available, I authorize Dancing Paintbrush Studio teachers to secure emergency medical care as needed. Although I understand that Dancing Paintbrush Studio will make every reasonable effort to provide safe environment, I am fully aware of the special dangers and risks inherent in participating in the activity, which may include physical injury or other consequences arising or resulting from the activity. Being fully informed as to these risks, I hereby consent to the student participating in the activities mentioned above. I hereby agree to indemnify and hold Beth Hird, her staff, and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense that they may incur as a result of the death or any injury or property damage that said minor may sustain while participating in said activity.

4) I give permission to photograph my child’s image, likeness, or depiction for use in advertisement in print and electronic media. I further waive any claim for compensation of any kind for use or publication of photographs.

I have carefully read this agreement, waiver, and release and fully understand its contents. I am aware that this is a release of liability and a contract between myself and Dancing Paintbrush Studio and I sign it of my free will.
last name *
relationship *
date *
Did you remember to submit your payment through Paypal? *
Payment MUST be made in order to hold your space. Payment may be made here: http://dancingpaintbrushstudio.com/summer-art-camp/registration/
Required
Please tell us how you heard about Dancing Paintbrush Studio Summer Art Camp
*
Required
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