2019 Summer Camp Registration
Please complete the form below, when finished, make a payment through the provided button on the Camps page of the website. If you are paying for multiple weeks you will need to edit the amount field to reflect the total payment needed. You will receive a receipt from PayPal with record of your transaction and we will reach out to you about next steps. You can also sign up and make a payment at a later date as long as it is before 4/1/2019. Payment per camp is $380 before 3/1/2019 and $430 after 3/1/2019. A fee will be held of $150 if a cancellation is made after 4/1/2019. There is no refund after 5/1/2019.
Email address *
Film & Story Summer Camp at St Alban's
Camper Info
Camper's Name *
Your answer
Have you read the payment and refund policy above? *
Required
Gender *
Age *
Your answer
Birthdate *
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Physician Name *
Your answer
Physician telephone *
Your answer
Medical plan and policy # *
Your answer
Allergies, physical or medical limitations or anything else you would like me to know. *
Your answer
Your child's interest and experience
wish they had more experience
wish they had more interest
Family's interest
One of Child's favorites
making projects by hand
film making
Attending Art Museums
Fine Art
critical thinking skills
Camp Sessions
Camps are $380 per week until 3/1/19. After 3/1/19 all camps cost $430. The last day to cancel is 5/1/19. If you cancel after 4/1/19 $150 will be held from your payment. No refund will be issued if you cancel after 5/1/19. Please select the camp your child wishes to attend. If you wish to attend more than one you will need to adjust your payment accordingly.
Please select a desired date and camp. *
Required
Parent / Guardian #1 *
Your answer
Parent / Guardian relationship Info
Email Address *
Your answer
Home Address *
Your answer
Primary Phone *
Your answer
Is it okay to Text Primary phone *
Parent / Guardian #2
Your answer
Email Address
Your answer
Home Address
Your answer
Primary Phone
Your answer
Is it okay to Text Primary phone
Persons authorized to pick up child from camp, please provide their name telephone *
Your answer
INDEMNIFICATION, WAIVER AND RELEASE:
By entering your name on the line below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.
In consideration of my, or my child’s participation in MPHallDesign Camp, taught by Mason Hall, I agree to: *
Required
Signature *
Your answer
Date *
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CONSENT FOR EMERGENCY MEDICAL TREATMENT:
By entering your name on the line below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.
As parent or authorized representative of the child / student listed above, I hereby give consent to Mason Hall and or Piper Lemons to obtain all emergency medical care prescribed by a duly licensed physician for said child. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of the child named above. The undersigned further agrees that Mason Hall or Piper Lemons is not legally or financially liable for any claim rising from any consent given in good faith in connection with such advised treatment. This authorization and consent to treatment of said minor is given to Mason Hall and Piper Lemons and shall remain effective until December 31, 2019. *
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Name: *
Your answer
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