Multi-Arts Winter Camp, 2017
February 20-24
Register for: *
Register for *
Number of Days of Attendance *
Specify Days of Attendance *
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Child's Last Name *
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Child's First Name *
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Age *
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Date of birth *
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Sex *
Parent / guardian name *
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E-mail address *
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Cell phone *
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Home phone
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Optional, Work phone
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Address *
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Best way to contact you in an emergency *
Emergency Contact name and phone number *
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Does child has any life threatening allergies? *
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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)”. *
Your answer
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. *
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Payment Method *
You can either mail in a check or pay online via Paypal http://www.multi-arts.org/winter-camp-2017.html
Payment Confirmation *
Please write the check number or Paypal email used below.
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I will pay the amount of: *
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Submit and pay online or print form and send with full payment of tuition 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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