Summer Art Camp 2017
Registration Form for Art Camp: Registrations must be received by the Tuesday before the week of camp you want your child to attend
Camper Last Name
Your answer
Camper First Name
Your answer
What grade will your camper begin in the Fall of 2016?
In order to attend camp, campers must have completed a year of Kindergarten. Some children may be attending a second year of kindergarten. These campers are still qualified to attend camp, as long as they have had a full year of Kindergarten!
Camper Age
Parent 1
Your answer
Parent 2
Your answer
Home Phone
Please enter number without spaces or dashes EX: 7405924981
Your answer
Cell Phone of Parent 1
Please enter number without spaces or dashes EX: 7405924981
Your answer
Work Phone
Please enter number without spaces or dashes EX: 7405924981
Your answer
Cell Phone of Parent 2
Please enter number without spaces or dashes EX: 7405924981
Your answer
Email of Parent 1
Your answer
Email of Parent 2
Your answer
Home Address
Your answer
Your answer
Name of Emergency Contact 1
Your answer
Phone Number of Emergency Contact 1
Please enter number without spaces or dashes EX: 7405924981
Your answer
Name of Emergency Contact 2
Your answer
Phone Number of Emergency Contact 2
Please enter number without spaces or dashes EX: 7405924981
Your answer
Your answer
Physician Number
Please enter number without spaces or dashes EX: 7405924981
Your answer
Dentist Name
Your answer
Dentist Number
Please enter number without spaces or dashes EX: 7405924981
Your answer
Camper T-Shirt Size
Our t-shirts are off white (non-bleached fabric) with a yearly camp design. The brand we get tend to run a little big in the youth sizes.
We welcome children of all abilities and needs!
Making us aware of any specific needs your camper may have will help us ensure a successful camp experience. Please list any known allergies/other conditions
Your answer
Please carefully select the theme weeks you would like your camper to attend from the series to follow. Each theme is a week long, HALF DAY session, either morning or afternoon. Each theme session is $75.00 for members and $90.00 for non-members. There is also a one-time $25.00 registration fee.
Week 1 AM
Dates: May 22-26 Theme: Sweet Home Appalachia
Week 1 PM
Dates: May 22-26 Theme: A Summer Abroad
Week 2 AM
Dates: June 12-16 Theme: Wizards!
Week 2 PM
Dates: June 12-16 Theme: Mythological Creatures
Week 3 AM
Dates: June 19-23 Theme: A Viking Voyage
Week 3 PM
Dates: June 19-23 Theme: The World of Ancient Egypt
Week 4 AM
Dates: June 26-30 Theme: Funky Fibers – Threading Together
Week 4 PM
Dates: June 26-30 Theme: Props to That! – Accessories for Play
Week 5 AM
Dates: July 10-14 Theme: Cats Vs. Dogs
Week 5 PM
Dates: July 10-14 Theme: Endangered Animals
Week 6 AM
Dates: July 17-21 Theme: A Galaxy Far Far Away…Jedi Camp
Week 6 PM
Dates: July 17-21 Theme: Super Heroes/Villains
Week 7 AM
Dates:July 31-Aug 4 Theme: Micro – It’s the Little Things
Week 7 PM
Dates: July 31-Aug 4 Theme: Macro – The Big Picture
Week 8 AM
Dates: August 7-11 Theme: Take Me There -Vehicles
Week 8 PM
Dates: Aug 7-11 Theme: The Art of Story Telling
Week 9 AM
Dates: Aug 14-18 Theme: The Art of Science
Week 9 PM
Dates: Aug 14-18 Theme: The Science of Art
Please select the weeks you would like to utilize our after care service this summer. Aftercare is from 4:00-5:00 daily and costs an additional $25.00 per week.
Week 1 May 22-26
Week 2 June 12-16
Week 3 June 19-23
Week 4 June 26-30
Week 5 July 10-14
Week 6 July 17-21
Week 7 July 31-August 4
Week 8 August 7-11
Week 9 August 14-18
Permission and Release:
Enter your name in the space below, along with today's date. This will act as your legal signature for the following questions.
Your answer
I understand that the name written in the previous space represents me and is my legal signature. I am stating that I am a parent or legal guardian of the camper named in this registration form. I understand that when I click "I agree" in the next questions, I am officially signing my name and agreeing with the Dairy Barn's terms.
In case of injury or Illness:
By clicking the accept box, I state that In case of accident or serious illness, I request that I/we be contacted. I give permission for emergency medical treatment and to be transferred to the nearest medical facility. I agree to assume all costs related to such treatment and I release the Dairy Barn from any responsibility for injury or illness that may occur while my child participates. I also give permission for my child to participate in The Dairy Barn Summer Art Camp.
Photography Release
The Dairy Barn respects your parental rights! We love Camp publicity, but we understand not all parents are comfortable having their children’s photos published. Photographs may be taken by Dairy Barn staff and used on the Dairy Barn website, Facebook page, or in teachers personal portfolios or personal social media pages. Photos may also be taken by local news media and used in newspapers and on their websites. If you want to allow photos of your camper to be used, click "Allow". If you do NOT wish you camper to be photographed, click "Don't Allow"
Parent and Camper Acknowledgement:
(After Reading Handbook) By agreeing to this acknowledgement, I state that I have thoroughly read and understand my duties and responsibilities as outlined in Summer Camp 2017 Parent/Camper Handbook. I understand that I will be held to these rules and guidelines and will be charged additionally if I fail to adhere to camp pick-up times clearly stated in this handbook. I understand that my child will be held to the Full Value Contract and will be expected to show good behavior and respect for all instructors, assistants and other campers. My child may be terminated from camp if there are severe behavior and respect issues that consequences and counseling do not resolve. I MAY receive a partial refund at the discretion of the Education Director.
Payment Options
Please indicate how you would like to submit your payment. To pay online, follow the link below this embedded form (The big friendly Yellow Button!) If you would like to send a check, please write: SAC (Summer Art Camp) for ___________ Your Camper's first and last name in the memo section. For Example: SAC for Atticus Stanton. If you are arranging with Lyn to pay in person, just select "Pay in Person".
This Form is now complete
To pay online, follow the link (the big friendly yellow button!) below this form on the webpage to our online Gallery Shop. Select the "Shop Items" in this case Summer Art Camp that apply and enter the appropriate quantities. You will need to select one "Registration Fee" Item, then however many themes you selected for your camper under the appropriate member, or non-member category. Remember, each half day week long session is a theme, or individual quantity in your cart.
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