Salem MSOA Application - Summer 2018
Salem MSOA offers Summer Camp the week of July 16th, Monday - Wednesday, with an art exhibit on the last day, after class concludes
- Painting and Drawing for Age 10 - 17 Years Old
- Painting, Drawing, Crafts for Age 7-9 Years Old
10 a.m. to 1:30 p.m. with a break for lunch

Cost is $200 per student, all supplies included.
A deposit of $35 is due at Registration to secure your spot. Balance is payable by the first day of camp.
When you submit this registration form, we will email you with the total due and instructions to remit deposit. :-)

Student Last Name *
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Student First Name *
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Student's Birth Date *
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Student Email
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Parent 1 Last Name *
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Parent 1 First Name *
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Parent 2 Last Name
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Parent 2 First Name
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Parent 1 email *
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Parent 2 email
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Parent 1 Daytime Telephone *
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Parent 2 Daytime Telephone
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Home Street Address for Mail *
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Home City/State *
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Home Zip Code *
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Emergency Contact 1 Name & Phone # *
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Emergency Contact 2 Name & Phone #
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Track Student plans to Attend this Summer *
Student is interested in these subjects / media this summer: *
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DISCOUNT CODE (if any):
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Please explain any student allergies or medical conditions we need to know about.
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Please Choose One Option: *
How did you hear about MSOA? *
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