Summer Camp Session *

July 10-12 : Art & Photography

July 24-26 : Music

Aug 7-9 : Art & the Community

Participant Name *

First Name

Last Name

Parent / Legal Guardian's Full Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

(###)

###

####

Work Phone

(###)

###

####

Cell Phone / Pager

(###)

###

####

Sex of Child *

Male

Female

Birth Date of Child *

MM

DD

YYYY

Do you give permission for photographs of your child to be taken? *

Photographs of camp participants may be taken for publicity purposes.

Yes

No