Teen Arts Camp (Ages 13 – 16)

Registration Form

Students Name:  ______________________                      Date of Birth: ____ / ___ / ____   

Parent(s) Name:  ______________________________________________

Address:  _________________________________________________

City:  __________________________  State:  ______  Zip:  ____________  County:  _____________

Phone (daytime):  _____________________  Phone (evening):  _________________

E-mail:  ______________________________________________________

Emergency Contact:  ________________________________  Phone:  _________

Relationship:  ________________________________________________

I agree to the terms and conditions outlined in this brochure & understand that absolutely no refunds will be made after May 13, 2011.

I (Parent/Guardian) _________________________ agree to provide health forms and emergency information prior to my child(ren) attending an ART Station program. I also agree to sign my child(ren) in to camp each afternoon and out at the end of each day. I agree to pay a penalty if I am late picking up my child(ren) from camp. Late fees are accessed when I pick my child(ren) up past 6:00 p.m. Fees are $5 for every 15 minutes past 6:00 p.m. and are payable directly to the facilitator.

Parent/Guardian Signature:________________________________

_____ Teen Arts Camp                                  Tuition:_________

_____  I want to purchase a family membership to qualify for Member rates.  (Add $35 to total)

_____  I am an ART Station Member & qualify for the Member rates. (Membership must be current during camp.)

_____  I am not an ART Station Member & will pay the Non-Member rates.

Total Tuition ___________

Registration Fee $20.00

Family Membership ___________

Total Due ___________

$50 Deposit Required  $50.00   

Balance Due ___________

Weekly tuition is due the Monday your child(ren) begins Teen Arts Camp.  The $50 non-refundable deposit is required for each camper to secure a place in Camp.  Sibling discounts are available at $10 off per additional siblings.

_____         I am enclosing a check in the amount of $_________________.

_____         Please charge my credit card account for $________________. 

            Circle One:           MC   VISA    AMEX    DISCOVER   

Account #:______________________________________     Exp. date:______

Signature:  _________________________________________________