Summer Camp Registration Form

New Moon Art Studio Summer Camp Registration Form

Register your child for our summer camp (ages 5–13). Please complete all required sections. Contact us with any questions.
Camper Information

Please provide details about the camper.
Camper Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
T-shirt Size
Parent/Guardian Information

Primary contact for the camper.
Primary Parent/Guardian Full Name

First NameLast Name
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact

Contact in case of emergency (other than parent/guardian).
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number(s)
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information

Provide relevant health information to ensure camper safety.
Known Allergies?
Allergies (please list all known allergies)
Any Medical Conditions?
Medical Conditions (please describe any conditions)
Any Medication Currently Taken?
Medications Currently Taken
Physician Name

First NameLast Name
Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Health Insurance Provider
Policy Number
Permissions and Waivers

Please review and provide your permissions for New Moon Art Studio.
Transportation

Specify pickup and drop-off arrangements.
Drop-off / Pick-up Options
Names of Authorized Pickup Persons (if applicable)
Payment Details

Review camp fees and select your payment method.

Camp Fees and Payment

Summer Art Camp (Full)

June 15 - Jun19

$529.00

Summer Art Camp (Full)

June 22 - June 26

$529.00

Summer Art Camp (Full)

July 6 - July 10

$529.00

Summer Art Camp (Full)

July 13 - July 17

$529.00

Summer Art Camp (Full)

July 20 - July 24

$529.00

Summer Art Camp (Full)

July 27 - July 31

$529.00

Summer Art Camp (August 3 - August 7)

August 3 - August 7

$529.00

Enter coupon

Total

Credit Card

All payments are non-refundable.
Signatures

Parent or guardian signature is required to complete registration.
Parent/Guardian E-Signature
Date Signed

MonthDayYear
Date
Should be Empty:

New Moon Art Studio Summer Camp Registration Form

Camper Information

Parent/Guardian Information

Emergency Contact

Medical Information

Permissions and Waivers

Transportation

Payment Details

Camp Fees and Payment*

Credit Card

Signatures

Camp Fees and Payment