Clone of Summer Camp Detailed Registration Form

Camper's Name 1

First NameLast Name

Camper's Name 2

First NameLast Name

Camper's Name 3

First NameLast Name

Ages

Gender

T-shirt size (Youth)

YesNo

Parent/Guardian Information

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Number

Format: (000) 000-0000.

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed any medications? If yes, please explain any instructions.

YesNo

Camp Weeks - Sibling Discount ($20) reflected in multiple children registration

Mixed Media Madness: Collage, Paint, Material and More- June 8 - 12

M - F 2:30am - 5:30pm

Ages: 13-17

Learn new techniques to build your mixed media artwork through college, paint, stencils, stamping, Gelli plating and more. Snacks and T-shirts provided.

$165.00 Quantity

Rise Above - 3D Art on Canvas - June 15 - 19

M - F 2:30pm - 5:30pm

Ages: 13-17

Build up your canvas with modeling paste, clay and objects around the room to convert your canvas from 2D to 3D and reach out to touch the viewer.

Snacks, and T-shirts provided.

$165.00 Quantity

Color Pencil Magic: Developing Drawing Skills using Colored Pencils - July 6-9

M-Th 2:30pm -5:30pm

Ages: 13-17 Learn basic drawing techniques using colored pencils. Learn to layer, shade and blend to get an unbelievable piece of artwork to be proud of.

Snack will be provided. **T-shirts are provided.

$165.00 Quantity

Color Blast: Customize Clothing With Art, Tie Dye, Paint and Iron-Ons July 13 - 17th

M-F 2:30am- 5:30pm

Ages 13-17

Take your clothes from ordinary to extraordinary, by using tie dye, bleach, fabric paint and Iron-Ons. Student will be provided a T-shirt to T-dye and paint on. If desired more items to accessorize student needs to bring shoes, jeans, or other shirts.

Snack and T-shirt will be provided.

$165.00 Quantity

Brushstrokes and Beyond, Watercolor, Acrylics and Oils July 27 - 30

M - Th 2:30pm - 5:30pm

Ages: 13-17

This week will be dedicated to teaching the essentials of painting using each medium, watercolor, acrylic and oil paints. The student will have many pieces of artwork that they can be proud of with very different techniques.

Snacks and T-shirt provided.

$165.00 Quantity

Total

$0.00

Credit Card

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Signature

Teen Summer Camp Registration

Camper Information

Credit Card