Arts Camp Registration Form
Please fill out this form and click submit.
Camper Information
Camper Name
*
Parents Email
*
This address will receive a confirmation email
Parents Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Date of Birth
Emergency Contact
Name of Emergency Contact
Relationship to Camper
Phone
Aurthorized Pick-Up
At the time of dismissal or in case of emergency, the following person has the authority to pick up my child.
Name
Phone
Email
My child has my permission to walk home at the end camp
*
Please select one option.
Yes
No
Select Option
Yes
No
Camper Medical Information
What allergies does the camper have?
What medications does the camper take?
What medical conditions does the camper have?
Submit
Description
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