SUMMER CAMP REGISTRATION FORM 2016
STUDENTS MUST COMPLETE REGISTRATION BEFORE ATTENDING CAMP
Student Name(s): ____________________________________________________________________
Date of Birth: ____________________________________
Parent/Guardian Name(s):___________________________Phone: ______________________________
Email Address: ________________________________________________________________________
Address / Street, City, State, Zip: __________________________________________________________
Emergency Contact: ____________________________________________________________________
Relationship: _________________________________________________________________________
Emergency Contact Home Phone: _____________________ Work Phone:________________________
Doctor / Pediatrician: ___________________________________________________________________
Pediatrician’s Phone: __________________ Pediatrician’s Address: _____________________________
Does your child have any allergies?: _______ If so, please list: __________________________________
How did you hear about Creative Arts Studio? _______________________________________________
1. Please check the location you would like your child to attend:
__ CAS I / Boerum Hill (310 Atlantic Ave.) or __ CAS II / Carroll Gardens (119 Union St.)
2. Please check the camp session(s) you would like your child to attend:
Summer Camp Fees
Registration: $25
Standard Weekly: $490
4 Weeks: $1,880
8 Weeks: $3,600
Early Drop-Off: $25/week
After Camp: $90/week
$25/day
Session I weeks of: Session II weeks of:
__ 7/11, __ 7/18, __ 7/25, __ 8/1 __ 8/8, __ 8/15, __ 8/22, __ 8/29
Session I Early Drop-off weeks of: Session II Early Drop-off weeks of:
__ 7/11,__ 7/18,__ 7/25, __ 8/1 __ 8/8, __ 8/15, __ 8/22, __ 8/29
Session I After Camp weeks of: Session II After Camp weeks of:
__ 7/11, __ 7/18, __ 7/25, __ 8/1 __ 8/8, __ 8/15, __ 8/22, __ 8/29
3. Please calculate your Summer Camp fee using the info to the right:
___ Camp Weeks + ___ Weeks of Early Drop-off + ___ Weeks of After Camp + $25 Registration = Total ____
Hours
Regular camp hours: 9am – 3pm
EARLY DROP-OFF: 8:30am (additional fee)
AFTER CAMP: 3 – 6pm (additional fee)
PAYMENTS & REGISTRATION
We accept Visa, Mastercard & Discover payable online or by phone
BY MAIL & WALK-IN: 310 Atlantic Ave, Brooklyn, NY 11201
BY TELEPHONE: (718) 797-5600
Please make checks payable to Creative Arts Studio
RELEASE AND WAIVER
The undersigned hereby waives and releases Sherri Hellman and the Creative Arts Studio from all claims as to any and all injuries that may incur or sustain at the Creative Arts Studio.
Student’s Name: ________________________________________________________
Gaurdian’s Name: _______________________________________________________
Address: _______________________________________________________________
Telephone: __________________________________
Signature: ___________________________________ Date: ______/_______/_______
_________I hereby grant permission to the Creative Arts Studio to take and use photographs/ videotapes of my child for the use of promotional materials for the studio.
_________ I hereby do not grant permission to the Creative Arts Studio to take and use photographs/videotapes of my child for the use of promotional materials for the studio.
Signature: ____________________________________ Date: _____/______/________
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