Art With Heart Camp Registration

Art. With. Heart. Camp is for children ages 7-14, and comes with a $20 registration fee.

Child's Name

*

Child's Age

*

Child's Date of Birth

*

Last School Grade Completed

*

Legal Guardian

*

Email

*

This address will receive a confirmation email

Home Phone

*

Cell Phone

*

Address

*

Payment $20.00

Choose 2 Activities for Week 1

*

Please select all that apply.

Instruments/Creative Movements Graphic Novel Design Arts & Crafts Drawing/Painting

Choose 2 Activities for Week 2

*

Please select all that apply.

Drawing/Paiting Arts & Crafts Graphic Novel Design Instruments/Creative Movements

Parents’ Permission to use photos of their child for publicity via our website and social media?

*

Please select all that apply.

Yes No

Does your child have any food allergies or special needs?

*

Has your child recieved the full COVID vaccine?

*

Please select one option.

Yes No

Emergency Contact

*

Emergency Contact Number

*

Relationship to Child

*

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Art. With. Heart. Camp is for children ages 7-14, and comes with a $20 registration fee.

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