Art With Heart Camp Registration

Child's Name

Child's Age

Child's Date of Birth

Last School Grade Completed

Legal Guardian

This address will receive a confirmation email

Home Phone

Cell Phone

Address

Payment $20.00

Please List the three following classes in order of preference. These are our Slot A Classes, and your child will be assigned one each week.

Arts & Crafts

Drawing & Painting

Ukulele & Drums (10 -12 year olds only)

Slot A Class Preference:

Please List the three following classes in order of preference. These are our Slot B Classes, and your child will be assigned one each week.

Puppet Theater
“What Do You Call That Dance?”
Folk Art

Slot B Class Preference:

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

Yes No

Does your child have any food allergies or special needs?

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 7-12, and comes with a $20 registration fee.

Art With Heart Camp Registration

Description

Please Fix the Following