SUMMER CAMP REGISTRATION

Summer camp online Registration Form

Instructions:
All payment for the Summer Arts Camp can be made by using paypal.
To make your payment, go to paypal's main home page (www.paypal.com), and click on the "send" tab at the top of the page.

Type in the following email address: tyrockafellow@yahoo.com, and the amount of payment ($40.00 before May 20th, $45.00 after May 20th).
Hit the "continue" button.

Select the "Goods or Services" button (This will give you purchase protection!), then log in with your paypal login.

Once you log in, please type the following information into the "special instructions to seller":
**"SUMMER ARTS CAMP," child's name, your email address.**

Once you've finished, you can complete the registration form below!

Fine arts camp registration form

(PLEASE SUBMIT ONE FORM PER CHILD ATTENDING THE CAMP!) THANKS!

* Indicates required field

Student Name *

First

Last

What are you registering for? *

Date of Birth *

School District (or home-schooled) *

What grade will your child be in the Fall? *

Parent Name #1 *

First

Last

Phone Number #1 *

PARENT NAME #2 (If applicable) *

First

Last

Phone Number #2 *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent Email #1 (Primary email) *

Parent Email #2 *

Name of emergency contact (other than parent) *

First

Last

Emergency contact Phone Number *

Allergies/pertinent health information or any medical conditions? *

Do you consent to your child appearing in photographs (without any names or other specific identification), to be used strictly for arts camp publicity purposes (such as newsletters, emails, etc.)? *

Yes No

HAVE YOU ALREADY SUBMITTED YOUR PAYMENT FOR THE CAMP? (If NOT, please do so BEFORE hitting the "Submit" button on this form!) *

Yes - I have submitted payment! No - Oops! I'll stop and do that first!

Submit