Creative Art Start: Summer Art Camp

Application

please check where applicable

E-mail Address: *
Name of student *
Date of birth of student *
Parent(s) name(s) *
Address *
Home phone *
Emergency contact name and phone *
Childs Doctor/phone *
Required medication
Caretakers name
Session 1 - Jun 14 - 18 (full day only)	Full day only ($750)
Session 2 - Jun 21- 25 (full day only)	Full day only ($750)
Session 3 - Jun 28 - Jul 02 (choose mornings only or full day)	mornings only ($425 per week) full day ($750 per week)
Session 4 - Jul 6 - 09 (no class July 5)(choose mornings only or full day)	mornings only ($340 per week) full day ($600 per week)
Session 5 - Jul 12 - 16 (choose mornings only or full day)	mornings only ($450 per week) full day ($750 per week)
Further comments or questions?

* RRequired feilds