Summer Art Camp Registration Form

Summer Art Camp Application
REGISTER BY JUNE 21ST FOR WEEK 1 AND JULY 2ND FOR WEEK 2! FIRST COME FIRST SERVED!

Click anywhere on the lessons below to see the videos and slideshows!
Camper Name*

First NameLast Name
Age *
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Mobile Phone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Camp Session*

Art Camp 1: Ages 5 to 14 - June 25-28, Tuesday to Friday 1:00 pm to 4:00 pmArt Camp 2: Ages 5 to 14 - July 9-12, Tuesday to Friday 1:00 pm to 4:00 pm
Medical Information
Does the camper have allergies including asthma?*
Please explain on the field provided including any food the camper is allergic to
Is the camper currently under medication? *
Please provide the details, the name of the medication and period of intake

Payment
$125 per week

You may submit your payment via CashApp or Paypal at the following links no later than June 21, 2024 for Week 1, and July 2, 2024 for Week 2. Only those paid by the due date will be fully registered. For the camp to make, there must be a minimum of 10 students and a maximum of 25 students. First come first served.

CashApp: $MistyGifford84

Paypal: paypal.me/mistygifford
Total amount to be paid:
I have paid in the amount of: *
I have paid via: *
I understand that by signing below, I release and waive, and further agree to indemnify or hold harmless Misty Gifford, the City of Burleson, Russell Farm Art Center, its individual members, agents, employees, and representatives thereof, as well as activity supervisors, from and against, any claim which I, any other parent or guardian, any sibling, the above-named child, or any other person, firm or corporation may have or claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries arising out of, during, or in connection with the child's participation in the activities (including all forms of transportation) or the rendering of emergency medical procedures or treatment, if any.

For questions or concerns, please contact Misty Gifford via email at:

misty.gifford@bisdmail.net
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Summer Art Camp Application