You may download and print this form directly from the website, or send an e-mail to SummerArtsCamp.MaconGA{at}gmail{dot}com and we will send you a printer friendly version.
~ Registration Form ~
Camper Information {one
form per child}
Last
Name: _______________ First Name:
_______________ Nickname: _______
Gender:
Male Female {circle one} Birth Date: __________ Age
by June 1, 2017: _____
Current
Grade: _____________ School:
________________________________________
Allergies:
___________________________________________________________________
Parent or Guardian Information
Mother’s
Full Name: __________________________ Phone:
______________________
Father’s
Full Name: ___________________________ Phone:
______________________
Guardian's Full Name: _________________________ Phone: ______________________
Address: ____________________________________________________________________
Address: ____________________________________________________________________
E-Mail:
______________________________________________________________________
Emergency
Contact{s}: _________________________________________________________
Fee
$150/Week per Camper payable by
cash or check.* Payment is due at time of registration.
Week One
June 12th
through June 16th
Monday
through Friday 9:00 AM ~ 12:00 NOON
Last Day for Registration: June 5, 2017
Week Two
June 19th through June 23rd
June 19th through June 23rd
Monday through Friday 9:00 AM ~ 12:00 NOON
Last Day for Registration: June 12, 2017
Drop Off Information
Please
drive all the way up the driveway and drop your camper kid{s} off near the covered camp site. Please continue around the circle and exit carefully. You may arrive and drop off your camper
kid{s} fifteen {15} minutes prior to the beginning of camp class {no earlier
please!}. Kindly leave as soon as
possible to allow for more drivers up the driveway without gridlock. Camp class begins promptly at 9:00 AM.
Camp class ends at 12:00 NOON and camper{s} must be picked up no later than 12:15 PM or a minimum charge of $10 per fifteen {15} will be billed. For pick up, please proceed up the driveway in the same manner as during the morning drop off.
Terms & Conditions
Medical, Photo, Damage Release ~ My child has permission to take
part in all camp activities. I give camp
staff permission to seek medical treatment for my child in case of injury or
illness. I give permission for use of
photographs of my child for camp publicity.
I give permission to camp instructor/director to dispense non-aspirin
fever reducer pain reliever as considered necessary.
Privacy Statement ~ The information on this form is considered confidential and will not be released to any third party except for {1} assisting healthcare providers in the event that professional medical treatment is required; {2} complying with a court, legal or regulatory order; or {3} seeking reimbursement for returned checks or other similar credit and/or payment matters. We do not sell, lend, rent, or otherwise share your private information to third party vendors of mail, e-mail, or other marketing lists.
Cancellation Fee ~ There will be a $50 cancellation fee per child for any camp cancellations made five {5} days prior to the first day of camp for which your child or children are registered.
I have read and agree to the terms and conditions above.
Signature:
_________________________________________
Date: __________________
Location: 4860
Forsyth Road , Macon , GA 31210
Please make checks payable to Suzanne M. Rogers and mail to 4860 Forsyth Road , Macon , GA
31210
If you
wish, you may attach a photograph of your child so that we will recognize him
or her upon arrival!
Total Amount Enclosed:
_________________________ Check Number: __________
Thank
you and see you soon!
