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:  ____________________________________________________________________

E-Mail:  ______________________________________________________________________

Emergency Contact{s}: _________________________________________________________


$150/Week per Camper payable by cash or check.*  Payment is due at time of registration.

2017 Camp Dates {circle one}

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  
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:  __________________

Camp Fee:  $150/Week per Child: ________________

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!