Student's name (first and last)

Student's Gender

male
female

Student's grade in Fall 2019

1st
2nd
3rd
4th
5th
6th
7th
8th

Please list any allergies or medical conditions for this child

Second Student's Name (first and last)

Second Student's gender

male
female

Second Student's grade in Fall 2019

Please list any allergies or medical conditions for this child

Parent's name

Contact email (All correspondence will be via email. You will receive updates as the time for camp approaches.)

Daytime phone

Emergency contacts & phone numbers

In case of minor cuts or scrapes, I authorize Asheland Studios to use an antibacterial spray with a bandage.

yes
no, please use a bandage only

In the event of a serious emergency and an emergency contact listed above cannot be reached in a timely manner, I authorize Asheland Studios to contact paramedics to transport my child to the nearest hospital for treatment. I understand that any medical bills incurred will be my responsibility to pay in full.

yes
no

Disclaimer: I understand that by submitting this registration, I am releasing Asheland Studios, Inc. and all other staff and affiliates from any and all liability for personal injury and/or property loss and damage which my child may incur as a result of participation in art camp. I also understand that by registering my child for camp I give my permission for any photos/videos taken during camp to be used for promotional and educational purposes.

Camp fees will be billed separately via email from PayPal and are due upon receipt to secure your child's spot in art camp.

Questions or comments?

Please click on the Submit button below. Your information will not be properly submitted until you click on the Submit button. If you do not receive an invoice from PayPal within 2 days, your registration was not properly submitted and we kindly ask that you please try again.

YOU MUST CLICK ON THE SUBMIT BUTTON BELOW FOR FORM TO BE SUBMITTED