No School Art Days & Spring Break

No School Art Days 2017-2018 & Spring Break 2018
Camper's Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender*

MaleFemale
Birth Date*

MonthDayYear
Please enter start date of camp*

MonthDayYear
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
E-mail*
Home Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Work Phone 2

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Emergency Number #2*

Area CodePhone Number
Health Information
Date of last tetanus shot
Any physical or other condition that would require special attention or medication while at camp?*
List any allergies (ex: bees,peanuts, dairy)*
Any dietary needs that we should know about?
I would like to receive your e-newsletter. Please add me to your mailing list.*

YesNo
Camper Photo Release
I agree that photos of my child can be taken on used on for Creative Roots newsletter, flyers and website. We do not post photos of children's faces, or tag children, on social media.*

YesNo
Please select the camps your child would like to attend*

October 13 – Clay FiguresNovember 3 - SewingNovember 8-10 - Flying CreaturesNovember 22 - Mini-House BuildingNovember 24 - Miniature Furniture BuildingDecember 18-22 - Winter Solstice Stories & ArtDecember 26-30 - PuppetryJanuary 15 - Peace FlagsJanuary 29 – Fiber ArtsFebruary 19 - Zen Tangles, Mandalas & YogaMarch 26-30 - The Imaginative World of Dr. SeussApril 13 - Sewing for MiniaturesInclement Weather - No School Camp Day
Before Care, Number of hours per week
After Care, Number of hours per week
Release of Liability and Refund Policy
Creative Roots Refund Policy

Payment for programs which are cancelled by Creative Roots at any time will be refunded in full.

Although we are unable to offer any other refunds, if your child is not able to attend ue to illness or unforeseeable circumstances, your family may be eligible for a credit towards other programs at Creative Roots. If your child prefers to register for another program at a later date, please contact Monique for other possible credit options.
In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. The camp carries secondary insurance. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites.

By submitting this form and entering your initials below, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18.
Please leave additional comments here:
Please sign below to indicate that you agree to the terms of release of liability and the refund policy.

Thank you
E-signature *

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My Products

No School Art Days$75.00

Quantity

Winter Break and Spring Break$325.00

Quantity

Winter Break - Week 2$280.00

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Total $0.00

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No School Art Days 2017-2018 & Spring Break 2018

Camper's Information

Parent or Legal Guardian Information

Emergency Contact Info

Health Information

Camper Photo Release

Credit Card