Register Summer Art Camp 1

REGISTER SUMMER ART CAMP - 2024

SUMMER ART EXPERIENCE with Paul Iezzi

Session 1 - June 24th - 28th l 9:00 am - 12:00 NOON

Cost: $150 - first child l $125/each - additional children

REGISTRATION FORM

Please submit one registration form per child.

* Indicates required field

Camper's Name *

First

Last

Camper's Age *

Camper's Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent / Guardian Name *

First

Last

Parent/Guardian's Phone Number *

Parent/Guardian's Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Parent/Guardian Authorization to participate *

This camper has my authorization to engage in the activities of the Gallery 53 Summer Art Camp program.

Permission to use photograph *

I allow taking photography of this camper that can be used for Gallery 53’s Summer Art Camp portfolio or advertising.

Liability *

I release Gallery 53/Arts & Crafts Association of Meriden, Inc., and any of its volunteers, staff, or director for any responsibility in case of accident, illness, or injury during this camper's enrollment.

Please describe any special medical (i.e., allergies) or learning needs your child may have. By letting us know in advance, we can provide the best possible experience for your child: *

By clicking “submit,” I say that I am the parent and/or guardian of the minor named above and have the legal authority to execute the above release.

You will be redirected to a payment page where you can pay by credit card or PayPal.

Submit