ART Station

2016 Camp & Performance Company Registration Form

Pre-camp & after-camp care is available from 8:00 - 9:00 AM5:00 - 6:00 PM*.

Camper’s Name ______Date of Birth______

Age______T-Shirt Size ______

Parent(s) Name______

Address______

City ______State ______

Zip ______County______

Day Phone ______Home Phone______

E-Mail______

Emergency Contact______Relationship______

Day Phone______Cell______Home______

2016CAMPDATES

Youth Performance Co.Weeks1 & 2 June 6 - 17

Arts Camp Week 3June 20 - 24

Arts Camp Week 4June 27–Jul 1

Arts Camp Week 5July 11 - 15

Arts Camp Week 6June 18 – 22

Teen Performance Co.Week 7July 25 - 29

PROGRAMS

Select weeks. Circle Pre-camp care (PCC) or After-camp care (ACC). Enter tuition amount.

____Week 1 & 2 Youth Performance Company PCC/ACCTuition:______

____Week3 Youth Arts Camp Full DayPCC/ACCTuition:______

____Week 4 Youth Arts CampFull DayPCC/ACCTuition:______

____Week 5 Youth Arts CampFull DayPCC/ACCTuition:______

____Week 6 Youth Arts CampFull DayPCC/ACCTuition:______

____Week 7 Teen Performance CompanyFull DayTuition:______

Total Tuition ______

Registration _$20.00_____

Family Membership ______

Subtotal ______

Multi-Week Arts CampDiscount-_____

(# of weeks x $10)

Pre-CampCare ($10/wk per child):______

After CampCare ($10/wk per child):______

Total Due ______

$75 Deposit Required__$75.00_____

Balance Due ______

STAFF USE ONLY

AMOUNT PAID AT REGISTRATION:

AMOUNT DUE:

*$10.00 per child per week applies to Pre and after camp care.

A $75 non-refundable deposit is required for each student to secure a place in Camp.

A limited number of partial scholarships are available for eligible students attending multiple weeks (a minimum of two weeks) of Arts Camp or Performance Company. DeKalb County School System Vouchers are available from school guidance counselors at selected schools. Please callART Station for a Scholarship Application.

Complete membership and payment information below.

_____ I want to purchase a family membership to qualify for Member rates.

(Add $35 to total)

_____I am an ART Station Member & qualify for the Member rates.

(Membership must be current during camp)

_____I am not an ART Station Member & will pay the Non-Member rates.

_____I am enclosing a check in the amount of $______.

_____Please charge my credit card account for $______.

Circle One: MC VISA AMEX DISCOVER

Account #:______Exp. date:______

Weekly tuition is due the Monday your child(ren) begins Arts Camp and/or Performance Company and each Monday thereafter. The $75 non-refundable deposit will be applied to the first week’s tuition.

I agree to the terms and conditions outlined in this brochure & understand that absolutely no refunds will be made after May 23, 2016.

I (Parent/Guardian) ______agree to provide health forms and emergency information prior to my child(ren) attending an ART Station program. I also agree to sign my child(ren) in to camp each morningand out at the end of each day. I agree to pay a penalty if I am late picking up my child(ren) from camp. Late fees are accessed when I pick my child(ren) up past 6:00 p.m.Fees are $5 for every 15 minutes past 6:00 p.m. and are payable directly to the facilitator.

Parent/Guardian Signature:______

Mail completed form to:

ART Station

P.O. Box 1998

Stone Mountain, GA30086

or fax to 770-469-0355

QUESTIONS?

Call (770) 469 1105