ArtSmart Camp 2023 Registration by Credit Card If you have any problems seeing the form below, please try refreshing the page. If this doesn’t work, please email email@example.com. Thank you very much for you patience and understanding. * denotes a required fieldCamper Name *Age as of 06/01/23 *List any allergiesDo you have any special directions regarding your child?Do you have an additional camper?YesNoAdditional Camper NameAge as of 06/01/23List any allergiesDo you have any special directions regarding your child?Do you have a third camper?YesNoThird Camper NameAge as of 06/01/23List any allergiesDo you have any special directions regarding your child?Do you have a fourth camper?YesNoFourth Camper NameAge as of 06/01/23List any allergiesDo you have any special directions regarding your child?Parent/Guardian Name *Email Address *Phone Number *Work Phone NumberStreet Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Please list at least one emergency contact other than yourself that we can contact if you are unreachable. There is space for two emergency contacts if you would like to add another.Emergency Contact Name *Alternate Emergency Contact NameEmergency Contact Relationship to Camper *Alternate Emergency Contact RelationshipEmergency Contact Number *Alternate Emergency Contact NumberPlease list the people allowed to pick up your child/children. We will not release your child to anyone not on this list. *ArtSmart Camp Rules Please check off each of the following Rules acknowledging you have read and agree to discuss/explain the following rules with your child prior to camp. Thank you!Our Campers will:1. *Listen to your teachers, follow instructions and classroom rules.2. *Respect and support your fellow campers. Everyone is different and will have strengths and weaknesses in different areas.3. *Do NOT touch anyone else’s art!4. *Try! Go for it….its your creative self, so you can’t mess up!5. *Maintain a Positive Focus: Our campers are expected to follow the Instructors so that they can get the most out of their time at camp and Maintain a positive attitude and interaction with all others involved in the program. Disruptive, distracting or problematic behavior that affects this learning environment will not be tolerated.6. *Respect All Other People's Personal Space. Keep hands, feet and all other objects to self.7. *Show respect for others: Campers will respect the rights and feelings of the other campers. Fighting, bullying, name calling, intimidations, bigotry of any kind, inappropriate language or any other form of emotional or physical abuse or unwanted contact directed to one another, Instructors or Volunteers, will not be tolerated and will result in immediate termination from the program and No Refund will be issued.*** Any camper who believes that he or she has observed or experienced prohibited behaviors should report it immediately to an Instructor/Director. ***8. *Respect our Locations/Venues: Campers will respect all facilities used during camp. Campers will pick up after themselves and work to keep the theater and classrooms clean.9. *Always be On Time10. *Do Not Leave Class Until Dismissed: Campers will not leave any session without permission. There may be times a camper needs a break from class because of stress or overstimulation. At these times, campers must request to leave class and will be escorted away from the group to recover by an adult.11. *Campers may not use cell phones or electronic games during classes. Parents please do not text or call campers during camp hours.12. *Dress Appropriately: Campers are expected to dress appropriately for all sessions. Items with provocative, offensive, violent or drug related pictures or slogans will not be permitted. Items advertising alcoholic beverages or tobacco products will not be permitted. Appropriate foot wear is always expected. No sandals, flip flops or bare feet will be allowed. Students should wear suitable shoes for movement such as tennis shoes.13. *Agree to Abide by the Three Strike Rule: Campers breaking any of the code of conduct rules will have the following disciplinary actions. The first instance: camper will be given a verbal warning by the Instructor. The second instance: camper will be given a verbal warning, and parent/guardian will be contacted. Third instance: camper will be dismissed permanently from camp and No Refund will be issued.14. *I understand the Sponsors and Staff of ArtSmart Summer Camp are not responsible for keeping track of or safety/functionality of any personal property campers bring to camp. This includes cell phones, video games, special art tools, clothing, lunch boxes, water bottles, toys, etc. I agree that I will not hold any Sponsor/Staff responsible for loss/damage to my child's items.Liability Waiver *I understand that my child's/children's participation in ArtSmart Camp can expose my child/children to dangers both from known and unanticipated risks. Acknowledging that such risks exist, I hereby release and discharge the Sponsors, its officers, agents, volunteers, and employees from any and all claims or liability for loss, personal injury, death or property damage my child/children may suffer while participating in the activity; including, but not limited to, any claim arising out of any condition of the premises at which the activity is held or the conduct of any person in connection with the preparation for, supervision of, or conduct of any activity, whether planned or unplanned. I specifically agree to release and hereby release the Sponsors and the officers, agents, volunteers, and employees of ArtSmart Camp for any negligence of the Sponsors, or its officers, agents, volunteers or employees. I agree to indemnify, defend, and hold harmless the Sponsors from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, death, or property damage from participation in ArtSmart Camp.COVID Waiver *With full knowledge of the risks involved, I hereby release, waive, discharge the Sponsors, their board, officers, independent contractors, affiliates, employees, volunteers, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by my child related to COVID-19 while participating in ArtSmart Camp and any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19. I agree to indemnify, defend, and hold harmless the Sponsors from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.I authorize the Sponsors to document my child's/children's participation in ArtSmart Camp in the manner selected below. I grant the Sponsors all rights to selected media and will receive no compensation in any form. All media will become the property of Sponsors and will be used for promotion purposes only. *PhotographsVideosNoneHow did you hear about ArtSmart Camp?Returning CamperFrom a Friend/Relative/Co-WorkerFacebookSchool SystemAbout MagazineFlyer/PosterTerms and Conditions I have read and reviewed camp rules with my child and understand that if my child cannot follow these rules, he/she is subject to dismissal from ArtSmart Camp with No Refund.I understand that payment in full is required to reserve space in ArtSmart classes and that after May 16, tuition is non-refundable.Select Payment Amount *ArtSmart Registration $1502 ArtSmart Registrations $3003 ArtSmart Registrations $4504 ArtSmart Registrations $600Total Payment$Credit / Debit Card *Card Number, Expiration Date (MM/YY), CVC (3 or 4 digits on back)All payments are processed through the secure Stripe payment processing system. 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