Multi-Arts Winter Camp,  2020                        
February 17-21
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Child's First Name *
Child's Last Name *
Age *
Date of birth *
Sex *
Parent / guardian names. & Cell phone. *
Optional, Work phone
Town *
Best way to contact you in an emergency *
Required
Emergency Contact name and phone number *
Does child has any life threatening allergies? *
Is there any information staff should know to help your child have a successful and fun day?
Does your child have an individual education plan, IEP?
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Does your child have a 504 plan?
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How did you learn about this program: *
“I give the Director and staff of the Multi-Arts Program permission to administer minor first aid to my child. Should more than a minor injury occurs, requiring emergency treatment, I give permission to the Director and staff to acquire emergency medical treatment (i.e. ambulance)”. *
Our pictures are a testimony of the rich environment your child enjoys at Multi-Arts and may stimulate a conversation with your child about their social and artistic experiences.  These pictures are also an important means to promote Multi-Arts.  I respectfully ask you to read and sign the following authorization.       I grant Multi-Arts permission to take photographs and/or videotape my child during the program’s activities. I understand that these may be used in future brochures, publicity materials, and on the website. The name of your child will not appear with the images.   No profit will be made from the images. *
Payment Method *
You can either mail in a check to PO Box 108, Hadley MA 01035 or pay online via Paypal  http://www.multi-arts.org/payment.html
Submit and pay online or send check to Multi-Arts - PO Box 108 - Hadley, MA 01035.
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