2021 ARTSCAMP Registration Form
Please complete this online form FOR EACH CHILD you wish to register for camp in its entirety.  All of the forms are due by the JUNE 4th.  

To secure your child's spot, the NON-REFUNDABLE amount must be paid via PayPal.

Here is a list of programs and pricing for the entire 4 week program:


1. MORNING ARTSCAMP ONLY- (8:45am-11:45am) - Students entering Grades K - 9th in September 2021

Price:  $750


2. AFTERNOON ONLY (1-5pm) Theater Production - Students entering Grades 3rd - 9th in September 2021 - SHOW ONLY- SHREK, Jr.

Price: $650

 
3. FULL DAY PROGRAM (8:45am-5pm) - Students entering Grades 3rd - 9th in September 2021-ARTSCAMP & SHOW - SHREK, Jr.

Price: $1,250
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CHOOSE 1 OPTION: *
Child's First Name *
Child's Last Name *
Child's Grade in September 2021 *
Child's Birth date *
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Home Address: *
School: *
Parent/Guardian Name *
Additional Parent/Guardian Name
Preferred Phone Number *
Preferred Email Address *
I understand that in order to secure my spot, my complete payment must be made at the time of registration via our PayPal link on our website. *
Required
I understand that all camp/show fees are NON-REFUNDABLE! *
Required
I understand that all campers will be required to submit a COVID Questionnaire DAILY and have their temperatures taken before they can enter the facility.   *
Required
I understand that all campers will be required to wear a mask throughout the day. *
Required
EMERGENCY INFORMATION
EMERGENCY RELEASE - PORT CHESTER COUNCIL FOR THE ARTS, INC. I hereby give my permission to the Port Chester Council for the Arts, Inc., its representatives or employees, permission to obtain medical treatment for my child(ren) in the case of any emergency.  I also grant the Port Chester Council for the Arts, Inc., its representatives or employees permission to take said child to Greenwich Hospital, Greenwich, CT, or White Plains Hospital, White Plains, NY, and obtain whatever emergency medical treatment may be deemed necessary by the physicians at said hospitals until I or another designated family member can be reached and/or arrives at said hospital. I agree to hold the Port Chester Council for the Arts, Inc., its representatives or employees blameless for any treatment or procedure performed at said hospital.  I also agree that neither I nor anyone on my behalf or on my child’s behalf shall prosecute any claim or course of action against the Port Chester Council for the Arts, Inc.  I UNDERSTAND THAT THE PORT CHESTER COUNCIL FOR THE ARTS, INC. WILL MAKE ITS BEST EFFORTS TO ADDRESS THE ALLERGIES OF ITS CAMPERS, HOWEVER, I UNDERSTAND THAT THERE MAY BE CIRCUMSTANCES BEYOND THE CONTROL OF THE COUNCIL AND ITS STAFF WHICH MAY INADVERTENTLY EXPOSE MY CHILD TO ALLERGENS, AND I AGREE TO HOLD THE COUNCIL AND ITS STAFF AND BOARD OF DIRECTORS HARMLESS FROM ANY INCIDENTS OF THIS TYPE WHICH MAY OCCUR WHILE MY CHILD ATTENDS ARTSCAMP 2021. I UNDERSTAND THAT I AM RESPONSIBLE FOR WHATEVER MEDICAL EXPENSES ARE INCURRED IN THE COURSE OF SUCH TREATMENT.
Signature for Emergency Release: *
Emergency Contact #1  - Name and phone # *
Emergency Contact #2 - Name and phone # *
List any other people that have permission to pick up your child: *
Child’s Physician *
Child’s Physician's Phone # *
Please list any medical limitations or allergies that your child may have:
Please add anything you would like us to know about your child, their health or their social/emotional well being.
COVID WAIVER
Waiver of Liability Relating to Coronavirus/COVID-19: I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may  be exposed to, or infected by, COVID-19. I understand that the risk of becoming exposed to or  infected by COVID-19 at ArtsCamp may result in actions, omissions, or  negligence of myself and others, including, but not limited to, ArtsCamp, Port Chester Council for the Arts, Inc. employees, contractors, volunteers, participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any  injury to myself (including, but not limited to, personal injury, disability, and death), illness,  damage, loss, claim, liability, or expense of any kind that I may experience or incur in connection with my attendance or my child’s attendance at ArtsCamp. On my behalf, I hereby release, covenant not to sue, discharge, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of ArtsCamp, Port Chester Council for the Arts, Inc. , its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after entering the ArtsCamp, Port Chester Council for the Arts, Inc., Crawford Park premises.
Signature for COVID Waiver: *
PHOTO RELEASE AND PARTICIPATION WAIVER
The undersigned, in consideration for participating in productions sponsored by the Port Chester Council for the Arts, Inc., hereby agrees to indemnify and to hold the Port Chester Council for the Arts, Inc., its officers, agents, designees and employees, harmless from any and all liability that results from being injured while participating in the above activity.The undersigned hereby certifies to the Port Chester Council for the Arts, Inc. that the participant is in good mental and physical condition, is in good health, and is otherwise able to participate in this activity.  The participant acknowledges that he/she will be solely responsible for the furnishing of all safeguards and appropriate clothing and equipment for protection against injury while participating in this activity.
Signature for Photo Release and Participation Waiver: *
To complete registration, click here to visit the PCCFA website to make payment: https://portchestercfa.org/summer-artscamp/
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