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Summer Art Camp 2022 - Camper Information Form
Thank you for signing up for a Summer Art Camp at The Westmoreland Museum of American Art!
Please complete this form at least one week prior to the beginning of the camp.
Contact Michael Carsone at
mcarsone@thewestmoreland.org
with questions.
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Please check the camp session that you registered for:
*
Week of June 13 (ages 7-12)
Week of June 26 (ages 13-17)
Shutterbugs Photography - Six Saturdays, July 9-Aug 13 (ages 5-9)
Shutterbugs Photography - Six Saturdays, July 9-Aug 13 (ages 10-14)
Shutterbugs Photography - Six Saturdays, July 9-Aug 13 (ages 15-17)
Required
Camper Information
Name of Child
*
Your answer
Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Parents' Names
*
Your answer
Home Phone
*
Your answer
Alternate Phone - Parent 1
Your answer
Alternate Phone - Parent 2
Your answer
Email
*
Your answer
Allergies/Special Needs/Behavior Diagnoses/Additional Comments
Your answer
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