Fall Art Camp Registration
Please fill out this form to register your child for the Museum of East Texas's Fall Art Camp
Ages 4-12, October 9-13, 9am-12pm.  Fill out a separate form for each child. 

Your spot will be reserved upon payment. 16 spots are available. $90 per student, museum members receive a 10% discount. 

Please call the museum at (936)639-4434 to make a payment over the phone, or stop by during business hours. (Tues-Fri 10a-5p, Sat-Sun 1-5p) No refunds. We apologize for any inconvenience. 
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Email *
Student Full Name *
Age *
Birthdate *
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Parent/Guardian Full Name
Parent/Guardian phone number *
Email address *
First Emergency Contact (Other than guardian/parent): *
Emergency Contact Phone number: 
 *
Allergies (Medication or Food): *
If yes, please list allergies and known reactions: *
Does the participant have and EpiPen *
Does the participant have asthma? *
If yes, does the participant have an inhaler? *
Please list any special needs we should be aware of: *
Immunizations including DPT or Tetanus current as of (10/1/23) *
PARENT/GUARDIAN AUTHORIZATION FOR EMERGENCY CARE: This health history accurately reflects the current status of the student list above. Student has permission to participate in all class activities except as noted by me or an examining physician. If I (or my emergency contact) cannot be reached in an emergency, I give permission to the Museum of East Texas and its agents to call 911. I understand the information on this form is confidential.  Please type parent/guardian name below as electronic signature.  *
Today's Date *
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Relationship to student *
Arrival/Departure Procedures
Participants with mobility issues may enter and exit using the front doors on the Plaza, or the south entrance on Paul Ave. Parking is provided in the north parking lot and on Paul Ave. 

The front doors will be open with additional limited parking in front of the Convention Center.

Please sign your students in 8:45 - 9:00, and sign them out by 12:15. If you will be late, please call the Museum at (936) 639-4434. The safety of your child is very important to us. Therefore we require that participants be picked up inside the building by parents/guardians or those designated below. 
Additional Pickup Person 1
Additional Pickup Person 2
Payment
Your spot will be reserved upon payment. $90 per student, museum members receive a 10% discount. 

Please call the museum at (936)639-4434 to make a payment over the phone, or stop by during business hours. (Tues-Fri 10a-5p, Sat-Sun 1-5p) No refunds. We apologize for any inconvenience. 
To receive a Member discount, please write name of eligible member:
A copy of your responses will be emailed to the address you provided.
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