Summer Camp Registration Form

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Required fields*

Email *

Enrollment: Which option(s) do you choose? * *

Camp program (8:30 - 3 pm); ($225 total; $50 due by 5/1 to hold your space in a class; an additional $75 due by 7/1, and final 100 due by 8/1)

Enrichment aftercare: (3 pm up to 6 pm) ($75 due by 8/1)

Early Bird Special ($195 for the camp program; due with registration)

Required

Student Information

Student's First Name *

Student's Last Name *

Age *

Student's Birth Date (if Child) *

YYYY

Gender

Male

Female

Prefer not to say

Clear selection

Proposed Study: Core class: an immersion instruction with morning and afternoon classes each day (total of 2 ½ hours/day)Indicate first and second choice. The number of students per class is limited to provide quality instruction. *

Musical Theater/Voice

Guitar (Instrument Provided)

Violin (Instrument Provided)

Sculpture

Does your child have prior instruction in these areas? Provide the number of years: *

Elective Class: Enjoy a class (60 minutes) in another field (Indicate 2) *

Drawing

Drums (Instrument Provided)

Guitar (Instrument Provided)

Dance (All Styles)

Student׳s Contact Information: Mailing Address, City. State, Zip *

Parent's First Name *

Parent's Last Name *

Parent's Email *

Parent's Phone (Mobile) *

Emergency Contact: Full Name *

Emergency Contact: Relationship to the Child *

Emergency Contact: Primary Telephone Number *

Would you like information about other ministries of Central Steele Creek Church?

Yes

Clear selection

If yes, do you have a specific request?

REQUIRED: I acknowledge that my registration is NOT complete until Central receives my REGISTRATION FEE of $30.I will be paying via the following method.

I am paying via the following method: *

Yes, I understand and I am paying online via the following link: http://bit.ly/30VaGEI

Yes, I understand and I am paying via check using the address noted below.

Release of images, videos, audio recordings, photos, and / or likeness

Photographs, video, and audio recordings of students may be used in promotional materials. These may include, but are not limited to, brochures, newspaper or magazine articles, DVD, Central Fine Arts Academy and/or the church website. Please be assured that minors will not be identified by name in any publication. By checking this release, I allow Central Fine Arts Academy to publish and release photo-graphs/recordings of my child and state that I understand that neither I nor my family will receive any form of compensation from said publication. I also hereby release Central Fine Arts Academy from all claims of every kind on account of such use.

Release of Images Agreement *

Yes, I am authorized to make this selection and grant permission for use by Central Steele Creek Presbyterian Church and its authorized affiliates.

REGISTRATION DEADLINE: Jun 30th - | Submit $30 registration fee using the following link: http://bit.ly/30VaGEI or sending a check. (Classes will be filled on a first come/first served basis.)

Online payment link: http://bit.ly/30VaGEI

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Make checks payable to:
Central Fine Arts Academy

Mail hard copy applications and all Academy correspondence to:
Academy Coordinator, Central Fine Arts Academy
9401 S. Tryon Street
Charlotte, NC 28273

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