Artreach Summer Camp Registration 2022
Sign in to Google to save your progress. Learn more
Email *
Name of Child *
Age *
Date of Birth *
Gender
Clear selection
School
Grade   *
Address *
Ethnicity
Clear selection
Race
Clear selection
Child Uses
Clear selection
Parent /Guardian Information
Employer *
Parent/Guardian name: *
Address *
Phone *
Work Phone *
Cell phone number
Email *
2 parent/Guardian Name: *
Marital status
Clear selection
If divorced who has legal custody? * A court order is needed if parent is denied access to the child. *
I authorize the following people to pick up my child from the After school Program. All authorized persons MUST BE AT LEAST 16 years of age and be prepared to show PHOTO ID.
Medical Information
Allergies and Special Needs
Does your child have any allergies *
Please list allergies
Does your child take any medication? *
Please List Medications
Does Your child have any special needs? *
Required
Please Describe
Physician Information
Physician's name *
Office name *
Address of Office *
Phone Number
Fax Number
Please indicate if your child has a history of the following.
Clear selection
Conditions of Acceptance
Conditions of Acceptance
1. I agree to return all After School Program (ASP) enrollment forms to the Hamilton Hill Arts Center prior to my child(ren) starting Camp. Children may not participate in the After School Program until all forms are completed and on file with the Center.
2. I understand that any changes to my original registration must be submitted in writing.
3. I understand that the hours of operation for the After school program are Monday through Friday from 2:30p.m. until 6:00. Summer Camp Hours are 10am -3 p.m. Children are to be picked up by 6:00 p.m for afterschool program and 3:00pm for summer camp. *** A FEE MAY BE ADDED FOR LATE PICK UP
4. I understand that my child must comply with ASP rules and standards of behavior. I agree that the Center’s ASP Staff has the right to enforce appropriate standards of conduct and may dismiss a member who infringes on the rights of others.
5. I give my permission for the use of any photographs, slides or videotapes, which may contain my child, to be used in the Hamilton Hill Arts Center promotional materials as well as social media.
6. I give my permission for my child to be transported to and from ASP field trips and activities.
7. I certify that my child is capable of participating in ASP activities.
8. I grant the Hamilton Hill Arts Center and it’s agents full authority to take whatever action they deem necessary regarding my child’s health and safety and I fully release the Hamilton Hill Arts Center and it’s agents from any liability in connection with those decisions
Child's Name
Parent Signature (Type in your name here to signify your agreement with and understanding of the above statements)   *
Date
MM
/
DD
/
YYYY
The following information is for grant purposes. Please fill out these additional forms so that we can continue our  programing.
Please indicate if you have access any of these services:
Family of One ,Income size
Clear selection
Family of Two, Income size
Clear selection
Family of Three, Income size
Clear selection
Family of Four, Income size
Clear selection
Family of Five, Income size
Clear selection
Family of Six Income size
Clear selection
Family of Seven, Income size
Clear selection
Family of Eight or more, Income size
Clear selection
I am registering my child for *
Required
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Hamiltonhillartscenter.org. Report Abuse
Google Forms