Creative Arts Camp Registration

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Event Timing: June 23-27, 2019, 5:30-8:45 pm
Event Address: 14506 E. 39th St., Independence, MO 64055
Contact Kathy Vest @ createartcamp@gmail.com

Student's Name: *

Birth Date: *

YYYY

Grade Fall 2019 *

Street Address: *

City/State/Zip *

Parent's Name: *

Parent's Phone Number during camp hours: *

Email *

Other contact name: *

Other contact's phone: *

Who will pick student up?

Does student have any allergies? *

Yes

If you answered yes above, please list allergies:

What school does student attend? *

What church does student attend, if any?

Class Choices

Please choose 3 classes and one alternate. Class choices are as follows:
Beginning Ukulele, Drums Routine, Musical Theater, Handbell Chimes, Creative Weaving, Artists' Workshop, Drama Skits, Puppets, Creative Dance, Hip Hop Dance, TWIGS, Sign Language

1st Class Choice *

2nd Class Choice *

3rd Class Choice *

Alternate Class Choice *

Prepayment of camp registration fee is required. Payment must be made by June 20th to hold your registration. If you would like to pay online, click below. *

https://squareup.com/store/christ-united-methodist-church-4 (you will be redirected to Square to pay). After paying, return to this page to submit registration.

I will mail a check. Payable to CUMC; mailed to 14506 E. 39th St. S., Independence, MO 64055; CAC in memo line

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