Cultivate Summer Camp 
Our Summer Vacation Programs are here! Students 6-12 and teens 13-18 can now spend summer vacation immersed in the arts. Cultivate’s classes and  programs are designed for students interested in developing skills, creativity, and self expression at any ability level. Each week will be packed with possibilities, imagination, and fun as students explore exciting activities each day: we will be hosting classes for two weeks with four hour time slots. Classes will be $150 a week. Please fill out the interest form below. 
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Students Name (First & Last) 
Parent / Guardians Name (First & Last)
Parent / Guardians Contact  (Email & Phone Number) 
Emergency Contact (Email & Phone Number) 
Age Group 
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Which week are you interested in? 
What types of interests does your student currently possess? (Can select multiple) 
Does your child have any allergies? If ‘yes’ please list (Each student will be given a snack per day) 
Does your child have any other physical or medical needs we should know about in order to better serve this student? 
Does your Student have any emotional/developmental needs or learning differences we should know about in order to better serve this student? What supports would you/the student benefit from while taking this class? i.g. reminders, physical supports, quiet time/breaks, etc.
I assume all risk of injury to my child or property connected with her/his/their participation in the program. I fully release Cultivate 7Twelve and its directors, agents, representatives, employees and contractors from any and all claims, suits, losses or expenses of any kind and from liability for injuries, death, losses and damages of any nature except only for such acts or omissions on Cultivate 7Twelve’s part that arise out of Cultivate 7Twelve’s  intentional or negligent wrongdoing and without fault of any kind on the part of my child, or on my part in failing to disclose pertinent information to Cultivate 7Twelve. I agree to the "Release of Liability" statement above.
Do you give Cultivate 7Twelve ongoing permission to use and reproduce images and videos of your child to: use in outreach and fundraising materials (including flyers, displays, newsletters, advertisements, press release packets, emails, social media, and general publicity) without any further compensation? I agree to allow myself/my child to be photographed according to the "Photo Permission" statement above.
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