MUSIC & ARTS SCHOOL

R E G I S T R A T I O N F O R M - C A M P S 2 0 1 3

Explore the Door Mondays $250 - TotalGirls of Summer Tuesdays $250 - TotalTinkerbell (Extravaganza of the Arts) Wednesdays $175 - TotalGirls Just Want To Have Fun Thursdays $225 - Total

Lunch Program: Yes No $ 50 - TotalIf you choose the Lunch Program, you do not need to pack a lunch for your child.

Examples of menu: Pizza, Grilled Cheese, PB & J, Subs and Chicken.

Choose Payment: In Full Two Payments Monthly Due Now Now & By June 15 We will arrange

Monthly: We will divide payment by the months remaining from when you register. March, April, May, June and July. Auto payment only from a debit/credit card. $5 fee per month.

NAME OF CAMPS ____________________________________________Student’s Name ___________________________ Parents’ Names _________________________ Address _________________________________________________________________________ City ________________________________________State ____________ Zip ________________Phone(home)__________________(work)_________________________(cell)_________________Phone (2nd Parent) ______________(work)________________________(cell)_________________School Name ______________________________Grade in Fall ____________Age___________E-Mail Address __________________________________________________________________Any Allergies? ___________________________________________________________________

I/We, the undersigned, hereby acknowledge the physical demands and inherent risks involved in Day Camp activity, guaranteeing the registered student(s) to be in sound physical, mental and emotional health. I/We agree to hold Music & Arts School of Door County, LLC, its officers, agents and employees, in both individual and official capacities, harmless from liability for accident, injury, loss or damage to person or property as a result of said student’s participation in any Music & Arts School of Door County, LLC activities. I give permission to allow my child to go to other destinations other than what is scheduled. I understand the schedule is tentative and may be subject to change. No Refunds.

____________________________________________________________________________ Signature required by Parent Date