Symbolic Art Day Camps
7:00 a.m. - 6:00 p.m.

Please note that all fields followed by an asterisk must be filled in.
05/19/2014, Staff Development Day
Becker Middle School
Molasky Middle School
An 'annual' registration fee: $25 is required for each new participant enrolled in Symbolic Art programs; Day camp rate: $30 each child and is non-refundable in the event participant is absent from the program. A portion of Day Camp fees may to applied to future Symbolic Art events at the sole discretion of the Symbolic Art Administrator.

Payments may be made in cash, money order, check, or credit card. Payments will only be accepted from adults listed on this form.

A $10 late fee will be assessed for each :15 min past 6:00 p.m.

To protect the safety of our children I understand each child must be signed in and out daily. The only person(s) authorized to pick up the child(ren) are those listed on this form; photo ID must be shown.
Children "will not" be released without proper identification "and" prior written authorization from enrolling parent/guardian. *Authorization via Email is acceptable
In the case of joint custody disputes - Symbolic Art staff will comply "Only" with "Written" instructions directed by court order on file with Symbolic Art (if applicable)
For ourselves, and/or on behalf of our child named above, our heirs, executors, and administrators, we hereby do expressly and forever waive and release Symbolic Art and their respective officers, employees, agents or representatives from any and all liability for personal injury or damages, sustained, incurred, arising from or connected with travel to, return from any and all classes, tournaments and/or special events, and all activities related to, or in connection with said activity by ourselves or by our child. *Symbolic Art is a community based organization focused on making sports, recreation and artistic expression fun for youth ages 3-17.

During programs or events sponsored by Symbolic Art staff may take photos of participants that may be used in professionally designed publications and promotional materials.

I have received, read and understand the contents of the parent letter

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