CAMPS FOR KIDS, SUMMERLIN

**SEASONAL CAMPS, 2018 * REGISTRATION FORM**
Please note that all fields followed by an asterisk must be filled in

* Indicates required field

Section #1 ~ Child's Information

Name of Child Enrolled in Camp *

First

Last

DATE OF BIRTH *

Name of School *

Allergies or Special Needs? N/A if not applicable *

Section #2 ~ Sibling's Info

Insert The Name(s) of Sibling(s) "N/A" if Not Applicable *

Sibling(s) Date of Birth *

Sibling(s) Allergies or Special Needs? N/A if not applicable *

Insert the name of the Last Symbolic Art Program Enrolled *

How Did You Hear About Symbolic Art Camp? *

Section #3
Enrolling Parent/Guardian Info

Parent or Guardian's Name *

First

Last

Parent or Guardian's Email *

Alternate Email *

Alt Phone# *

Insert The Name & Phone Number To Receive Text Messages *

Insert Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Section #4
Emergency Contact Info

1st Emergency Contact's Name N/A if Not Applicable *

First

Last

Phone# N/A if Not Applicable *

2nd Emergency Contact's Name N/A if not applicable *

First

Last

Phone# N/A if Not Applicable *

Insert Name(s) of anyone other than parent, guardian or emergency contact who may pick up Child(ren) *

Symbolic Art Seasonal Camps, 2018

Please select which camps children are being enrolled *

Winter Break Week #1 : 12/26-12/28 Winter Break Week #2 : 12/31-1/4/2019

Symbolic Art Camp Notes:

Camp participants must pack a cold lunch, a water bottle and at least two snacks for AM (9:30 am) & PM (2:30 pm)
Campers should wear appropriate attire i.e. gym shoes to participate in group games and recreational activities

Winter Break "No Camp" on the following dates:

Christmas Eve & Day | Dec 24th & 25th
New Year's Day | Jan 1, 2019

Winter Break Camp Location:
Becker Middle School
9151 Pinewood Hills Dr. #401
Las Vegas, NV 89134
Hours: 7:00 am - 6:00 pm
SymbolicaArt@SymbolicArtCenter.com

Fee Disclosure*

An 'annual' registration fee: $25 is required for each new participant not currently enrolled in other Symbolic Art programs; Symbolic Art Seasonal Camp rates: Winter Break *Week #1 - $85 each child Winter Break *Week #2 $95 1st Child/$85 2nd Child+ Enrollment fees are non-refundable in the case where a participant is absent from the program. Day Camps and Daily/Drop-In Rate: $30 per day. A portion of Seasonal Camp fees may to applied to future Symbolic Art seasonal camps, programming or special events at the sole discretion of the Symbolic Art Administrator. Payments may be made in cash, money order or credit card. Payments will only be accepted from adults listed on this form. A $10 late fee will be assessed for each :15 minutes past 6:00 p.m. (e.g. 6:05 pm / pick up = $10)

Agree & Consent *

I understand the above and consent

Sign-In & Sign-Out

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.

Agree & Consent *

I understand the above and consent

Children "will not" be released without proper identification "and" prior written authorization from enrolling parent/guardian. *Authorization via Email is acceptable

AGREE & CONSENT *

I understand the above and consent

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)

AGREE & CONSENT *

I Understand the above and consent

Waiver of Claim*

For ourselves, and/or on behalf of our child named above, our heirs, executors, and administrators, we hereby do expressly and forever waive and hold harmless Symbolic Art Central, Inc dba Symbolic Art and their respective officers, employees, agents or representatives from any and all liability for personal injury or damages, sustained, incurred, arising from and/or connected with travel to, return from any and all classes, activities, 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 4-14.During programs or events sponsored Symbolic Art staff may take photos of participants that may be used in professionally designed publications, Symbolic Art websites, social media platforms and other promotional materials.

AGREE & CONSENT *

I understand the above and consent

Parent Letter*

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

AGREE & CONSENT *

I understand the above and consent

Please Type Your Name to Acknowledge An Acceptance of Symbolic Art Terms & Conditions

Name *

First

Last

Submit Registration Form

*PLEASE COMPLETE OUR REGISTRATION FORM ABOVE BEFORE SUBMITTING PAYMENT.

Winter Break Camp
Week #1 | December 26 - 28, 2018

Winter Break Camp Week #1 @ Becker MS (Each Child)

$85.00

Winter Break Camp
Week #2 | December 31 - Jan 4, 2019

Winter Break Camp Week #2 @ Becker MS (1st Child)

$95.00

Winter Break Camp Week #2 @ Becker MS (2nd Child)

$85.00

"All people are gifted with inherent artistic talents and abilities"

**SEASONAL CAMPS, 2018 * REGISTRATION FORM**
Please note that all fields followed by an asterisk must be filled in

Section #1 ~ Child's Information

Section #2 ~ Sibling's Info

Section #3
Enrolling Parent/Guardian Info

Section #4
Emergency Contact Info

Symbolic Art Seasonal Camps, 2018

Fee Disclosure*

Sign-In & Sign-Out

Waiver of Claim*

Parent Letter*

Please Type Your Name to Acknowledge An Acceptance of Symbolic Art Terms & Conditions

*PLEASE COMPLETE OUR REGISTRATION FORM ABOVE BEFORE SUBMITTING PAYMENT.

Winter Break Camp Week #1 @ Becker MS (Each Child)

Winter Break Camp Week #2 @ Becker MS (1st Child)

Winter Break Camp Week #2 @ Becker MS (2nd Child)

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"All people are gifted with inherent artistic talents and abilities"

SEASONAL CAMPS, 2018 * REGISTRATION FORM Please note that all fields followed by an asterisk must be filled in

Section #1 ~ Child's Information

Section #2 ~ Sibling's Info

Section #3Enrolling Parent/Guardian Info

Section #4Emergency Contact Info

Symbolic Art Seasonal Camps, 2018

Fee Disclosure*

Sign-In & Sign-Out

Waiver of Claim*

Parent Letter*

Please Type Your Name to Acknowledge An Acceptance of Symbolic Art Terms & Conditions

*PLEASE COMPLETE OUR REGISTRATION FORM ABOVE BEFORE SUBMITTING PAYMENT.

Winter Break Camp Week #1 @ Becker MS (Each Child)

Winter Break Camp Week #2 @ Becker MS (1st Child)

Winter Break Camp Week #2 @ Becker MS (2nd Child)

Follow us!

**SEASONAL CAMPS, 2018 * REGISTRATION FORM**
Please note that all fields followed by an asterisk must be filled in

Section #3
Enrolling Parent/Guardian Info

Section #4
Emergency Contact Info