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Art, Ecology & Circus Camp 2024 - Scholarship Recipient

If you have heard from us that your child is elligible for a camp scholarship, we need you to register the camper by filling out the following form.

If you have been awarded a partial scholarship, we will follow up with you about paying the remainder of amount.

Contact Information

Camper Name

First Name

Last Name

Camp Program Sign Up *

My child will only attend programming from 9 am to 2 pm, and be picked up at 2.

My child will stay for afternoon activities and I will pick them up at 5 (or shortly afterwards)

Age *

at the time of the camp - July 22nd, 2024

Gender *

T-shirt size

Parent / Guardian *

First Name

Last Name

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email *

(what to bring list, weekly schedule, snacks, performance information will be sent to email, if applicable)

Verify Email *

Phone *

Will the camper’s address be different during camp than that given above? If so, please indicate how we can contact the child during the camp.

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Contact Phone

Name of responsible party at this address

Relationship to camper

Whom may we contact in the event of an emergency? *

First Name

Last Name

Emergency Contact Number *

Please indicate below if the camper has any allergies, medical conditions, or nutritional conditions and needs we should know about.

Statement of Consent & Liability Release *

By checking this box, I give my permission for the above mentioned camper to participate in DSAEC's Art & Ecology & Circus Camp. It is my understanding that the camp will include activities such as hiking, wading, creek stomping, field, and wildlife observations, as well as inadvertent exposure to potentially harmful animals and/or plants (such as bees, wasps, and poison ivy). In consideration of DSAEC’s acceptance of this child’s registration, I assume any risk connected with this child’s participation in such activities related to personal or bodily injury and agree to hold harmless the Dreaming Stone Arts and Ecology Center, its officials, directors, employees, volunteers, and agents for damage arising from any injury to this child. I authorize DSAEC Arts & Ecology & Circus Camp staff to arrange for transportation and/or necessary emergency treatment for this child should the need arise and I cannot be reached. Furthermore, I understand that I must sign a Waiver of Liability (provided by DSAEC) before the child is able to attend the camp.

I agree to the above Statement of Consent, and understand that I will need to sign a Waiver of Liability before camp begins

Press Release Form *

As a parent of the above mentioned camper, I hereby consent that any photographs, videotapes, recordings, etc., in which my child appears may be used by the Dreaming Stone Arts and Ecology Center, in whatever way they desire, and that these photographs, records, etc., shall become the property, which they may use free and clear of any claims on my part.

Yes