The Dairy Barn Arts Center · Teen Summer Art Camp 2021 Registration

Teen Camp 2021 Dates: July 26 - 30

Monday - Friday 10:00 AM - 4:00 PM

Camper Name

*

First Name

Last Name

What grade will your camper begin in the Fall of 2021?

*

In order to attend Teen Camp, campers must be in Grade 8 - 12.

8

9

10

11

12

Camper birth date

*

(mm/dd/yyyy)

We welcome children of all abilities and specific needs!

Making us aware of any specific needs your camper may have will help us ensure a successful camp experience. Please list any known allergies/other conditions including medications campers will be taking during camp hours. We strive to accommodate all campers and if you have any questions or concerns please don't hesitate to contact our Education Director (kelly@dairybarn.org.)

Camper T-Shirt Size

*

Our t-shirts are off white (non-bleached fabric) with a yearly camp design. The brand we get tend to run a little big in the youth sizes.

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

First Parent/Guardian's Name

*

First Name

Last Name

First Parent/Guardian Cell

*

Please enter without dashes or marks EX: 7405924981

First Parent/Guardian Email

*

Second Parent/Guardian's Name

First Name

Last Name

Second Parent/ Guardian Cell

Please enter without dashes or marks EX: 7405924981

Second Parent/Guardian Email

Home Phone Number

Please enter without dashes or marks EX: 7405924981

Parent/Guardian Work Number

Please enter without dashes or marks EX: 7405924981

Name of Emergency Contact 1

*

First Name

Last Name

Number of Emergency Contact 1

*

Please enter without dashes or marks EX: 7405924981

Name of Emergency Contact 2

First Name

Last Name

Number of Emergency Contact 2

Please enter without dashes or marks EX: 7405924981

Camper's Physician's name or preferred medical facility

EX: Holzer

Number of Camper's Physician or preferred medical facility

Please enter without dashes or marks EX: 7405924981

Permissions and Release

*

Enter your name in the space below, along with today's date. This will act as your legal signature for the following 4 questions.

Acknowledge

*

I understand that the name written in the previous space represents me and is my legal signature. I am stating that I am a parent or legal guardian of the camper named in this registration form. I understand that when I click "I agree" in the next questions, I am officially signing my name and agreeing with The Dairy Barn's terms.

I agree

In case of injury or Illness:

*

By clicking the accept box, I state that In case of accident or serious illness, I request that I/we be contacted. I give permission for emergency medical treatment and to be transferred to the nearest medical facility. I agree to assume all costs related to such treatment and I release the Dairy Barn from any responsibility for injury or illness that may occur while my child participates. I also give permission for my child to participate in The Dairy Barn Summer Art Camp.

I agree

Photography Release

*

The Dairy Barn respects your parental rights! We love Camp publicity, but we understand not all parents are comfortable having their children’s photos published. Photographs may be taken by Dairy Barn staff and used on the Dairy Barn website, Facebook page, or in teachers' personal portfolios or personal social media pages. Photos may also be taken by local news media and used in newspapers and on their websites. If you want to allow photos of your camper to be used, click "Allow". If you do NOT wish you camper to be photographed, click "Don't Allow".

Allow

Don't Allow

Parent and Camper Acknowledgement:

*

(Please review the SAC Handbook, linked below.) By agreeing to this acknowledgement, I state that I have thoroughly read and understand my duties and responsibilities as outlined in the Summer Camp 2021 Parent/Camper Handbook. I understand that I will be held to these rules and guidelines and will be charged additionally if I fail to adhere to camp pick-up times clearly stated in this handbook. I understand that my child will be held to the Full Value Contract and will be expected to show good behavior and respect for all instructors, assistants and other campers. My child may be terminated from camp if there are severe behavior and respect issues that consequences and counseling do not resolve. I understand that I will not receive a refund unless at the discretion of the Education Director.

I Agree

Summer Art Camp Handbook

Billing Contact Information

Name on Card

*

First Name

Last Name

Email

*

Verify Email

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Payment Totals

Count the total number of themes your camper is signed up for and select to appropriate amount at either the member or non-member rate, select the appropriate amount of weeks of Aftercare and select one (1) registration fee.

Payment *	Quantity
$25 - One-time Registration Fee (Required)
$180 - Household Membership Rate
$200 - Non-Member Rate

Join The Dairy Barn Arts Center!

Summer Art Camp Scholarship Program

We believe that all kids should have the opportunity to attend Summer Art Camp at The Dairy Barn. Every year, your support helps us offer scholarships to families who wouldn't be able to afford camp otherwise.

Still have credit from last year's cancelled art camp? You can donate some or all of your credit to the scholarship program if you choose. Contact director@dairybarn.org for more information on how to make this happen.

We appreciate your support!

Amount

$80 - Sponsor a child for a half-rate one week of summer camp

$160 - Sponsor a child for one week of full-day summer camp

$

Teen Summer Art Camp 2021 Registration

Please read the Parent Camper Handbook before registering your camper.

If you were registered for Summer Art Camp / Teen Camp last year (2020) when camp was cancelled due to Covid-19 and asked for credit rather than a refund, please contact Leah Magyary (director@dairybarn.org) before filling out this form.

Teen Camp 2021 Dates: July 26 - 30

Billing Contact Information

Payment Totals