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KIDS SCULPTURE CAMP
Registration Form: TO BE FILLED OUT BY PARENT OF CHILD.

What Program are your registering for?______________________________________
What dates are that program? ______________________________________________
How many weeks? ____________

Print, fill out, send with check or credit card information. Questions, 1-210-696-9813; gilbertebarrera@gmail.com. Address to: Sculptors Academy, 11354 Vance Jackson Rd., San Antonio, Texas 78230

Contact Information:
Main Emergency Phone: _________________________________________________

Childs Name: __________________________________________________________
Childs Gender: _________________________________________________________
Childs Age: ___________________________________________________________
Childs Birth month, day, year: _____________________________________________
Childs Address: ________________________________________________________
Childs School Name: ____________________________________________________

Mothers Name:__________________________________________________________
Address:_______________________________________________________________
City: __________________________________________________________________
State: _________________________________________________________________
Zip Code:______________________________________________________________
Phone: (____)_____-________
Cell phone: (____)_____-________Other___________
E-mail: _______________________________________________________________
Website: ______________________________________________________________
Face book: ___ yes ___ no; Other Social Site?_________________________________
Occupation:____________________________________________________________

Fathers Name: _________________________________________________________
Address:______________________________________________________________
City: _________________________________________________________________
State: ________________________________________________________________
Zip Code:_____________________________________________________________
Phone: (____)_____-________
Cell phone: (____)_____-________Other___________
E-mail: ________________________________________________________________
Website: ______________________________________________________________
Face book: ___ yes ___ no; Other Social Site?_________________________________
Occupation:____________________________________________________________

TO WHOM SHOULD BILLING BE SENT ?
_____________________________________________________________________
NAME
_____________________________________________________________________
ADDRESS: STREET OR BOX #
_____________________________________________________________________
CITY STATE ZIP

Childs Medical and Alerts Information

IN CASE OF MEDICAL EMERGENCY, I hereby give permission to the medical authorities, EMS and doctors contacted by the Camp to secure medical care and treatment for my child named above. (THIS PERMISSION IS REQUIRED BEFORE ADMITTING A CHILD TO THE KIDS SCULPTURE CAMP)

SIGNATURE OF PARENT___________________________________________________________________________

DATE ___________________________________________________________________________________________________

MEDICAL ALERTS OR CONDITIONS OF MY CHILD THAT EMS, EMERGENCY TECHNICIANS OR DOCTORS SHOULD KNOW ABOUT: ___________________________________________________________________________________________________
___________________________________________________________________________________________________

CHILDS SPECIAL FOOD OR DIETARY ISSUES? ____________________________________________________________
ALLERGIES? __________________________________________________________________________________________________

Zero Tolerance Policy.
Any misbehavior [first day or any day] is grounds for cancellation of registration and removal of your child with no refund. Disrespect of camp personell or other child students is grounds to be expelled. Children distracting other children from art learning or art working will be separated permanently or else expelled. Please advise your child of these notices each morning of camp.
Bad behaviors destroy the learning atmosphere for other children. Bullying, language, meaness, rough play, hitting or hitting back or behaviors causing one child to chase another or to retaliate or to come to the director in fear or in tears is automatic exclusion. There are no refunds.
Your child will be separated meanwhile you are coming to pick them up.

Children sitting idle, not producing or attempting to do art work will also be asked to not come back.

WOULD YOU ABLE TO VOLUNTIEER?

YES         NO

IF YES, FULL TIME?________ OR PART TIME?____________ WHAT HOURS?_____________________________

WHAT DAYS? MONDAY TUESDAY WENDSAY

FROM WHOM DID YOU HEAR ABOUT THE KIDS SCULPTURE CAMP (NAME & ADDRESS)?