QUINLAN VISUAL ARTS CENTER
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SPOTLIGHT Scholarship Form
*
Indicates required field
Camper Name
*
First
Last
Age
*
GRADE ENTERING FALL FOR FIRST CAMPER
*
Younglings (rising 3rd and 4th graders)
Middles (rising 5th and 6th graders)
Olders (rising 7th graders)
T-Shirt
*
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
2nd Camper Name
*
First
Last
[object Object]
Age
*
GRADE ENTERING FALL FOR Second CAMPER
*
Younglings (rising 3rd and 4th graders)
Middles (rising 5th and 6th graders)
Olders (rising 7th graders)
T-Shirt
*
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Parent/ Guardian Name
*
First
Last
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
County of Residence
*
Phone Number
*
2nd Number
*
EMERGENCY CONTACT
*
First
Last
Phone Number
*
Relation to child
*
Second EMERGENCY CONTACT
*
First
Last
[object Object]
Phone Number
*
Relation to Child
*
Child's Doctor
*
First
Last
Phone Number
*
Special Medical Needs: (to assist teachers, if registering 2 children indicate special instructions by child)
LIST ANY MEDICAL OR LEARNING PROBLEMS THAT WOULD AFFECT CAMP ACTIVITIES
*
LIST ALLERGIES AND STEPS TO BE TAKEN IN CASE OF EXPOSURE
*
DOES YOUR CHILD REQUIRE AN EPIPEN? IF YES, YOU NEED TO SEND ONE WITH YOUR CHILD EVERY DAY.
*
Yes
No
MEDICATIONS/OTHER:
*
IN THE EVENT THAT THE PARENT, GUARDIAN OR EMERGENCY CONTACT IS NOT AVAILABLE IN CASE OF EMERGENCY, I HEREBY GRANT THE QUINLAN VISUAL ARTS CENTER MY PERMISSION TO SECURE EMERGENCY MEDICAL TREATMENT FOR MY CHILD.
*
Yes
No
I HEREBY GIVE PERMISSION FOR MY CHILD/REN TO PARTICIPATE IN SPOTLIGHT AT THEJohn S. Burd Center of the Performing Arts . I HEREBY RELEASE & HOLD HARMLESS THE QUINLAN VISUAL ARTS CENTER, IT’S STAFF, IT’S REPRESENTATIVES AND OR/AGENTS FROM ALL LIABILITIES AND ANY MISHAPS THAT MAY BEFALL MY CHILD/REN INCLUDING, BUT NOT LIMITED TO, THE ACTIVITIES IN THE CLASSROOM AND/OR OUTSIDE THE CENTER SUMMER CAMP FACILITY.
*
Yes
Transportation
: I understand that we the family, are responsible for arranging all transportation for my child/ren to and from the John S. Burd Center for Performing Arts
ALTERNATE PICK-UP
*
First
Last
Phone Number
*
ALTERNATE PICK-UP
*
First
Last
Phone Number
*
Media Release
: I understand that staff photographers and/or television crews will at times be present to photograph or film the Quinlan Visual Arts Center classes, workshops, SPOTLIGHT camp session and exhibitions. I hereby give my permission for resulting promotional photographs and television and/or television footage, which may include my child, to be used for promotional purposes on television, in newspapers, magazines, and press releases, on the arts center website or any other media deemed appropriate by the Board of Trustees of the Quinlan Visual Arts Center.
CLASSROOM POLICIES AND PAYMENT PROCEDURES (CPPP): BY CLICKING BELOW I ACKNOWLEDGE THAT I HAVE READ THE CPPP BELOW.
*
I acknowledge the Quinlan policies.
*Classroom Policies and Payment Procedures
:
SPOTLIGHT at the Quinlan Visual Arts Center is considered a class and therefore all
Classroom Policies and Payment Procedures
apply (click for detailed information).
SPOTLIGHT is non-refundable.
No deferred tuition payment system is available, nor may tuition be prorated. The Quinlan is not responsible for classes missed due to student absences.
All instructors reserve the right to remove disruptive influences from their class.
No refund will be given in the event of a dismissal.
Camp scholarships will be under review of the Executive Director of the Quinlan Visual Arts Center. Please call 770-523-2575 or email
[email protected]
if you have any further questions about camp scholarships.
Submit
HOME
Education
Quinlan School of Art
Adults
Workshops
>
One Day Workshops
Summer Art Camps
Educators Resources
Exhibitions
Past Exhibitions
Engagement
BECOME A MEMBER
SUPPORT US
INTERNSHIPS/VOLUNTEER OPPORTUNITES
Donations
Sponsor us
IN THE NEWS
ABOUT
Staff and Board
YPAC
History