Scholarship for Clay Camp

Clay Camp Scholarship Form

* Indicates required field

Camper Name *

First

Last

Age *

Camp Session *

Session One: June 3 - 7 Session Two: June 10 - 12 Session Three: June 24 - 28 Session Four: July 8 -12

2nd Camper Name *

First

Last

Age *

Camp Session *

Session One: June 3 - 7 Session Two: June 10 - 12 Session Three: June 24 - 28 Session Four: July 8 -12

Parent/ Gaurdian Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

County of residence *

Phone Number *

Second Phone Number *

Emergency Contact *

First

Last

Phone Number *

Relation to Child *

Second Emergency contact *

First

Last

Phone Number *

Relation to the Child *

Child's Doctor *

First

Last

Phone Number *

Special Medical Needs: (to assist teacher, if registering 2 children indicate special instructions by child)

LIST ANY MEDICAL OR LEARNING PROBLEMS THAT WOULD EFFECT 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. *

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 SUMMER ART CAMP AT THE QUINLAN VISUAL ARTS CENTER. 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 CLAY CAMP FACILITY. *

Yes

Transportation: I understand that we the family, are responsible for arranging all transportation for my child/ren to and from the Quinlan Visual Arts Center camp sessions.

ALTERNATE PICK-UP PERSON *

First

Last

Phone Number *

ALTERNATE PICK-UP PERSON *

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, Clay Camp sessions 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. *

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: Clay Camp at the Quinlan Visual Arts Center is considered a class and therefore all Classroom Policies and Payment Procedures apply (click for detailed information). Clay Camp 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. You may transfer your tuition to another session of Clay Camp if notification of intent transfer is given FIVE FULL (5) business days before the first class, and if space is available. (A $15 transfer fee will apply.) If no space is available, no refund will be given. You may give your canceled space to another student. Students may bring a friend to camp as long as the staff and teachers have been informed at least one day prior to arrival, as space is often limited. All guests must have a completed Parental Consent and Medical Release form. If we have indicated a class is full and you register anyway you will be contacted to change your date or you will be issued a refund.

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

Quinlan Visual Arts Center

514 GREEN STREET N.E., GAINESVILLE GA 30501
770-536-2575

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