2017 Art Camp

Cathedral Logo w Name

Christ Church Cathedral 2017 Summer Art Camp Registration
Art Camp June 5-9


Child's Name:

Age as of Jan 1, 2017: FEMALEMALE


Address During School Year:

Phone at this address with Area Code:

Name of Parent or Legal Guardian:

Parent/Guardian Email:

Parent/Guardian Phone Numbers:

List any alternative Emergency Contact Names and Numbers:


Child's Name:

Please list any special medical conditions, dietary needs or food allergies we should know about. If none, write "none." This information will be kept confidential, but for your child's safety, we will need to know any prescriptions your child may be taking, so we can fully inform emergency personnel. If your child will need to take medication during camp hours, please inform camp staff.

I hereby give my authorization and consent for the rendering to my child, by a licensed physician or physicians, of such medical services and treatment as may become necessary in a medical emergency. Such consent and authorization shall include also the cooperation and assistance of nurses, technicians, assistants, other physicians and any qualified medical personnel working under the supervision of licensed physicians.



Please tell us if we have your permission to publish a photo of your child at choir or art camp.Photos might be
used on our website, in a newsletter or in a flyer. Check One:
I GIVE permission for a photo of my child to be published as described above.I DO NOT GIVE permission for a photo of my child to be published.
The cost for one child to attend one camp is $100. The child may register for the second camp at a cost of $75. The child's siblings may also register for a cost of $75 per child per camp. Please complete a separate registration form for each child.
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