(Please read carefully to make sure that all information is correct. A separate registration form must be completed for each participant)

Transcription

1 (Please read carefully to make sure that all information is correct. A separate registration form must be completed for each participant) This form must be filled out even if registered online to provide more information about your child. If you registered online, please write registered online in the payment section. Participant Information: Participant s Last Name: First Name: Parent/Legal Guardian s Full Name: Street Address: Telephone: Home( ) Work ( ) Cell/Pager Sex of Child: ο Male ο Female Age of Child: (Minimum Age is 6) Date of Birth: Month Date Year address where confirmation may be sent Are you a Member of the Bowers Museum at the Family Level or above? If you wish to renew or begin a new membership please call (714) Photographs of camp participants may be taken for publicity purposes. Do you give permission for photographs of your child to be taken? Yes No How did you hear about us? Returning Camper Kidseum Flyer Bowers Museum Flyer Bowers website Internet Parenting Magazine Kidsguide Newspaper Friend Other Please make your registration choices from the following selection: (Check all your choices)

2 Additional fee for extended camp hours 8:00-9:00 AM- $ :00-6:00 PM-$50.00 Total Camp Name Date and Fee AM & PM Care Camp 1 Explore the Art of Frida Kahlo Camp II Junior Archaeology Camp June June 26 June 30 Please circle if adding extended care Camp III Past, Present, Future Art (please note this is a 3 day camp) Camp IV Stop Motion Animation Camp V Stop Motion Animation Camp Camp VI Ancient Arts of China Camp VII Ancient Egypt Camp VIII Discovering the First Americans Camp IX Mysteries of the Museum Total July 5-7 Members: $115 Non-members $130 July Members: $190 Non-members $215 July Members: $190 Non-members $215 July July 31- August 4 Aug 7-11 August (Children enrolled in Extended Care late pickup must absolutely be picked up by 6:00 PM. A late charge of $10.00 will be assessed every 15 minutes past 6:00 PM until your child is picked up. Payment in full of this late charge is required at the time you pick up your child). Parents must provide a sack lunch and drink. No microwavable meals please.

3 Kidseum will provide a light snack each day from 10:15 AM-10:30 AM Pre-registration is required, we cannot guarantee that there will be room in camps if you do not register your child with full payment in advance. For more information call or visit the website Fax number: (714) Address: 1802 N. Main St. Santa Ana, CA (Please note that Kidseum is a separate building from the Bowers Museum, drop off and pick up will take place at Kidseum) Kidseum@bowers.org Payment is required in full per child, per camp session at the time of registration. Cancellations and Refunds In light of the fact that the Bowers Kidseum has expended the time and other resources necessary to make this Summer Art Camp Program a rewarding and educational experience for the camp participants, the following refund policy shall apply: a) If a participant s registration is cancelled in writing thirty (30) days or more prior to the beginning of a camp session, a full refund of all fees paid to date will be refunded. b) If a participant s registration is cancelled in writing two-weeks prior to the beginning of a camp session, one-half of all fees paid to date will be refunded. c) If a participant s registration is cancelled less than two-weeks prior to the beginning of a camp session, no refund will be given at all for any reason. All written requests for cancellation should be directed to the Bowers Kidseum. Within two-weeks of receipt of such written notice of cancellation, Bowers will mail a check to the requesting party Camp Kidseum ART & ARCHAEOLOGY CAMPS: Around the World in 9 Weeks

4 I have thoroughly read and completed this Registration form and agree to all of its terms. Parent or Guardian (Check One) Signature Print Name Date: PLEASE NOTE: Your reservation is not guaranteed until you pay in full and turn in this form. Summer Camp Parental Permission/Medical Form (Please read this form fully and Carefully before Signing. A separate form must be completed for each participant) Please Print 1. I, the parent/legal guardian give my permission for (child s name) to participate in the Bower s Summer Camp during the week of, I have also listed my child s allergies and medical condition(s) or restriction(s) on this form, including the name and telephone number of the child s physician or health care facility. 3. I have listed the persons authorized to pick up my child on this form. I understand that the Bowers Kidseum and its Education Partners and their agents or employees are authorized to release my child to any of the persons so listed. 4. In the event my child becomes ill or injured and requires immediate medical attention I hereby authorize the Bowers Kidseum and it employees to consent to on my behalf to x-rays, examinations, anesthetic, medical or surgical procedures, treatment or hospital care, deemed necessary and advisable by and rendered under the supervision of any physician or surgeon licensed under the provisions of the State

5 of California on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of the physician or at the hospital. 5. I understand and agree that this consent to treatment in advance, following the provisions of California Family Code 6910 does not relieve the parent or guardian of any and all financial responsibilities for such treatment. 6. I further agree to waive, release, absolve, indemnify and hold harmless, to the full extent permitted by law, the Bowers Kidseum including their employees, from any and all liability and/or claim of injury arising out of camp activities, including but not limited to transportation to and from the activities, whether the result of negligence or for any other cause, for the duration of this camp. 7. I have read and understand the provisions and legal significance of this form and I voluntarily waive any rights, claims or actions regarding personal injury, losses or damages. Executed this day of, 2016, at, California. By οparent or οguardian (Check One) (Signature) (Print Name) Please list all Allergies: Please list all Medical Conditions or Restrictions: Does your child/ren have special needs?: -

6 CHILD S PHYSICIAN OR MEDICAL FACILITY Physician s Name: Office Address: Telephone: Home ( ) Work ( ) Cell/Pager ( ) In case of emergency, please notify: Telephone: Home ( ) Work ( ) Cell/Pager ( ) Alternate emergency notification: Telephone: Home ( ) Work ( ) Cell/Pager ( ) I certify that the above information is true and correct. Executed this day of, 2015, at, California. By (Signature) (Print Name) οparent or οguardian (Check One) PERSONS AUTHORIZED TO PICK UP STUDENT Only authorized persons with valid proof of ID will be allowed to remove the student from the facilities. Please notify the camp authorities immediately should this information change. 1) Name: Telephone: Home ( ) Work ( ) Cell/Pager ( ) 2) Name: Telephone: Home ( ) Work ( ) Cell/Pager ( ) 3) Name: Telephone: Home ( ) Work ( ) Cell/Pager ( ) I certify that the above information is true and correct. Executed this day of, 2017, at, California. By (Signature) (Print Name) οparent or οguardian (Check One)