ArtsCamp 2012 Registration Form

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• January 30th – Early Registration Opens for ArtsClub Members • February 13th – Registration Opens for General Public •

ArtsCamp REGISTRATION

Registration Guidelines: Complete a separate registration form for each participant. Please photocopy the form if applicable. Pay attention to camper age limits and enroll only in age appropriate programs. Program availability is updated regularly on the ArtsCamp web page. You will be informed within two business days if a program you signed up for is full. Confirmation letters will be sent out within three weeks of receipt of your registration. Cancellation Policy: Only cancellations made at least 14 days in advance of the camp start date will receive a refund, minus a $25 service fee per person per program. In case of insufficient registration, The ArtsCenter reserves the right to cancel a program two weeks before the start of a session. In this instance, participants will receive a full refund. Program Fees: Fees differ from program to program, with some costing more due to smaller class size or higher material costs. There is a non-refundable $25 application fee per family, per summer. Full payment is due upon registration. Please contact 919.929.2787, ext. 204 with payment related questions.

Camper’s Name __________________________________________________________________________________________ Camper’s Date of Birth _________________________________ Camper’s Grade (as of Fall 2012) _____________________ Medical Conditions/Special Needs __________________________________________________________________________ List all allergies, medications _______________________________________________________________________________ (ArtsCenter Staff will not administer, dispense, or store any medications, with the exception of emergency medications, such as Epi Pen)

Parent/Guardian’s Name ___________________________________________________________________________________ Address _________________________________________________________________________________________________ City _______________________________________________ State ____________ Zip _______________________________ Phone (Day) _____________________________________ (Evening) _______________________________________________ Email ___________________________________________________________________________________________________ (Email will be used as primary contact for ArtsCamp receipts and information, unless you request otherwise.)

Emergency Contact Name _______________________________ Emergency Contact Phone ________________________ (if parent(s) cannot be reached)

Please read and sign the following: I have read and agree to The ArtsCenter Inc.’s policies (above), and I understand that The ArtsCenter Inc. may photograph my child during camp. Photographs may be used in The ArtsCenter, Inc. publications and approved media sources, unless I request otherwise in writing. In consideration of The ArtsCenter, Inc. making summer camp programs available to my child, I hereby release The ArtsCenter, Inc., its employees, volunteers and agents from any and all liability, cost/expense associated with any injury or illness my child may sustain while participating in any of the summer programs. In case I cannot be reached in an emergency, I give my permission to The ArtsCenter, Inc. to call for Emergency Medical Services (911) and/or to select a physician to secure proper treatment for my child. _________________________________________________________________________________ ____________________________

Parent/Guardian signature (required) Date Payment Information

Mail completed forms to:

Fees paid by (please check one)

• Cash

• Check (payable to The ArtsCenter) Check No. _____________

The ArtsCenter

300-G East Main Street

• Visa/MC/Discover/AmEx

Card No. ________________________________________________________________

Attn: ArtsCamp

Carrboro, NC 27510

Exp. Date _________________ Security Code ________________ When paying by credit card, forms may

Become an ArtsClub member today and receive reduced tuition now!

be faxed to 919.969.8574. After sending

The ArtsCenter is a not-for-profit organization that depends on individual donations.

$ __________ Family Contributor ($150 to receive discounts on summer camp, events, and classes for adults and children for a 12-month period.) $ __________Would you like to contribute to The ArtsCamp scholarship fund? (please specify amount)

fax, please call 919.929.2787, ext. 204 to confirm fax has been received.

Total Fee $ __________________________________

from following page – includes camps, extended care and lunches

ArtsClub Membership/Renewal $ __________________________________ Contribution to Scholarship Fund $ __________________________________ $ 25.00 Application Fee (per family) $ __________________________________ TOTAL $ __________________________________ Please also complete the following page


ArtsFocus - 1 Week (2 nd-7 th

gr ade unl es s ot he rwi s e no ted)

ArtsFocus - 2 Week

KidsCamp (2nd-7th Grade)

Little Campers (K-1st Grade)

Camp

AM or PM ($100… $95) or Full Day ($200… $190)

Early Arrive $10

Late Depart $20

Boxed Lunch $30

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Dates

Time & Cost* (Circle AM/PM from the options below)

Secret Gardens

June 11-15

Once Upon a Time

June 18-22

Carnival Kaleidoscope

June 25-29

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Sea to Shining Sea

July 2-6

AM or PM ($80… $75) or Full Day ($160… $150)

$8

$16

$24

Animal Kingdom

July 9-13

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Appetite for Art

July 16-20

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Birds of a Feather

July 23-27

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

July 30-Aug 3

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Recycled Art

Aug 6-10

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Art Safari

Aug 13-17

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Circus! Circus!

Aug 20-24

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Adventures at Sea

June 11-15

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Art and Nature

June 18-22

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Arts Around the World: Asia

June 25-29

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Blue Planet

American Arts

July 2-6

AM or PM ($80… $75) or Full Day ($160… $150)

$8

$16

$24

Myths, Magic, & Legends

July 9-13

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Arts Around the World: Africa

July 16-20

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Time Machine

July 23-27

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

July 30-Aug 3

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Aug 6-10

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Aug 13-17

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Aug 20-24

AM or PM ($100… $95) or Full Day ($200… $190)

$10

$20

$30

Funky Folk Art Arts Around the World: South America Ancient Art Adventures Modernist Mashup Ceramics 1

June 11-22

PM- 1:00-4:00 pm ($265… $245)

N/A

$40

$60

Ceramics 2

June 25-July 6

PM- 1:00-4:00 pm ($240… $220)

N/A

$36

$54

Let's Make a Play 1

July 2-13

AM- 9:00 am-Noon ($240… $220)

$18

N/A

$54

Ceramics 3

July 9-20

PM- 1:00-4:00 pm ($265… $245)

N/A

$40

$60

Ceramics 4

July 30-Aug 10

PM- 1:00-4:00 pm ($265… $245)

N/A

$40

$60

Let's Make a Play 2

Aug 13-24

AM- 9:00 am-Noon ($265… $245)

$20

N/A

$60

Ceramics 5

Aug 13-24

PM- 1:00-4:00 pm ($265… $245)

N/A

$40

$60

$10

N/A

$30

Puppetry and Mask Making

June 11-15

AM- 9:00 am-Noon ($145… $135)

Beginning Sewing (2nd-4th grade)

June 11-15

AM- 9:00 am-Noon ($145… $135)

$10

N/A

$30

Drawing Techniques 1

June 11-15

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Beginning Sewing (5th-7th grade)

June 11-15

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Sculpture and Papier Mâché

June 18-22

AM- 9:00 am-Noon ($145… $135)

$10

N/A

$30

Sew for You Camp (3rd-7th grade)

June 18-22

AM- 9:00 am-Noon ($145… $135)

$10

N/A

$30

Cartooning & Comics 1

June 18-22

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Sew for You Camp (age 13+)

June 18-22

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Drawing Techniques 2

June 25-29

AM- 9:00 am-Noon ($145… $135)

$10

N/A

$30

Masks & Costumes (4th-7th grade)

June 25-29

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Create Your Own Book

July 2-6

PM- 1:00-4:00 pm ($130… $120)

N/A

$16

$24

Sew for Your Doll (3rd-7th grade)

July 9-13

AM- 9:00 am-Noon ($145… $135)

$10

N/A

$30 $30

Hip Hop & Urban Dance 1

July 9-13

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

Purses & Bags (3rd-7th grade)

July 9-13

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Painting Techniques

July 16-20

AM- 9:00 am-Noon ($145… $135)

$10

N/A

$30 $30

Knit One, Purl Two (3rd-7th grade)

July 16-20

AM- 9:00 am-Noon ($145… $135)

$10

N/A

Cartooning & Comics 2

July 16-20

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Digital Photography (5th-7th grade)

July 23-27

AM- 9:00 am-Noon ($145… $135)

$10

N/A

$30

July 23-27

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Collage: Beyond the Surface

Ceramics Intensive

July 30-Aug 3

AM- 9:00 am-Noon ($145… $135)

$10

N/A

$30

Fashion & Fiber Arts

July 30-Aug 3

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Hip Hop & Urban Dance 2

Aug 6-10

AM- 9:00 am-Noon ($145… $135)

$10

N/A

$30

Curtain Up!

Aug 6-10

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Scrap Sculpture

Aug 13-17

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

Portaits & Landscapes

Aug 20-24

PM- 1:00-4:00 pm ($145… $135)

N/A

$20

$30

* General public price ... ArtsClub Family Contributor price

Total

TOTAL: (including camps, extended care and lunches) $ _________


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