ART Station
2016 Camp & Performance Company Registration Form
Pre-camp & after-camp care is available from 8:00 - 9:00 AM & 5:00 - 6:00 PM*.
Camper’s Name _________________________________Date of Birth______________
Age_________________ T-Shirt Size ________________________________________
Parent(s) Name___________________________________________________________
Address_________________________________________________________________
City ________________________________________________ State ______________
Zip ___________________________County____________________________________
Day Phone ____________________________Home Phone_______________________
E-Mail__________________________________________________________________
Emergency Contact_____________________________Relationship________________
Day Phone__________________Cell___________________Home_________________
2016 CAMP DATES
Youth Performance Co.
Arts Camp
Arts Camp
Arts Camp
Arts Camp
Weeks 1 & 2
Week 3
Week 4
Week 5
Week 6
June 6 - 17
June 20 - 24
June 27 – Jul 1
July 11 - 15
June 18 - 22
PROGRAMS
Select weeks. Circle Pre-camp care (PCC) or After-camp care (ACC). Enter tuition amount.
____Week 1 & 2 Youth Performance Company
PCC/ACC
Tuition:_________
____Week 3
Youth Arts Camp
Full Day
PCC/ACC
Tuition:_________
____Week 4
Youth Arts Camp
Full Day
PCC/ACC
Tuition:_________
____Week 5
Youth Arts Camp
Full Day
PCC/ACC
Tuition:_________
____Week 6
Youth Arts Camp
Full Day
PCC/ACC
Tuition:_________
Total Tuition ___________
Registration _$20.00_____
Family Membership ___________
Subtotal ___________
Multi-Week Arts Camp Discount -_____
(# of weeks x $10)
Pre-Camp Care ($10/wk per child):____________
After Camp Care ($10/wk per child):____________
Total Due ___________
$75 Deposit Required __$75.00_____
Balance Due ___________
STAFF USE ONLY
AMOUNT PAID AT REGISTRATION:
AMOUNT DUE:
*$10.00 per child per week applies to Pre and after camp care.
A $75 non-refundable deposit is required for each student to secure a place in Camp.
A limited number of partial scholarships are available for eligible students attending multiple
weeks (a minimum of two weeks) of Arts Camp or Performance Company. DeKalb County
School System Vouchers are available from school guidance counselors at selected schools.
Please call ART Station for a Scholarship Application.
Complete membership and payment information below.
_____ I want to purchase a family membership to qualify for Member rates.
(Add $35 to total)
_____ I am an ART Station Member & qualify for the Member rates.
(Membership must be current during camp)
_____ I am not an ART Station Member & will pay the Non-Member rates.
_____ I am enclosing a check in the amount of $_________________.
_____ Please charge my credit card account for $________________.
Circle One: MC VISA AMEX DISCOVER
Account #:_________________________________________
Exp. date:______
Weekly tuition is due the Monday your child(ren) begins Arts Camp and/or Performance
Company and each Monday thereafter. The $75 non-refundable deposit will be applied
to the first week’s tuition.
I agree to the terms and conditions outlined in this brochure & understand that
absolutely no refunds will be made after May 23, 2016.
I (Parent/Guardian) _________________________ agree to provide health forms
and emergency information prior to my child(ren) attending an ART Station
program. I also agree to sign my child(ren) in to camp each morning and out at
the end of each day. I agree to pay a penalty if I am late picking up my child(ren)
from camp. Late fees are accessed when I pick my child(ren) up past 6:00 p.m.
Fees are $5 for every 15 minutes past 6:00 p.m. and are payable directly to the
facilitator.
Parent/Guardian Signature:______________________________________________
Mail completed form to:
ART Station
P.O. Box 1998
Stone Mountain, GA 30086
or fax to 770-469-0355
QUESTIONS?
Call (770) 469 1105