Teen Camp 2015 June 22nd - 26th Student Name

The Dairy Barn Arts Center Proudly Presents:
Teen Camp 2015 June 22nd - 26th
Teen camp is designed to provide arts enrichment for teens in 8th-10th grade. Teen Camp is
one of Education Director Lyn Stanton's favorite things! Dairy Barn Artist in Residence
Lisa Brooks will be coming back to the Barn to co-teach with Lyn for a wonderful
week! This week is going to be a veritable smorgasbord of creativity and productivity. Students can participate in this immersive arts experience and explore different types of art and
art processes. The wall between the Ceramics Room and the Art Room will be opened for
the week to create a giant shared studio space. Activities will include: Designing and screen
printing T-Shirts, explorations in ceramics, outdoor installation arts and much more.
Student Name:_________________________
Student Age: __________ Entering Grade: _________
Parent Name: ________________________________________
Home Phone: _________________ Cell: ___________________
Address: _____________________________________________
Email: _______________________________________________
Emergency Contact: _________________ #_________________
Allergies (Please List) ___________________________________________
T-Shirt Size: (Circle one) Small
Medium Large X-Large XX-Large
Students are encouraged to bring additional fabric items to print on. These items should be cotton, linen, silk; cloth that can take ink! (think bags, bandannas, jeans etc.)
Daily Schedule
Morning Arrival: 9:45-9:55
Students are to bring:
Bagged Lunch and Snack
Sunscreen/bug spray if needed
Water Bottle
Comfortable shoes (No Flip Flops)
Clothing that can get dirty/stained
Personal media device (music and headphones)
to be used only during open studio time
Join Or Renew Your Membership Here: Just Add To The Total!
FEE: $250.00 Or MEMBERS $225.00
Membership Fee (if applicable) $100:____________
Teen Camp Fee: $250.00/non-members
$225.00/members:
_____________
Total Enclosed/Paid :______________
Please make Checks payable to The Dairy Barn
(Circle) Cash Check Credit Card
#___________________________ Exp_________CVV______
Credit Card Policy: A 5% of total fee is added to cover cost of
credit card service (Checks preferred!)
In case of emergency, I request that I/we be contacted. I give permission for emergency medical treatment and transfer to the nearest medical facility. I
agree to assume all costs related to such treatment and I release the Dairy Barn from any responsibility for injury or illness that may occur while my child
participates. I give permission for my child to participate in the Teen Art Camp (Please Check)
I allow my student to be photographed for press and
publicity (Please Check)
Parent or Guardian Signature: ____________________________________________Date: __________________________