Arts Boot Camp

KingsportARTS – KEYPAD
Arts Camp Application
June 1-5, 2015 -- 8am-5pm
for grades 6-12 ►$300
Name:___________________________________________Age:_________________ DOB:___________________
Address:__________________________________________ City, State & Zip:_____________________________
Day-time Telephone # _____________________________ Emergency Contact Tel. #:________________________
Names of Parents/Guardian:______________________________________________________________________
Address (if different than that of camper):____________________________________________________________
E-mail: _______________________________________________________________________________________
Allergies (Camper):_____________________________________________________________________________
Medications:___________________________________________________________________________________
Other medical conditions:________________________________________________________________________
Please list everyone who has permission to pick up your child; we will be checking ID’s:
_____________________________________________________________________________________________
Scheduling Conflicts:____________________________________________________________________________
Scheduling conflicts will not change or reduce the price for the week.
Given the nature of this camp, campers should wear “work clothes”. Each camper should bring a lunch every day.
While Arts Camp is designed to be a fun and creative learning opportunity, it is important that campers respect the
time and talents of the instructors and fellow campers. Disruptive behavior will NOT be tolerated.
Payment is due with registration by May 15, 2015 and is non-refundable. Registration is confirmed upon receipt of
application and payment. Payment and registration can be dropped off 10 a.m. – 3 p.m., Monday-Thursday at
KingsportARTS, Suite 216, Renaissance Center or applications can be mailed to: KingsportARTS, 1200 East
Center St., Kingsport, TN 37660. Pay with credit card online at KingsportARTS.org.
You will be notified through e-mail about class schedule, the closing night event, and other details.
□ In the event of an emergency, where reasonable attempts have been made to contact me, I hereby give consent for
the administration of any treatment deemed necessary from any hospital reasonably accessible.
□ Permission is given to use photos taken during the Summer Arts Camp for publication and/or publicity purposes.
In consideration of myself/my child __________________________ (print name) being able to participate in the
Summer Arts Camp, I, the undersigned, do hereby release KingsportARTS and the City of Kingsport, their officials,
employees, agents, representatives, insurers, sureties and assigns or anyone acting on their behalf, from any and all
claims of liability for death, personal injury or property damage of any kind or nature whatsoever, arising out of and
in the course of my or my child’s presence, participation in or observation of any KingsportARTS activity. This
release extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown.
Parent/guardian signature__________________________________ Date__________________________