2012 CAMP ARTumpka
FOR KIDS Ages 6 through 14 Alabama River Region Arts Center 300 W. Tallassee St. (mail only P.O. Box 1172) Wetumpka, AL 36092 JUNE 4 – 8 and JULY 9 – 13 9:00 A.M. -‐ 12:00 NOON REGISTRATION FORM Name _________________________________Size t-‐shirt*_______ Age ____________ Name _________________________________Size t-‐shirt*_______ Age ________** Name _________________________________Size t-‐shirt*_______ Age ________** Name _________________________________Size t-‐shirt*_______ Age ________** *Free t-‐shirt with full paid early registration (postmarked 4/26) by 4/28.
Mailing Address__________________________________________________________ Street/P.O. Box
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State
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HOME CELL HOME CELL HOME CELL
Parent’s Name ______________________________ Phone_________________ Contact/Daytime ____________________________ Phone _________________ Emergency Contact __________________________ Phone _________________ E-‐mail Address __________________________________________________________ CAMP SESSIONS: (Check One) ____First Camp June 4 – 8, $95 ($85 ARRAC member) # ___ x _______ ____Second Camp July 9 – 13, $95 ($85 ARRAC member)
# ___ x
____Both Camps June 4 – 8 & July 9 – 13, $190 ($170 ARRAC member)
_______ _______
(Take an extra $10 savings with advanced payment for both Camps $180 ($160 ARRAC))
**$10 Discount for each additional child from the same household) (# ___ -‐ 1 ) x -‐10 –_______
Total Due (Checks only, credit cards are not accepted at this time)
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NOTE: $15 of each session above includes a Non-‐refundable registration fee.
Please list any medical condition or allergy that would limit your child’s participation in an activity: ______________________________________________________________ PLEASE RETURN COMPLETED FORM ALONG WITH TUITION TO: Alabama River Regions Arts Center, P.O. Box 1172, Wetumpka, AL 36092 For more information PHONE: 334-‐578-‐9485 • EMAIL: artsclub@arrac.org • see WEBSITE: www.arrac.org