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Summer Camp Sign-Up Form

To register, please fill out this form online, then print, sign and return with your deposit check enclosed.

Child's Name:
Male Female  Age:   Birth Date:

Child's Name:
Male Female  Age:   Birth Date:

Name of Parent/Guardian:
Permanent Address:
City:  State: Zip:
Email (Required):

Permanent Home Phone:  Cell Phone:

Emergency Phone:

Family Dr's Name:  Telephone:
Insurance Coverage:  Policy Number:
Child Release Password (Anyone other than the parent or legal guardian must use this word to pick up a child in lieu of written permission.)
Please remember to apply our 10% sibling discount
  Group Name #Days/ Week # Wks Start Date Full Day Half Day Tuition
1st Child
2nd Child
GROUP NAMES: AGES 3-4 HAMSTERS; AGES 4-5 FROGGIES; AGES 6-8 GECKOS

DEPOSIT AND REFUND POLICY
 A 50% deposit is due at the time of registration to reserve your child's space. Balance is due on or before May 31st. Cancellations received before May 31st will be refunded, minus $100 service fee. There are no refunds for cancellations received after May 31st. In the event of serious illness or accident during or before camp, a prorated refund will be given when accompanied by a physician's letter minus the $100 service fee.

In the event that your balance has not been received by the deadline of June 1st your child's registration will be reduced to the amount of time equal to the deposit received. This will be calculated from week one of camp. Refer to the tuition page for these amounts if necessary. There will be a $50 change fee applied.

A $50 service fee per family will be charged for changes made after we have received your registration.

TERMS AND CONDITIONS
  • Medical forms are due by June 28th regardless of your start date at camp.
  • No refunds will be granted for sick or absent days.
  • No children will be released to a non-family member without knowing the CHILD RELEASE PASSWORD you indicated on the previous page of the sign up form.
  • The legal guardian(s) hereby gives approval and consent for the child's participation in the activities of The Art Farm.
  • The legal guardian understands and acknowledges that his/her child's participation in the activities is completely voluntary and has familiarized him/her with the activities in which hazards and/or dangers are inherent. Accordingly, the Art Farm has taken safety measures to minimize the risk of injury to the participants in such activities.
  • The Art Farm cannot ensure or guarantee that the participants, equipment, premises and/or activities will be free of hazards, accidents and/or injuries.
  • The child and legal guardian agree to abide by the rules and regulations established by the Art Farm for the health, safety and welfare of everyone involved.
  • If in the judgment of the program director it is deemed necessary to use medical, surgical or dental aid for the child's health, the legal guardian hereby permits the program director to do so.
  • All photos taken during the course of camp activities are the property of The Art Farm and can be used as deemed necessary.
  • All children participating in swim must bring a swim cap to camp in their bag with their names on them in permanet marker.
  • On swim days children must come to camp in their bathing suit with a towel and a clean dry change of clothes.

I have read and fully understand the above terms and conditions

Signed:   Date:

To register, please fill out this form online, then print, sign and return with your deposit check enclosed.

Please make check payable to: The Art Farm in the City • 419 East 91st Street • New York, NY 10128
Phone 212.410.3117• Fax 212.410.3525  Email: [email protected]

Tuition  :   Medical Form  :  The Art Farm in the City home page