Art Camp 2019 Registration
Hello! We're glad that you are interested in the Art Camp 2018. Please fill out the form below to register your child. (If registering siblings, please register each child separately.). This is a secure form. At the end of the form you will be able to pay the registration fee through PayPal.
Child's First Name*
Child's Last Name*
Nickname:
Age*
Grade Entering: *
Gender
 Boy
 Girl
Date of Birth
Name of a Parent*
Home Address: Street *
Home Address: City, State*
ZIP Code:*
Home/Primary Phone*
Email (to send a registration receipt)*
Mobile phone number:
Home Church (if applicable):
Siblings Attending camp (First & last name, and age)
Emergency Contact Person
Emergency Phone Number
Allergies (if any):*
Doctor's Name
Doctor's Phone Number
Medical issues or special needs:
I give the camp staff permission to administer basic First Aid to my child in case of injury. I further permit camp staff to contact the listed medical contact(s).*
Person (other than parent) who may pick up my child
An Art Camp T-shirt comes with your registration. Please select the shirt size you desire.*
 Youth - XS
 Youth - S
 Youth - M
 Youth- L
 Youth - XL
 Adult - S
 Adult - M
 Adult - L
Confirmation: If you entered an email address above we will email you a confirmation of this registration. Otherwise we will send a confirmation in the US mail.
I understand that my child may be photographed at the Art Camp while participating in regular daily camp activities. I understand that these photographs may be used by Prince of Peace in promoting the Art Camp, either in print or on the internet."

>> Please check the box (below) to acknowledge this, and give your consent for us to publish pictures with your child, if alone, in our events photo gallery.

*
I give permission for my child (named above) to attend the Art Camp as listed above. I understand that the information I give for this registration will only be used by Prince of Peace Lutheran Church.*
You can pay the registration fee online through PayPal (there is a credit card option). The transaction is secure and a receipt will be forwarded to you.
To register by mail, download the printable form, fill out, sign and mail it with a check for made out to Prince of Peace Lutheran Church. Registration is:
• $25 per child
• $30 per child after June 24th

Mail to: Prince of Peace Lutheran Church, 6020 Pittsford-Palmyra Rd., Fairport, NY 14450


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