2025 Summer Arts Camps Application Summer Arts Camp 2025 Camper's InformationCamper's Name(Required) First Last Camper's Date of Birth: mm/dd/yyyy(Required) Camper's School(Required) Camper's Home Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian InformationParent/Guardian Name(Required) First Last Parent/Guardian Relation to Camper(Required) Parent/Guardian Preferred Phone(Required)Parent/Guardian Email(Required) Parent/Guardian Alternate PhoneAdditional Parent/Guardian Name First Last Additional Parent/Guardian Preferred PhoneAdditional Parent/Guardian Email Emergency ContactEmergency Contact Name(Required) First Last Emergency Contact Phone(Required)Medical Information (if applicable)In case of medical emergency, I understand that effort will be made to contact me. If I cannot be reached, I hereby give permission to the physician selected by the adult leader to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child named above.(Required) I agree Parent/Guardian Medical AuthorizationMedical Insurance Company Name Medical Insurance Policy Number Medical Insurance Member ID # Family Doctor / Clinic Name Family Doctor / Clinic PhoneConsentsThe above camper has my permission to attend activities with leaders from St. Michael and All Angels Church. I understand activities will be under the supervision of one or more adult leaders approved by the church. I waive any claim against the church and its approved leaders.(Required) I agree Parent/Guardian ConsentI have read and understand that my child will be expected to follow the ARTS camp rules and behavior guidelines. Violators will be warned: further problems will result in dismissal from camp without reimbursement.(Required) I agree Parent/Guardian ConsentI grant permission to St. Michael’s to share photographs and video taken of my child while at Arts Camp for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner.(Required) I agree I do not agree Parent/Guardian ConsentDoes your child have any needs we should be aware of, so that we may provide him/her with the best possible camp experience? Please explain.(Required)Date MM slash DD slash YYYY .
