Imaginers & Dreamers Summer Camp 24 Week 9

Summer Camp Bonus Week 8/19 - 8/23: Upcycling

Camper Information

Child's Name

First

Last

Parent/Guardian Name

First

Last

Email (Parent/Guardian)

Camper’s Age the first day of camp

Current Residence

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Information

Emergency Contact #1 (Parent or Legal Guardian)

First

Last

Phone (E Contact #1)

Emergency Contact #2 (Other than Parent Above)

First

Last

Phone (E Contact #2)

Primary Care Physician or other provider of medical care

First

Last

Phone (Primary Care Physician)

Health Information

Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware?

No
Yes

You answered 'Yes' to the question above, Please explain.

Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child’s camp experience is positive?

No
Yes

You answered 'Yes' to the question above, Please explain.

Immunization Infromation

Where do you currently reside?

WITHIN the United States, a United States territory, or the District of Columbia
OUTSIDE the United States, a United States territory, or the District of Columbia

Does the camper have any immunization exemptions because of a parental or guardian objection or medical contraindication?

No
Yes

You answered 'Yes' to the question above. Please list exemptions.

Attach record of vaccination or immunity on Department form MDH-896.

Click or drag files to this area to upload. You can upload up to 2 files.

You may upload .pdf, .jpg, or .webp files here. File may not exceed 2MB.

Medication Information

Please check NO or YES if your child will need to take ANY FORM OF MEDICATION (Including prescription medication or over the counter medication) during camp hours ONLY, including any prescribed EMERGENCY MEDICATION.

No
Yes

IMPORTANT:

You checked 'YES' above.

YOU MUST SUBMIT A MEDICATION ADMINISTRATION AUTHORIZATION FORM SIGNED BY A PHYSICIAN, PHYSICIAN ASSISTANT, or NURSE PRACTITIONER DUE May 31, 2024.

ALL MEDICATION ADMINISTRATION AUTHORIZATION Forms must be
completed and submitted by May 31, 2024. If this signed Medication Administration
Forum is not submitted to Art Works Now by May 31, 2024, your registration will be
canceled.

Policies

Photo Release Policy:

By granting permission for registrant’s name, voice, photographic likeness, and student work to be used by Art Works Now, the following applies: For valuable consideration received, I grant to Art Works Now and its legal representatives and assignees, the irrevocable and unrestricted right to use and publish photographs or videos of the undersigned minor children, for editorial, trade, advertising, and any other purpose and in any manner and medium; and to alter and composite the same without restriction and without my inspection or approval. I hereby release Art Works Now and its legal representatives and assignees from all claims and liability relating to said photographs.

I grant permission for the registrant's name, voice, photographic likeness, and student work to be used by Art Works Now.

Yes
No

Health Policy:

Stay home if you are sick, if you are positive for COVID-19, or if you are showing symptoms of COVID-19, a cold, or the flu.

Anyone found to be positive for COVID-19, or who is actively exhibiting symptoms of COVID-19,, or flu while on AWN premises will be sent home immediately.

While participating in an on-site program, participants shall notify Art Works Now immediately of a positive test result for COVID-19 via email to the Senior Director of Programs, Manique Buckmon at manique@artworksnow.org.

Masks are optional.

I acknowledge I have read and will comply with health policy for attending in-person programming (mandatory)

Yes

Cancellations, Refunds, Transfers, and Credits Policy:

As a non-profit organization, AWN is committed to ensuring access to art high-quality arts education and experiences for all. To achieve this, we are committed to maintaining affordable tuition rates and are unable to provide refunds for registrations at this time. However, we do accept requests for transfers or credit in the event that registrants are unable to complete a class. All requests must be emailed to info@artworksnow.org. Please note, transfers are subject to availability and are not guaranteed. In addition, no transfers or credits will be provided for requests received less than two weeks prior to the first class session.

If you have questions, please contact us by phone at 301-454-0808 or email at info@artworksnow.org.

I acknowledge I have read the cancellations, refunds, transfers and credits policy (mandatory)