Village Art House
Art Enrichment Day Camp
2013 Application
Click here to download this form as a pdf.
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Available Sessions Please mark your 1st & 2nd choices
Session 1: 8:30 am to 11:00 am June 10th through June 14th _________
Session 2: 12:30 pm to 3:00 pm June 10th through June 14th _________
Session 3: 8:30 am to 11:00 am June 17th through June 21st _________
Session 4: 12:30 pm to 3:00 pm June 17th through June 21st _________
If your 1st choice session is already full, your child will be enrolled in your 2nd choice session. All students will receive an e-mail or phone confirmation informing them of their acceptance.
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Child’s Name ________________________________________________
Age ____________________
School Attended _____________________________________________
Grade Completed _________
Home Address ________________________________________________________
Parent’s Name _________________________________
Parent’s E-mail _________________________
Phone To Reached Parent (Day) _______________________ (Evening) _________________________
Emergency Contact Name ___________________________________ Phone ____________________
My child, ________________________________, will be attending the Art Enrichment Day Camp. I understand that I will be responsible for getting my child to and from the Village Art House. No supervision will be available before or after the session times. Therefore, children should arrive promptly, and be picked up on time. The following person is authorized to pick up my child:
Name ______________________________________ Phone Number ____________________
If your child is not permitted to leave with a particular person, please notify us.
Applications are due by Friday, May 31, 2013. Please mail a completed application and a check for $80 per child (made payable to “Village Art House”) to:
Kathy McCoy
Village Art House
120 North Market Street
Batavia, OH 45103
For questions about this program, please contact Joy Mansfield at (513) 479-4949, or jmartgirl@roadrunner.com.
Click here to download this form as a pdf.
