Kids Create! 2023 Registration

Parent/Guardian Name*
Prefix First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Phone*
Emergency Phone*
Do you participate in a homeschool coop?*
Name of Homeschool Coop (including City, State, and Zip Code):
Campers
Child 1
Name:
First Last
Nickname:
Birthday:
MM slash DD slash YYYY
Medical conditions/food allergies:
Select your week:
- K5 Week 1 (June 5-9) K5 campers must turn 5 years by September 1, 2023
- K5 Week 2 (June 12-16) K5 campers must turn 5 years by September 1, 2023
- K5 Week 3 (June 19-23) K5 campers must turn 5 years by September 1, 2023
- 1st-6th Week 1 (June 5-9)
- 1st-6th Week 2 (June 12-16)
- 1st-6th Week 3 (June 19-23)
T-shirt Size:
Friend Request:
Child 2
Name:
First Last
Nickname:
Birthday:
MM slash DD slash YYYY
Medical conditions/food allergies:
Select your week:
- K5 Week 1 (June 5-9) K5 campers must turn 5 years by September 1, 2023
- K5 Week 2 (June 12-16) K5 campers must turn 5 years by September 1, 2023
- K5 Week 3 (June 19-23) K5 campers must turn 5 years by September 1, 2023
- 1st-6th Week 1 (June 5-9)
- 1st-6th Week 2 (June 12-16)
- 1st-6th Week 3 (June 19-23)
T-shirt size:
Friend Request
Child 3
Name
First Last
Nickname:
Birthday:
MM slash DD slash YYYY
Medical conditions/food allergies
Select your week:
- K5 Week 1 (June 5-9) K5 campers must turn 5 years by September 1, 2023
- K5 Week 2 (June 12-16) K5 campers must turn 5 years by September 1, 2023
- K5 Week 3 (June 19-23) K5 campers must turn 5 years by September 1, 2023
- 1st-6th Week 1 (June 5-9)
- 1st-6th Week 2 (June 12-16)
- 1st-6th Week 3 (June 19-23)
T-shirt size:
Friend Request:
Permissions
Terms of Agreement:*
- I authorize the Museum & Gallery to act for me according to their best judgment in any emergency requiring medical attention. I understand that M&G is not responsible for any expense incurred because of any injury or illness.
Photography Release:
- I hereby give the Museum & Gallery permission for my child(ren) to be photographed by M&G photographers for material to be used by the Museum & Gallery. I grant M&G a nonexclusive, royalty-free license to use the photographs in all forms and media, including composite or digitally enhanced modifications, for the purpose of advertising future events or any other lawful purposes. I waive the right to inspect or approve the final product and understand that no royalties or any other type of monetary compensation will be awarded to individuals involved. I have read this release form and fully understand its contents. M&G is unable to provide prints of any photographs taken.
Payment
Kids Create! Non-member registration fee (non-refundable) Quantity
For quantity, enter the number of campers registered.
Price: $90.00
Kids Create! Member registration fee (non-refundable) Quantity
For quantity, enter the number of campers registered.
Price: $85.00
Total
$0.00
Credit Card*
Card Details
Cardholder Name
Comments?
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Kids Create! 2023 Registration

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Child 3

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