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Petite Palette on the Gogh
Summer Art Camp
Registration
Petite Palette on the GoghSummer Art Camp Registration
Contact:
321-277-5819
heidi@heidilifrage.com
http://heidilifrage.com
Participant Information
First Name
Last Name
Birth Date
(YYYY-MM-DD)
*
🛈
+
Current
Grade
3 Yrs
4 Yrs
K
1st
2nd
3rd
4th
5th
School Name
*
Household / Adult Primary Contact
Parent First Name
*
Parent Last Name
*
Relationship to Participants:
*
Mother
Father
Guardian
Other
Address 1
*
Address 2
City
*
State
*
Zip
*
Home Phone
Cell Phone
*
Email Address
*
Emergency Contact
Emergency Contact First Name
*
Emergency Contact Last Name
*
Emergency Contact Phone
*
Relationship to Child
*
Choose Your Camp Days
This Camp is Full, July 31st week is still open
-
Art Camp with Ms. Susan at Azalea Park All Week 220.00
All Week July 31-August 4
Little Explorers Camp at Audubon Park All Week 220.00
All Week Camp June 26-June 29th
Art and Cooking Camp with Mr Foster and Ms Messina at Audubon Park Elementary All Week 220.00
All Week Camp June 19-June 22
Jump Start into Middle School with Kate Demory and Heidi Lifrage 125.00 Session ! July 31 August 1 125,00 Session 2 August 2 August 3 125.00 Session 2 July 2,3
Jukt 31 August 1 Session 1
August 2 August 3 Session 2
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