Camp Bloom Winter Wonderland Workshop JANUARY 28 || Hanover Arts and Activities Center

Camp Bloom Winter Wonderland Workshop JANUARY 28

January 18th, 2021 | Forms

This is the registration page for Camp Bloom Winter Wonderland Workshop on Thursday, January 28, 2021 6PM-8PM

*If you are looking to register for the January 30 workshop, please go back and click on that registration.

Camp Bloom Jr. Winter Wonderland Workshop January 28

Participant 1 (child) Name*
First Last
Nickname
Address*
Street Address City State / Province / Region ZIP / Postal Code
Age as of July 1, 2020
School Attending in Fall 2020
Grade in Fall 2020
Participant 2 (child) Name
First Last
Nickname
Address
Street Address City State / Province / Region ZIP / Postal Code
Age as of July 1, 2020
School Attending in Fall 2020
Grade in Fall 2020
Parent/Guardian Name*
First Last
Email*
Cell Phone*
Work Phone
Other Parent or Legal Guardian Name
First Last
Other Parent or Legal Guardian Cell Phone
Email*
Cell Phone*
Work Phone
Other Parent or Legal Guardian Name
First Last
Other Parent or Legal Guardian Cell Phone
EMERGENCY CONTACT INFORMATION
in the event that a secondary contact must be made.
Name*
First Last
Relationship
Emergency Contact Cell Phone*
PERMISSION
May we photograph/videotape you/your child at The Center?*
- Yes
- No
May we use photos taken of your/your child in our flyers, brochures, newsletters and/or website for publicity?*
- Yes
- No
Name(s) of people who may pick up your child(ren) from the Center*
Only these people will be allowed to sign your child(ren) out from the Center.
Name(s) of people who MAY NOT pick up your child(ren) from the Center.
Payment Method*
- I will bring a check to the workshop.
- I will pay using a credit card by January 22, 2021(PayPal link below)
COVID 19 Procedure Agreetment
I agree to abide by The Center's COVID guidelines.
Due to state guidelines on COVID, The Center requires that attendees wear masks, adhere to social distancing guidelines, and agree to health checks and sanitation guidelines during camp sessions.
Parents and guardians agree to use best judgement for allowing children to attend and will not hold The Center liable for any illness.
MAILING ADDRESS: Hanover Arts & Activities Center PO Box 486 500 S. Center Street Ashland, VA 23005
Special Instructions, Allergies

Camp Bloom Winter Wonderland Workshop JANUARY 28

This is the registration page for Camp Bloom Winter Wonderland Workshop on Thursday, January 28, 2021 6PM-8PM

*If you are looking to register for the January 30 workshop, please go back and click on that registration.

Camp Bloom Jr. Winter Wonderland Workshop January 28

EMERGENCY CONTACT INFORMATION

PERMISSION

PAY TUITION ONLINE HERE: