24 King Oak terrace

Weymouth Ma 02189

617-780-7730

Registration Form

Child’s Name:__________________________________________

Child’s Age:_______

Mother’s / Father’s Name:_______________________  ______________________________

Address:________________________________________________________

Phone:______  ______  ______

Email_____________________________

Emergency Contact:________________________

Phone:______  ______  ______

Summer Art Camp 2019

Date course begins: ___ ___ ___Am session_____  PM session____Lunch____

Amount Due: $ _________

Please print this form and enclose payment , cash or checks made out to:

 Art Barn

24 king oak terrace

Weymouth ma 02189

Any Food Allergies? Let me know

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Permission to photograph your child for advertising purposes? yes, no (circle)