Registration Form:

Name of Camper _________________________ Age ____
Address of Camper ______________________________
Arts Interest/Experience _________________________________________
Why I want to go to art camp. (to be filled in by campers ages 8-13)
___________________________________________________________________
___________________________________________________________________
Medical concerns (allergies,etc.)_________________________________________________

Name of Parent/Guardian __________________________
Phone No. where parents/guardian can be reached during camp hours. _______

Parents and Guardians are welcome to volunteer during the art camp week and/or
provide snacks during the week. Please state which day you are willing to help. ___________

Camp is open to children between the ages of 8-13 who have a genuine interest in the arts.
Camp is limited to 25 children on a first come, first served basis.

HCAC Summer Art Camp uses photos of the camp and campers in publicity for the camp and Hampshire County Arts Council events on the web: www.hampshirearts.org and/or other media.

Parents/Guardians are expected to pick up campers by 12 noon daily.
HCAC Summer Art Camp reserves the right to ask destructive or disruptive campers to leave without return of camp fee.

For Parents/Guardians: Please read, sign, and mail in with camp fee.

Waivers of Liability

I hereby free the State of West Virginia, the West Virginia Schools for the Deaf and the Blind, and its personnel from liability in the event of accident, harm or injury while he/she is in or about the buildings and grounds of the West Virginia Schools for the Deaf and the Blind.
Name of Child __________________________________ Date ________

Parent/Guardian Signature ____________________________________

I hereby free the Hampshire County Arts Council, HCAC Summer Art Camp, and its personnel from liability in the event of accident, harm or injury while my child is attending Summer Art Camp.
Name of Child ____________________________________ Date _____
Parent/Guardian Signature _____________________________

Camp fee is $30.00 for the week-long camp.
Make checks payable to: Hampshire County Arts Council
(please note in memo line: Summer Art Camp)

Mail with registration form to:
Shelly Draper, HC 65 Box 4965 Romney WV 26757 by June 1, 2007!