Foundry Art Camp

ADMIN

Participant Information

Participant Name

Date of Birth

Gender

Male
Female

School

Grade in Fall 2021

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Parent/Guardian Information

Parent/Guardian Name 1

Address

Zip Code

Phone Number

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Parent/Secondary Contact

Phone Number

Emergency Contact

Phone Number

Registration Information

Full-Day Camp / $215

June 7 – 11 / Plants + People ($215.00) [Sold Out]
June 14 – 18 / Monet’s Magical Monarchs ($215.00) [Sold Out]
June 21 – 25 / Wonders of Waters ($215.00) [Sold Out]
June 28 – July 2 / Painting in the Park ($215.00) [Sold Out]
July 12 – 16 / Nature’s Bounty ($215.00) [Sold Out]
July 19 – 23 / Purposeful Plastic ($215.00) [Sold Out]
July 26 – 30 / Amazing Animals ($215.00) [Sold Out]
Aug 2 – 6 / Sustainable Surrealists ($215.00) [2 remaining]

* We may have additional spots in SOLD OUT sessions depending on the age of your child. Please contact Jenny Kettler, Program Director to inquire about availability: [email protected]

Registration Fee* ($20.00)

Running Total

$20.00

Coupon Code

Total

$20.00

Medical Information

In the event of a medical emergency, please provide the following pertinent health information:

Primary Care Doctor

Doctor's Phone Number

Health Considerations

Please list the medication name(s), instructions, times administered and whether it can be held in the care of STAFF or CAMPER.

If your child has no medication needs type N.A.

Medication Needs Form

Is there any additional information staff should know about to ensure your child has a safe and fun summer at camp?

If not, type N.A.

Additional Information:

If your child has special needs or accommodations please contact Program Coordinator, Jenny Kettler at:
636-255-6179 or [email protected],

Pick up Authorization

List YOURSELF and anyone authorized to pick up your child (i.e. relatives, carpool drivers, babysitters, etc.)

Please include: Name, Relationship to participant and Phone Number.

Authorized for pick-up

My child/children will be walking/riding a bike to and from camp.

Waivers

Yes, my child has permission to enjoy climbing at Climb So iLL. Click on the link below to fill out the climbing waiver.

No, my child does NOT have permission to climb at Climb So iLL.

* Your child will not be allowed to climb unless the Climb So iLL waiver is complete.

Yes, I have filled out the Climbing Waiver

Parent Packet

I have read and agree to the terms above.

Consent Waiver Form

I accept responsibility for abiding by the policies in this Foundry Art Camp Program Parent/Guardian Manual.

I agree to make myself and my child familiar with all policies and information contained in the Manual.

I acknowledge I have read, understand and agree I am solely financially responsible for the emergency medical care and transportation of my child in the event of a medical emergency.

I acknowledge that this Manual is not a contract, creates no legal obligations upon the City of St. Charles or the Foundry Art Centre, and creates no legal rights of a parent or child participating in these programs.

I and my child agree to abide by all rules and regulations set forth by the City of St. Charles and the Foundry Art Centre.

I hereby give The Foundry Art Centre or persons(s) or agencies operating in its authorized behalf complete permission to take (me/my child) on any outing which is planned and supervised by the Foundry Art Centre and to take (me/my child) to and from designated program sites. Scheduled programs and/or locations are subject to change without prior notification.

In the event that I, or one of the Primary, Secondary, or Emergency Contacts listed above cannot be reached, I hereby give permission to transport via ambulance to the nearest emergency room, which is SSM St. Joseph's or other medical facility deemed necessary by medical personnel and to the physician(s) selected to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above. I AGREE THAT I (parent/guardian) AM RESPONSIBLE FOR 100% OF THE COST REGARDLESS IF MY CHILD IS TREATED AT OR BY MEDICAL CARE THAT IS IN OR OUT-OF-NETWORK..

I grant to The Foundry Art Centre (St Charles, MO) and/or the Greater Saint Charles Convention & Visitors Bureau, their representatives, and employees the right to take photographs of me, my children, and my property in connection with classes and programs, during sponsored Foundry Art Camp activity. I agree that The Foundry Art Centre (St Charles, MO) and/or the Greater Saint Charles Convention & Visitors Bureau, their assigns, and transferees, may use and publish the photographs of me for any lawful purposes (including but not limited to event publicity, illustration, advertising, and Web content), whether in print and/or electronically, with or without my name. There will be no financial payment to me for use of my or my camper’s image.

I have read and understand the Foundry Art Camp Program Participant Code of Conduct and the Parent Manual, that (me/my child) will be expected to adhere to the best of their abilities at all times. I understand (I/my child) can be excluded at any time during the program by the Foundry Art Centre staff if it is judged that (I/my child) (have\has) hampered the safety, welfare or enjoyment of other participants in the program.

I, the undersigned, agree to the terms above.

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Donation

Your contribution makes it possible for the Foundry Art Centre to serve the greater St. Louis area through arts and culture. You're support helps fund exhibitions, events and educational programs. Became a part of the Foundry's legacy today!

Donations are 100% tax deductible.

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