Total Fee $ __________________________________from following page – includes camps, extended care and lunches

ArtsClub Membership/Renewal $ __________________________________

Contribution to Scholarship Fund $ __________________________________

Application Fee (per family) $ __________________________________

TOTAL $ __________________________________

Please also complete the following page

ArtsCamp REGISTRATION

Camper’s Name __________________________________________________________________________________________ Camper’s Date of Birth _________________________________ Camper’s Grade (as of Fall 2012) _____________________ Medical Conditions/Special Needs __________________________________________________________________________List all allergies, medications _______________________________________________________________________________ (ArtsCenter Staff will not administer, dispense, or store any medications, with the exception of emergency medications, such as Epi Pen)Parent/Guardian’s Name ___________________________________________________________________________________Address _________________________________________________________________________________________________City _______________________________________________ State ____________ Zip _______________________________ Phone (Day) _____________________________________ (Evening) _______________________________________________ Email ___________________________________________________________________________________________________(Email will be used as primary contact for ArtsCamp receipts and information, unless you request otherwise.)

Emergency Contact Name _______________________________ Emergency Contact Phone ________________________(if parent(s) cannot be reached)

Please read and sign the following: I have read and agree to The ArtsCenter Inc.’s policies (above), and I understand that The ArtsCenter Inc. may photograph my child during camp. Photographs may be used in The ArtsCenter, Inc. publications and approved media sources, unless I request otherwise in writing. In consideration of The ArtsCenter, Inc. making summer camp programs available to my child, I hereby release The ArtsCenter, Inc., its employees, volunteers and agents from any and all liability, cost/expense associated with any injury or illness my child may sustain while participating in any of the summer programs. In case I cannot be reached in an emergency, I give my permission to The ArtsCenter, Inc. to call for Emergency Medical Services (911) and/or to select a physician to secure proper treatment for my child. _________________________________________________________________________________ ____________________________Parent/Guardian signature (required) Date

Mail completed forms to: The ArtsCenter Attn: ArtsCamp 300-G East Main Street Carrboro, NC 27510

When paying by credit card, forms may be faxed to 919.969.8574. After sending fax, please call 919.929.2787, ext. 204 to confirm fax has been received.

Registration Guidelines: Complete a separate registration form for each participant. Please photocopy the form if applicable. Pay attention to camper age limits and enroll only in age appropriate programs. Program availability is updated regularly on the ArtsCamp web page. You will be informed within two business days if a program you signed up for is full. Confirmation letters will be sent out within three weeks of receipt of your registration.

Cancellation Policy: Only cancellations made at least 14 days in advance of the camp start date will receive a refund, minus a $25 service fee per person per program. In case of insufficient registration, The ArtsCenter reserves the right to cancel a program two weeks before the start of a session. In this instance, participants will receive a full refund.

Program Fees: Fees differ from program to program, with some costing more due to smaller class size or higher material costs. There is a non-refundable $25 application fee per family, per summer. Full payment is due upon registration. Please contact 919.929.2787, ext. 204 with payment related questions.

• January 30th – Early Registration Opens for ArtsClub Members • February 13th – Registration Opens for General Public •

$ 25.00

Payment InformationFees paid by (please check one) • Cash • Check (payable to The ArtsCenter) Check No. _____________ • Visa/MC/Discover/AmEx Card No. ________________________________________________________________Exp. Date _________________ Security Code ________________

Become an ArtsClub member today and receive reduced tuition now! The ArtsCenter is a not-for-profit organization that depends on individual donations. $ __________ Family Contributor ($150 to receive discounts on summer camp, events, and classes for adults and children for a 12-month period.) $ __________Would you like to contribute to The ArtsCamp scholarship fund? (please specify amount)

Puppetry and Mask Making June 11-15 AM- 9:00 am-Noon ($145… $135) $10 N/A $30Beginning Sewing (2nd-4th grade) June 11-15 AM- 9:00 am-Noon ($145… $135) $10 N/A $30

Drawing Techniques 1 June 11-15 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30

Beginning Sewing (5th-7th grade) June 11-15 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Sculpture and Papier Mâché June 18-22 AM- 9:00 am-Noon ($145… $135) $10 N/A $30Sew for You Camp (3rd-7th grade) June 18-22 AM- 9:00 am-Noon ($145… $135) $10 N/A $30Cartooning & Comics 1 June 18-22 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Sew for You Camp (age 13+) June 18-22 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Drawing Techniques 2 June 25-29 AM- 9:00 am-Noon ($145… $135) $10 N/A $30Masks & Costumes (4th-7th grade) June 25-29 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Create Your Own Book July 2-6 PM- 1:00-4:00 pm ($130… $120) N/A $16 $24Sew for Your Doll (3rd-7th grade) July 9-13 AM- 9:00 am-Noon ($145… $135) $10 N/A $30Hip Hop & Urban Dance 1 July 9-13 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Purses & Bags (3rd-7th grade) July 9-13 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Painting Techniques July 16-20 AM- 9:00 am-Noon ($145… $135) $10 N/A $30Knit One, Purl Two (3rd-7th grade) July 16-20 AM- 9:00 am-Noon ($145… $135) $10 N/A $30Cartooning & Comics 2 July 16-20 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Digital Photography (5th-7th grade) July 23-27 AM- 9:00 am-Noon ($145… $135) $10 N/A $30Ceramics Intensive July 23-27 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Collage: Beyond the Surface July 30-Aug 3 AM- 9:00 am-Noon ($145… $135) $10 N/A $30Fashion & Fiber Arts July 30-Aug 3 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Hip Hop & Urban Dance 2 Aug 6-10 AM- 9:00 am-Noon ($145… $135) $10 N/A $30Curtain Up! Aug 6-10 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Scrap Sculpture Aug 13-17 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30Portaits & Landscapes Aug 20-24 PM- 1:00-4:00 pm ($145… $135) N/A $20 $30 A

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Adventures at Sea June 11-15 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Art and Nature June 18-22 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Arts Around the World: Asia June 25-29 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30American Arts July 2-6 AM or PM ($80… $75) or Full Day ($160… $150) $8 $16 $24Myths, Magic, & Legends July 9-13 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Arts Around the World: Africa July 16-20 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Time Machine July 23-27 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Funky Folk Art July 30-Aug 3 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Arts Around the World: South America Aug 6-10 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30

Ancient Art Adventures Aug 13-17 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Modernist Mashup Aug 20-24 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30 K

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Camp Dates Time & Cost* (Circle AM/PM from the options below) Early Arrive

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Secret Gardens June 11-15 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Once Upon a Time June 18-22 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Carnival Kaleidoscope June 25-29 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Sea to Shining Sea July 2-6 AM or PM ($80… $75) or Full Day ($160… $150) $8 $16 $24Animal Kingdom July 9-13 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Appetite for Art July 16-20 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Birds of a Feather July 23-27 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Blue Planet July 30-Aug 3 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Recycled Art Aug 6-10 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Art Safari Aug 13-17 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30Circus! Circus! Aug 20-24 AM or PM ($100… $95) or Full Day ($200… $190) $10 $20 $30 L

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Ceramics 1 June 11-22 PM- 1:00-4:00 pm ($265… $245) N/A $40 $60Ceramics 2 June 25-July 6 PM- 1:00-4:00 pm ($240… $220) N/A $36 $54

Let's Make a Play 1 July 2-13 AM- 9:00 am-Noon ($240… $220) $18 N/A $54

Ceramics 3 July 9-20 PM- 1:00-4:00 pm ($265… $245) N/A $40 $60Ceramics 4 July 30-Aug 10 PM- 1:00-4:00 pm ($265… $245) N/A $40 $60Let's Make a Play 2 Aug 13-24 AM- 9:00 am-Noon ($265… $245) $20 N/A $60Ceramics 5 Aug 13-24 PM- 1:00-4:00 pm ($265… $245) N/A $40 $60 A

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TOTAL: (including camps, extended care and lunches) $ _________* General public price ... ArtsClub Family Contributor price