Kids Art Camp Registration! | The Tipsy Paintbrush | Drink Wine and Paint in Charlotte NC

Kids Art Camp Registration!

– Cost is ~~$150~~ $125 per child.
– PLEASE NOTE! Your child’s reservation is not completed until payment is made.
– On clear days, the group will go to the park for lunch.
***Please take a good picture (head shot) of your child/children and send in with the registration form.

All Field are Required

Camp Name:

Child Name :

Birth Date :

Parent/Guardian Name :

Cell Phone No. :

Email Address :

(we will send camp details via email.)

Home Address :

Emergency Contact Information (in case you are unavailable)

(At least one adult OTHER THAN parent/guardian authorized to pick up child. Please list NAME, PHONE #, and RELATIONSHIP to child.)

Does your child have allergies?

Yes

If YES, please describe any indicated precautions and emergency procedures.

(Please include child's physician name and contact information.)

Does your child have any special needs?

Yes

If so, please describe below, or call us so that we can discuss the best plan for your child.

(We want to make sure all children are taken care of !)

Emergency Medical Release. PLEASE READ CAREFULLY and AGREE with the statement below.

Agree

(In the event of injury or serious illness, I give permission for The Tipsy Paintbrush Kids staff to obtain medical treatment for my child. I understand that if my child needs to be transported to an emergency facility, that decision will be made by the emergency team responding to the call.)

Photographic Release. PLEASE READ CAREFULLY and AGREE with the statement below.

Agree

(I give permission to The Tipsy Paintbrush Kids to use photographs and videos of my child in any and all publications and all other media without limitation for the limited purpose of publicity and advertising for The Tipsy Paintbrush Kids.)

Digital Signature :

(My digital signature below confirms that the above information is accurate; that the guidelines and procedures of the programs my child is registered for will be adhered to; and that I understand it is my responsibility to keep the above information current.)

Child Image :

Please send us a good "head/face shot" of your child so we know exactly who they are when they come in the door!

Payment Method:

Paypal

Enter Voucher code: