Test Summer Form

    MaleFemale

    Tuition

    • NJWA Morning Arts Camps 8:30-12:30
      • 3 Weeks: Early Registration Rate: $695 (+$30 registration fee)
      • 2 Weeks: Early Registration Rate: $590 (+$30 registration fee)
      • 1 Week: Early Registration Rate: $295 (+$30 registration fee)


    • Early Morning Drop-Off (7:30 am): $125/3 weeks OR $10/day

    • Afternoon Adventures at the Y (12:30-4:30 pm)
      • $695/3 weeks
      • $240/week
    • Extended care past 4:30 is available directly through the Y

    The registration fee will be waived for current Music Studio students.

    Early Morning Drop-off $125 3/weeksEarly Morning Drop-off $10/day billed later

    Registering for all three weeks?
    YesNo - Just 1 or two weeks

    Are you a current student at the NJWA Music Studio?

    NoYes

    Does student have any allergies?
    NoYes

    Does student have a medical condition?
    NoYes

    Does student have asthma/wheezing?
    NoYes

    Has student had Chicken Pox?
    NoYes

    Does student have contact lenses?
    NoYes

    Does student have physical limitations?
    NoYes

    Are immunizations up to date?
    NoYes

    Please List any medications and reasons for taking:

    Note: If a child is to be given medications during the Workshop, a Physician's note is required. All medications must be in the original container. No medications will be given without a Physician's note and the appropriate container.

    Any additional medical notes:

    Emergency Contact #1
    Name
    Phone:

    Emergency Contact #2
    Name
    Phone:

    Primary Physician (required)
    Physician Name:
    Physician Phone:

    Dentist Contact (will use physician if blank)
    Dentist Name:
    Dentist Phone:

    Preferred Hospital:

    Medical Insurance:
    Insurance ID/Group: