Test Summer Form Campers Name (required) Street Address (required) City (required) State (required) Zip (required) MaleFemale Age on July 8, 2019 (required) 45678910111213141516171819 DOB (required) Grade as of September 2019 Jr-KK123456789101112 Your Name - Must be guardian. (required) Main Phone (required) Parents Cell Work Phone Your Email (required) 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) $TBA/3 weeks $TBA/week Extended care past 4:30 is available directly through the Y The registration fee will be waived for current Music Studio students. Camp Selection Age: 4-6 Young Explorers - Morning OnlyAge: 5-6 Young Explorers + Afternoon Adventures - Full DayAge: 7-10 Elementary Artists - Morning OnlyAge: 7-10 Elementary Artists + Afternoon Adventures - Full DayAge: 8-18 Virtuoso Chamber - Morning OnlyAge: 8-15 Virtuoso Chamber + Afternoon Adventures - Full DayAge: 10-18 Jam-A-Rama - Morning OnlyAge: 10-15 Jam-A-Rama + Afternoon Adventures - Full Day 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 Select Weeks 1st Week only 7/6-101st & 2nd Weeks 7/6-171st & 3rd Weeks 7/6-10 & 7/20-242nd Week only 7/13-172nd & 3rd Weeks 7/13-243rd Week only 7/20-24 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: If a parent/guardian cannot be reached in case of a medical emergency, consent is hereby given that my child may receive medical and/or surgical care as recommended by a physician or hospital. The NJWA Summer Arts Workshop does not assume liability for the aggravation of a pre-existing medical condition.