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

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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)

  • $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.

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
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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

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Are you a current student at the NJWA Music Studio?

NoYes
[group isStudent]

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Does student have any allergies?
NoYes
[group hasAllergies]

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Does student have a medical condition?
NoYes
[group hasMed]

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Does student have asthma/wheezing?
NoYes
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Has student had Chicken Pox?
NoYes

Does student have contact lenses?
NoYes

Does student have physical limitations?
NoYes
[group haslimits]

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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.

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