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

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.