Application Received On:

Confirmation -

Send:

Sent:

_______________________________________________________________________

ENROLLMENT APPLICATION
AGOURA HILLS CAMPUS
_______________________________________________________________________

STEP 1: PARENT INFORMATION
To begin, type in all necessary family information. A working Email
address is required as most camp communications are sent this way.
(This is NOT the K CAMP application)
_______________________________________________________________________

Are you a new or returning family?

New Returning

I am attending:

Session 1 Session 2 Session 1 & 2

Days I will be attending:

2 Days per Week 3 Days per Week 5 Days per Week

Enroll me with friends:

Yes No

MOM
First Name		Last Name
Address		City
State		Zip
Home Phone		Work Phone
Cell Phone		Email

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DAD or SECOND GUARDIAN
First Name		Last Name
Address		City
State		Zip
Home Phone		Work Phone
Cell Phone		Email

_______________________________________________________________________

Emergency Contact(s)

Phone Number

Family Doctor

Phone Number

Authorized person(s) to pick up my child(ren)

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STEP 2: HOW DID YOU HEAR ABOUT US?
In an effort to better target our marketing campaigns, please let
us know where you first heard about our program.
______________________________________________________________________

LA Parent		Friend		Flyer		The Acorn
Banner		Internet		Postcard		At School
Other

STEP 3: YOUR FIRST CHILD'S INFORMATION
Complete all fields below for the first child you are enrolling
______________________________________________________________________

First Name		Last Name
Sex	Female Male	Age in June
School		Current Grade

If you can, enroll me with my friends
I am attending camp alone

______________________________________________________________________

STEP 4: YOUR SECOND CHILD'S INFORMATION
Complete all fields below for the second child you are enrolling
______________________________________________________________________

First Name		Last Name
Sex	Female Male	Age in June
School		Current Grade

If you can, enroll me with my friends
I am attending camp alone

______________________________________________________________________

STEP 5: YOUR THRID CHILD'S INFORMATION
Complete all fields below for the third child you are enrolling
______________________________________________________________________

First Name		Last Name
Sex	Female Male	Age in June
School		Current Grade

If you can, enroll me with my friends
I am attending camp alone

______________________________________________________________________





STEP 6: WORKSHOP CHOICES FOR YOUR FIRST CHILD
You are now ready to select your first child's workshops. Please rememeber to
check daily workshop schedules BEFORE making your choices as some workshops
may already be closed. You and your child should select two choices of workshops
within each of the four time periods as your first choice may close between
the time you complete your application and the time we receive it.
If so, we will automatically enter your child into their second choice.

Session One:M/W/F Check Workshop Status Click Here!
Time	1st Choice	2nd Choice
9:00 - 10:10	259 MYSTIFYING MAGIC 260 DIGITAL PHOTO 261 CREATIONS IN CLAY 262 LET'S DANCE! 263 HOT ART/COOL SCIENCE 264 FUNNY CHARACTERS 265 SPOOL KNITTING	259 MYSTIFYING MAGIC 260 DIGITAL PHOTO 261 CREATIONS IN CLAY 262 LET'S DANCE! 263 HOT ART/COOL SCIENCE 264 FUNNY CHARACTERS 265 SPOOL KNITTING
10:35 - 11:45	266 MAGIC AND MORE! 267 BEGINNING WEB DESIGN 268 HIGH SCHOOL MUSICAL 2 269 AFRICAN HAND DRUMMING 270 THE NATURE OF ART 271 ANIMAL DRAWING 272 SCRAPBOOKING	266 MAGIC AND MORE! 267 BEGINNING WEB DESIGN 268 HIGH SCHOOL MUSICAL 2 269 AFRICAN HAND DRUMMING 270 THE NATURE OF ART 271 ANIMAL DRAWING 272 SCRAPBOOKING
12:45 - 1:55	273 MYSTIFYING MAGIC 274 PAPER ARCHI-TECTS 275 PUPPETS AND PLAYS 276 FENCING 277 DA VINCI'S WORKSHOP 278 SCULPEY CREATIONS 279 BEGINNING CHESS	273 MYSTIFYING MAGIC 274 PAPER ARCHI-TECTS 275 PUPPETS AND PLAYS 276 FENCING 277 DA VINCI'S WORKSHOP 278 SCULPEY CREATIONS 279 BEGINNING CHESS
2:20 - 3:30	280 MAGIC AND MORE! 281 POSTERIZE IT! 282 SUMMER SPA 283 FENCING 284 YOGA WORKS 285 ACRYLIC PAINTING 286 CHECKMATE	280 MAGIC AND MORE! 281 POSTERIZE IT! 282 SUMMER SPA 283 FENCING 284 YOGA WORKS 285 ACRYLIC PAINTING 286 CHECKMATE

Session One:T/TH Check Workshop Status Click Here!
Time	1st Choice	2nd Choice
9:00 - 10:10	288 ROBOTIX 289 CERAMICS 290 CREATIVE DANCE 291 YOGA WORKS 292 CHARCOAL SKETCHING 293 COLONIAL CRAFTS	288 ROBOTIX 289 CERAMICS 290 CREATIVE DANCE 291 YOGA WORKS 292 CHARCOAL SKETCHING 293 COLONIAL CRAFTS
10:35 - 11:45	294 PORTRAIT PHOTOGRAPHY 295 ROBOTIX 296 CREATIONS IN CLAY 298 HOT ART/COOL SCIENCE 299 WATERCOLORS 300 TRASH TO TREASURE	294 PORTRAIT PHOTOGRAPHY 295 ROBOTIX 296 CREATIONS IN CLAY 298 HOT ART/COOL SCIENCE 299 WATERCOLORS 300 TRASH TO TREASURE
12:45 - 1:55	301 MYSTIFYING MAGIC 302 DECOUPAGE 303 FENCING 304 CAPOERIA 305 MEET THE ART MASTERS 307 FUNNY CHARACTERS	301 MYSTIFYING MAGIC 302 DECOUPAGE 303 FENCING 304 CAPOERIA 305 MEET THE ART MASTERS 307 FUNNY CHARACTERS
2:20 - 3:30	308 MAGIC AND MORE MAGIC! 309 COMPUTER COLLAGE 310 FENCING 311 CAPOERIA 313 DRAGONS & ROBOTS 314 MASTERS IN MIXED MEDIA	308 MAGIC AND MORE MAGIC! 309 COMPUTER COLLAGE 310 FENCING 311 CAPOERIA 313 DRAGONS & ROBOTS 314 MASTERS IN MIXED MEDIA

Session Two:M/W/F Check Workshop Status Click Here!
Time	1st Choice	2nd Choice
9:00 - 10:10	315 WOODWORKING 316 CREATIONS IN CLAY 317 KARATE 318 MUSIC OF THE RAINFORESTS 319 HOT ART/COOL SCIENCE 320 FUNNY CHARACTERS 321 MYSTIFYING MAGIC	315 WOODWORKING 316 CREATIONS IN CLAY 317 KARATE 318 MUSIC OF THE RAINFORESTS 319 HOT ART/COOL SCIENCE 320 FUNNY CHARACTERS 321 MYSTIFYING MAGIC
10:35 - 11:45	322 WOODWORKING 323 DIGITAL PHOTO 324 KARATE: TANG SOO DO 325 HAND DRUMMING 326 THE NATURE OF ART 327 PASTEL TECHNIQUES 328 CARD SHARKS	322 WOODWORKING 323 DIGITAL PHOTO 324 KARATE: TANG SOO DO 325 HAND DRUMMING 326 THE NATURE OF ART 327 PASTEL TECHNIQUES 328 CARD SHARKS
12:45 - 1:55	329 WOODWORKING 330 BEGINNING WEB DESIGN 331 PUPPETS AND PLAYS 332 FENCING 333 DA VINCI'S WORKSHOP 334 CHARCOAL SKETCHING 335 CHECKMATE	329 WOODWORKING 330 BEGINNING WEB DESIGN 331 PUPPETS AND PLAYS 332 FENCING 333 DA VINCI'S WORKSHOP 334 CHARCOAL SKETCHING 335 CHECKMATE
2:20 - 3:30	336 WOODWORKING 337 POSTERIZE IT! 338 SUMMER SPA 339 FENCING 340 YOGA WORKS 341 DRAGONS & ROBOTS 342 BEGINNING CHESS	336 WOODWORKING 337 POSTERIZE IT! 338 SUMMER SPA 339 FENCING 340 YOGA WORKS 341 DRAGONS & ROBOTS 342 BEGINNING CHESS

Session Two:T/TH Check Workshop Status Click Here!
Time	1st Choice	2nd Choice
9:00 - 10:10	343 WOODWORKING 344 COMPUTER COLLAGE 345 CERAMICS 347 YOGA WORKS 348 DRAGONS & ROBOTS 349 FABRIC ART	343 WOODWORKING 344 COMPUTER COLLAGE 345 CERAMICS 347 YOGA WORKS 348 DRAGONS & ROBOTS 349 FABRIC ART
10:35 - 11:45	350 WOODWORKING 351 PAPER ARCHI-TECTS 353 YOGA WORKS 354 HOT ART/COOL SCIENCE 355 ANIMAL DRAWING 356 AFRICAN EMBROIDERY	350 WOODWORKING 351 PAPER ARCHI-TECTS 353 YOGA WORKS 354 HOT ART/COOL SCIENCE 355 ANIMAL DRAWING 356 AFRICAN EMBROIDERY
12:45 - 1:55	357 WOODWORKING 358 PAPERCRAFTING 359 FENCING 360 CAPOEIRA 361 MEET THE ART MASTERS 362 ACRYLIC PAINTING	357 WOODWORKING 358 PAPERCRAFTING 359 FENCING 360 CAPOEIRA 361 MEET THE ART MASTERS 362 ACRYLIC PAINTING
2:20 - 3:30	365 ELECTRONIC ARTS 366 FENCING 367 CAPOERIA 368 THE NATURE OF ART 369 STORY ILLUSTRATION 370 CRAZY CROCHET	365 ELECTRONIC ARTS 366 FENCING 367 CAPOERIA 368 THE NATURE OF ART 369 STORY ILLUSTRATION 370 CRAZY CROCHET

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STEP 7: WORKSHOP CHOICES FOR YOUR SECOND CHILD
You are now ready to select your second child's workshops. Please rememeber to
check daily workshop schedules BEFORE making your choices as some workshops
may already be closed. You and your child should select two choices of workshops
within each of the four time periods as your first choice may close between
the time you complete your application and the time we receive it.
If so, we will automatically enter your child into their second choice.

MY SECOND CHILD....

IS ENROLLING IN

(enter your child's name above)

Session One 5 Days a Week - $1216 Session One 5 Days a Week - with Extended Care -$1548.5 Session One M/W/F - $704 Session One M/W/F -with Extended Care - $896.5 Session One T/TH - $512 Session One T/TH - with Extended Care-$652 Session Two 5 Days a Week - $960 Session Two 5 Days a Week -with extended care- $1222.5 Session Two M/W/F - $576 Session Two M/W/F -with Extended Care - $733.5 Session Two T/TH - $384 Session Two T/TH - with Extended Care-$489

and Session Two 5 Days a Week - $960 Session Two 5 Days a Week -with extended care- $1222.5 Session Two M/W/F - $576 Session Two M/W/F -with Extended Care - $733.5 Session Two T/TH - $384 Session Two T/TH - with Extended Care-$489

Camp Merchandise, double click name to see item

do you want a camp shirt? 1 Small - $13 2 Small - $26 1 Medium - $13 2 Medium - $26 1 Large - $13 2 Large - $26

do you want a lunch box and water bottle? 1 - $20

do you want a camp hat? 1 Olive Green - $15 1 Ceramic Blue Trim - $15 1 Navy Blue Trim - $15 1 Orange Trim - $15

If your second child is attending the same session(s)
as your first child is, you are entitled to a 5% discount.
Select that now. Does not apply to extended care fees.

Session One Discount - Select Here 5% Discount on Session One M/W/F of - $35.20 5% Discount on Session One T/TH of - $25.60 5% Discount on Session One M to F of - $60.08

Session Two Discount - Select Here 5% Discount on Session Two M/W/F of - $28.80 5% Discount on Session Two T/TH of - $19.20 5% Discount on Session Two M to F of - $48

____________________________________________________________________

MY THIRD CHILD....

IS ENROLLING IN

(enter your child's name above)

Session One 5 Days a Week - $1216 Session One 5 Days a Week - with Extended Care -$1548.5 Session One M/W/F - $704 Session One M/W/F -with Extended Care - $896.5 Session One T/TH - $512 Session One T/TH - with Extended Care-$652 Session Two 5 Days a Week - $960 Session Two 5 Days a Week -with extended care- $1222.5 Session Two M/W/F - $576 Session Two M/W/F -with Extended Care - $733.5 Session Two T/TH - $384 Session Two T/TH - with Extended Care-$489

and Session Two 5 Days a Week - $960 Session Two 5 Days a Week -with extended care- $1222.5 Session Two M/W/F - $576 Session Two M/W/F -with Extended Care - $733.5 Session Two T/TH - $384 Session Two T/TH - with Extended Care-$489

Camp Merchandise, double click name to see item

do you want a camp shirt? 1 Small - $13 2 Small - $26 1 Medium - $13 2 Medium - $26 1 Large - $13 2 Large - $26

do you want a lunch box and water bottle? 1 - $20

do you want a camp hat? 1 Olive Green - $15 1 Ceramic Blue Trim - $15 1 Navy Blue Trim - $15 1 Orange Trim - $15

If your third child is attending the same session(s)
as your other kids are, you are entitled to a 5% discount.
Select that now. Does not apply to extended care fees.

Session One Discount - Select Here 5% Discount on Session One M/W/F of - $35.20 5% Discount on Session One T/TH of - $25.60 5% Discount on Session One M to F of - $60.08

Session Two Discount - Select Here 5% Discount on Session Two M/W/F of - $28.80 5% Discount on Session Two T/TH of - $19.20 5% Discount on Session Two M to F of - $48

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Now add up all amounts selected and enter your
total tuition payment where indicated below.
Use a calculator, total tuition is not automatically entered.

MY TOTAL TUITION IS...

Please Note:
Material fees, if any, will be billed when we process your application.
If you will be paying by credit card, material fees, if any, will be charged at that time.
If paying by check, we will bill you for any outstanding material fees due.
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STEP 10: PAYMENT METHOD
How would you like to pay for camp tuition?
If you pay by check, just mail the total tuition (above)
in with your completed application.
If you elect to pay by credit card an additional 3%
will be added to total tuition fees.
We do not accept American Express.
Make Checks Payable to: The Summer Art Academy

Card Type	Visa MasterCard
Cardholder Name
Account Number
Expiration Date

CARDHOLDER SIGNATURE: __________________________________________
(Sign above after you have printed out your completed application)
____________________________________________________________________

STEP 11: TERMS AND CONDITIONS
Please read our terms and conditions, registration cannot be
completed without signing and clicking the accept box below

1. ENROLLMENT: Children will be enrolled in workshops on a first-come, first-served basis. Enrollment above or below the recommended grade level will be considered in special cases. 2. MEDICAL INFORMATION: Your child's health is important to us. Your medical form must be on file with us prior to your child's first day of camp. Please advise us in advance of any special medical needs your child may have. Campers must be in good health: Allergies and other conditions, which might affect the health, safety or welfare of the camper, must be noted on the health history form provided. The Art Camp provides student accident protection for campers. Parents insurance is primary.By signing and accepting below, you allow the Art Camp to select a physician should your child be confronted with a medical emergency and you cannot be reached. 3. ABSENCES: There are no makeup days for absences or for days missed and parents are financially responsible for all days that their child has registered to attend. There will be no prorating of tuition for missed workshops due to sickness or travel, or any other reason. 4. TUITION: Full tuition must accompany each application in order for your child to be registered for workshops. A 5% discount is offered for a additional siblings enrolled in the same session from the same immediate family. All discounts apply to the session fee only and not to any workshop material fees. A 3% finance charge will be added when using a credit card. There is a $10 fee on all returned checks. 5. WORKSHOP CHANGES: Workshop changes will be made on a space available basis at the directors or assistant directors discretion. Changes will be considered during the first week of camp only, no exceptions. A $10 fee per workshop is due at the time the change is made. 6. WORKSHOP CANCELLATIONS: We reserve the right to limit class size, substitute instructors or cancel workshops for which there are not enough children enrolled. Every effort will be made to place your child in their second choice or into a similar workshop offered. 7. WITHDRAWALS AND REFUNDS: We do not offer refunds for camper's time off, missed days, family vacation, partially missed days, any medical reasons or anything else that requires time off from camp. Should you withdraw from the summer program prior to June 3rd 2008, you will receive a full refund minus a $100 cancellation fee PER child PER session enrolled. After June 3rd, 2008 there will be NO refunds - NO exceptions. If your child is dismissed from our summer program for disciplinary measures, you will receive a refund equal to 50% of unused tuition for the time remaining. While the Art Camp strives to make Camp enjoyable for all campers, satisfaction with the experience is subjective on the part of the child and the parent. Therefore, it is understood and agreed that the Art Camp cannot and does not guarantee or warrant any campers' satisfaction. It is also understood and agreed that there are no other agreements, expressed or implied, between the Art Camp and me or my child regarding the Art Camps programs or activities. 8. HESCHEL WEST ACKNOWLEDGEMENTS: You acknowledge that the Summer Art Academy is a sublease tenant of Abraham Joshua Heschel Day School West, a California nonprofit mutual benefit corporation (Heschel-West). Parent/Legal Guardian further acknowledges that as a material inducement for Heschel-West to allow the sublease of Heschel-West premises to Summer Art Academy, all campers parents and legal guardians must absolve Heschel-West of any and all liabilities occurring to such campers while on the premises or related to in any way to Summer Art Academy. By executing herein, you expressly acknowledge that Heschel-West has no supervisory or other obligations to Summer Art Academy or its invitees and such parents and legal guardians hereby forever release, discharge and absolve Heschel-West, its employees, directors, officers, agents and contractors from and against any and all liability that occurs, resulting from or relating to any campers attendance at Summer Art Academy. 9. YOU FURTHER AGREE: A. To pay for any material fees for those workshops that have fees associated with them. Allow you child's image to be used in any and all promotional photographs, videos or websites and print ads. B. To not hold the Art Camp responsible for any articles of clothing or personal belongings that are lost or damaged by theft, fire, natural disaster or other occurrence.

I ACCEPT:

DATE: ______________

PARENT/GUARDIAN SIGNATURE: ______________________________________
(Sign above after you have printed out your completed application.
By signing above you accept all our terms and conditions.)
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