Application Received On:

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_______________________________________________________________________
ENROLLMENT APPLICATION
AGOURA HILLS CAMPUS
_______________________________________________________________________

STEP 1: PARENT INFORMATION
To begin, complete all necessary family information. A working Email
address is required as most camp communications are sent this way.
_______________________________________________________________________

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 my friends:

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

_______________________________________________________________________

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)

_______________________________________________________________________

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: TUITION CALCULATION AND GROUP SELECTION
Please select all the session(s) and group (s) you are enrolling in. Decide if
you will need extended care, which is billed at $7 per hour if you sign up in
advance. One camp T-Shirt and all materials are included in your tuition.
This shirt must be worn daily.
Then add up all amounts selected and enter your
total tuition payment where indicated below.

MY FIRST CHILD....

IS ENROLLING IN

(enter your child's name above)
______________________________________________________________________

Select your session(s) from the pull down menu's below*

Session One 5 Days a Week - $1276 Session One 5 Days a Week - with Extended Care -$1608.5 Session One M/W/F - $734 Session One M/W/F -with Extended Care - $926.5 Session One T/TH (Bleu Cheese) - $542 Session One T/TH (Bleu Cheese) - with Extended Care-$682 Session Two 5 Days a Week - $1020 Session Two 5 Days a Week -with extended care- $1282.5 Session Two M/W/F - $606 Session Two M/W/F -with Extended Care - $763.5 Session Two T/TH (Chedder Cheese) - $414 Session Two T/TH (Chedder Cheese) - with Extended Care-$519

and Session Two 5 Days a Week - $1020 Session Two 5 Days a Week -with extended care- $1282.5 Session Two M/W/F - $606 Session Two M/W/F -with Extended Care - $763.5 Session Two T/TH (Chedder Cheese)-$414 Session Two T/TH (Chedder Cheese)-with Extended Care-$519

Child Shirt Size? Small Medium Large

Camp Merchandise, double click name to see item

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 other child is attending our older program
during the same session(s) as your K Camper is,
you are entitled to a 5% discount. Select that now.

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 - $60.80

Session Two Discount - Select Here 5% Discount on Session Two M/W/F of - $28.8 5% Discount on Session Two T/TH of - $19.2 5% Discount on Session Two M to F of - $48

____________________________________________________________________

Use a calculator, total tuition is not automatically entered.

MY TOTAL TUITION IS...

____________________________________________________________________

STEP 5: 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 6: 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 each 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. 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. 6. 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. 7. 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.)
____________________________________________________________________

STEP 7: MEDICAL INFORMATION FORM
Please click below to open up the camp medical form.
When complete, print this out and mail with your applciation.
Your child will not be enrolled in workshops
without a completed medical form!

MEDICAL FORM
____________________________________________________________________

STEP 8: ORDER A FRESH LUNCH FOR YOUR KIDS
Please click the Fresh Lunches bar below to register for camp lunches and snacks.
If you have signed up for extended care make sure you order an after camp snack!

____________________________________________________________________

THAT'S IT! NOW PRINT OUT YOUR COMPLETED
APPLICATION AND SIGN WHERE REQUIRED.
Along with your completed and signed medical form, mail it in with your tuition check to:

4130 Greenbush Ave. Sherman Oaks, CA. 91423.

All applications must be MAILED in and are
processed in the order which they are received.

NOW JUST WATCH FOR YOUR CONFIRMATION OF ENROLLMENT BY EMAIL.
SEE YOU AT CAMP!