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    Tubman Children in The Arts 2010 Summer Heritage Camp Application

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    brazilianbombshell9
    The document is an application for the 2010 Summer Heritage Camp at the Tubman Children in the Arts program. The application collects information such as the child's name, age, grade level, t-shirt size, emergency contacts, medical conditions, and availability. Parents must sign to consent to their child's participation, acknowledge pick-up policies, and release the museum from liability. The camp runs from June 14-18 and June 21-25, with Friday trips to Atlanta, and instructs children ages 7-12 in class activities. Parents are given behavior expectations and contact information.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Tubman Children in The Arts 2010 Summer Heritage Camp Application

    Uploaded by

    brazilianbombshell9
    22 views3 pages
    The document is an application for the 2010 Summer Heritage Camp at the Tubman Children in the Arts program. The application collects information such as the child's name, age, grade level, t-shirt size, emergency contacts, medical conditions, and availability. Parents must sign to consent to their child's participation, acknowledge pick-up policies, and release the museum from liability. The camp runs from June 14-18 and June 21-25, with Friday trips to Atlanta, and instructs children ages 7-12 in class activities. Parents are given behavior expectations and contact information.

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    HERITAGE%20CAMP%20Application%202010

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    The document is an application for the 2010 Summer Heritage Camp at the Tubman Children in the Arts program. The application collects information such as the child's name, age, grade level, t-shirt size, emergency contacts, medical conditions, and availability. Parents must sign to consent to their child's participation, acknowledge pick-up policies, and release the museum from liability. The camp runs from June 14-18 and June 21-25, with Friday trips to Atlanta, and instructs children ages 7-12 in class activities. Parents are given behavior expectations and contact information.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    22 views3 pages

    Tubman Children in The Arts 2010 Summer Heritage Camp Application

    Uploaded by

    brazilianbombshell9
    The document is an application for the 2010 Summer Heritage Camp at the Tubman Children in the Arts program. The application collects information such as the child's name, age, grade level, t-shirt size, emergency contacts, medical conditions, and availability. Parents must sign to consent to their child's participation, acknowledge pick-up policies, and release the museum from liability. The camp runs from June 14-18 and June 21-25, with Friday trips to Atlanta, and instructs children ages 7-12 in class activities. Parents are given behavior expectations and contact information.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Tubman Children in the Arts

    2010 SUMMER HERITAGE CAMP APPLICATION


    Ages 7-12
    TODAY’S DATE: ___/___/____

    (To better process our records, please fill out one application per child)

    Grade Level: ____ 1st Time Participant? Y___N___ Museum Member: Y___N___
    Name:___________________________________ Age:__ Gender: M__F__ / Y__N__
    Address:_____________________________ City:_______________State: ___Zip:______
    Phone #____________________ Other #___________________ Cell #_______________
    Parent(s) or Guardian(s):
    Name:___________________________________No:______________________
    Name:___________________________________No:______________________
    Emergency Contacts:
    Name:___________________________________No:_______________________
    List any medical conditions and/or allergies that your child suffers (*please give details).
    Please Circle T-shirts Size (all sizes are adult) S M L XL
    Camp hours are from 9am – 3pm. Monday – Thursday, and Friday 6am – 5:30pm.

    Please circle your week of preference


    Week 1: June 14 – 18, 2010 OR June 21 – 25, 2010

    Name of person(s) responsible for pick-up at 3:00 pm


    Name: _______________________________________________ Phone #________________________
    Name: _______________________________________________ Phone #________________________

    • All parents or assigned guardians must sign in and out their child(ren).
    • All participants should be prepared to participate in class activities with the instructor .

    By signing below, I understand that I am giving consent for the above named child to participate in the Tubman African
    American Museum’s Heritage Camp. I am authorized, as the child's parent or legal guardian, to give said consent.

    ________________________________________ __________________
    Parent/Guardian Signature Date

    **YOU WILL BE NOTIFIED IF CHILD IS ACCEPTED TO CAMP


    340 Walnut Street
    Macon, GA 31201
    478.743.8544 * 478.473.9063

    Release of Liability

    I am giving my authorized consent for my child__________________________________ to


    participate in the Tubman African American Museum – Children in the Arts Program. By signing
    below, I understand and agree that by giving consent, I am releasing the Tubman African American
    Museum, the Tubman Board of Directors, the Tubman Advisory Board, the Tubman employees and
    the Tubman volunteers of liability for injuries caused by accidents or otherwise. Furthermore, I
    understand that the Tubman Board of Directors, Tubman Advisory Board, the Tubman employees
    and Tubman volunteers will not be named as defendants in any lawsuits for any reason whatsoever.

    ___________________________________________
    Signature of consent and release of liability

    ___________________________________________
    Print Name

    ___________________________________________
    Date

    www.tubmanmuseum.com
    340 Walnut Street
    Macon, GA 31201
    478.743.8544 * 478.473.9063

    FACT SHEET (Please keep this page for your records)

    TUITION: Free (Lunch Provided)

    HOURS & DAYS OF SESSIONS:


    Monday – Thursday
    June 14th – June 18th 2010 (Camp 1)
    June 21st - June 25th, 2010 (Camp 2)
    9am – 3pm
    Friday’s Only ~ 6am – 5:30pm (Trip to Atlanta)

    INSTRUCTORS:

    Outreach Coordinator: Director of Education & Outreach:


    Quinton Tard Anita Ponder, J.D.
    Contact Number: (478) 743-8544

    Policies: (Please read carefully, all policies strictly enforced)

    • Assignments or reports must be turned in to prove class participation.


    • All participants should be prepared to participate in cooperation with the instructor.
    • Parents must notify the education assistant regarding any medical conditions and special issues
    concerning each child.
    • In the event of an outing, all food restrictions and allergies must be noted on the application in an
    effort to better prepare for each student attending the workshop series.
    • Fighting, cursing, and stealing are causes for automatic suspension. (No exceptions)
    • Students are not allowed to sign themselves in or out. (This is for security purposes)
    • Students should be picked up promptly at 3:00 pm. After care is not provided.

    Behavior Code:

    • Students are expected to follow all rules.


    a. Gum, candy, drinks and food are not allowed during workshop.
    b. Raise your hand to get permission to speak or leave session area.
    c. Hands, feet and body should remain off of all art objects within Museum.
    d. Respect and obey all staff and session instructors.

    www.tubmanmuseum.com

    For more information, contact Quinton Tard, Outreach Coordinator @ 478-743-8544


    The mission of the Tubman Museum is to educate people about African American art,
    history & culture

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