Apply for Summer Arts Program

Parent/Guardian Information
Phone Number:
Alternate/Emergency Phone Number:
Email address:
Participant 1 Information
Full Name:
Preferred name/Nickname:
Date of birth:
25 26 27 28 29
2 3 4 5 6
9 10 11 12 13
16 17 18 19 20
23 24 25 26 27
30 31 1 2 3
6 7 8 9 10
13 14 15 16 17
20 21 22 23 24
Number of days:
Participant 2 Information
Dismissal I herby grant permission to the following person(s) to pick up my child.
Full Name:
Full Name:
Early Dismissal I herby grant permission for the early release of my child (e.g., to attent the YMCA).

Media Release I hereby grant permission to record my child.s/ward.s likeness and/or voice for use by television, films, radio, or printed media to further the aims of CANO in related campaigns and magazine articles, booklets, posters and in any other ways they may see fit. I give permission for my child to be photographed by CANO either individually or as part of a group participating in summer art program activities, including offsite trips. These photographs may be used on various camp brochures, posters, postcards, reports, an Internet site, CANO.s social media sites, and/or as part of a slide presentation to promote participation and interest in the camp
Total number of days:
Total Amount:
Medical Release -- PDF Download