Apply for Summer Arts Program

Parent/Guardian Information
Parent/Guardian:
Parent/Guardian 2:
Address:
City:
State:
Zip:
Phone Number:
Alternate/Emergency Phone Number:
Email address:
 
Participant 1 Information
Full Name:
Preferred name/Nickname:
Date of birth:
   
 
Week 1 07/01 - 07/05 M Tu W Th F
Week 2 07/08 - 07/12 M Tu W Th F
Week 3 07/15 - 07/19 M Tu W Th F
Week 4 07/22 - 07/26 M Tu W Th F
Week 5 07/29 - 08/02 M Tu W Th F
Week 6 08/05 - 08/09 M Tu W Th F
Week 7 08/12 - 08/16 M Tu W Th F
Week 8 08/19 - 08/23 M Tu W Th F
 
Number of days:
Amount:
 
Participant 2 Information
   
Dismissal I herby grant permission to the following person(s) to pick up my child.
Full Name:
Relationship:
 
Full Name:
Relationship:
** Please bring photo identification.
 
Early Dismissal I herby grant permission for the early release of my child (e.g., to attent the YMCA).

 
Media Release (Required -- please check one) Yes, I do    No, I do not
...grant permission for my child to be photographed by CANO either individually or as part of a group participating in summer art program activities, including off-site trips. These photographs may or may not be used on various program brochures, posters, postcards, reports, the CANO website, CANO’s social media sites, and/or as part of a slide presentation to promote participation and interest in the program.
 
Nut Free Policy (Required) I understand that the CANO Summer Program is a nut-free space due to participants’ life-threatening allergies. I will pack nut-free snacks only.
 
Total number of days:
Total Amount:
Medical Release -- PDF Download