Art Buzz Kids Camp                                                                                          Summer 2018 Registration Form:
Please note, your child's space is not confirmed until you have completed the registration and payment form online.
Please contact our studio if you have any questions: 540-381-6964 or christiansburg@wineanddesign.com

PLEASE NOTE ALL FOOD MUST BE PEANUT FREE. Snacks, lunch, treats! Thank you.

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Email *
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Child's Name *
Choose the week of summer camp to register for: *
Required
Is Your Child Attending Half Day or Full Day Camp?
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Does Your Child Need Before and/or After Camp Care?
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Child's Age *
Child's T-Shirt Size *
Parent or Guardian Name *
Cell # *
Alternate # *
Emergency Contact *
At least one adult OTHER THAN parent/guardian, who is authorized to pick up child. Please list NAME, PHONE#, and RELATIONSHIP to child. 
Does your Child have allergies? *
If YES, please let us know below, or call us so that we can discuss what is best for your child.
It is VERY important to us that EVERY child feel loved, inspired, and important!
Art Buzz Kids is a peanut free camp. Please Acknowledge that you have read this request and will not send a snack or lunch that contains peanuts. *
Emergency Medical Release: PLEASE READ CAREFULLY and AGREE with the statement below *
In the event of injury or serious illness, I give permission for Wine and Design/Art Buzz Kids staff to obtain medical treatment for my child. I understand that if my child needs to be transported to an emergency facility, that decision will be made by the emergency team responding to the call. I also understand that I will  be called immediately and informed of any emergency situation that arises.
Required
Digital Signature *
My digital signature below confirms that the above information is accurate; that the guidelines and procedures of the programs my child is registered for will be adhered to; and that I understand it is my responsibility to keep the above information current.
Art Buzz Kids is the Children's Division of Wine & Design
1580 North Franklin St Suite 4
Christiansburg VA 24073
540-381-6964
christiansburg@wineanddesign.com
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