plus camp 2012 application
DESCRIPTION
We cannot hold a space for your child without the $200 camp fee. No refunds after June 25, 2012. Checks should be dated 7/1/2012 and made to BPAC PLUS. Mail to: MSAI, DSU Box 3213, 1003 W. Sunflower Road, Cleveland, MS 38733 Mail to: MSAI, DSU Box 3213, 1003 W. Sunflower Road, Cleveland, MS 38733 Contact Laura Howell with any questions, 662-846-4844 or [email protected].TRANSCRIPT
Hours: 9:00am – 3:30pm Monday – Friday, Final performance Saturday @10:00 am
Checks should be dated 7/1/2012 and made to BPAC PLUS.
Second-child discount: $175.
CAMPER INFORMATION
FIRST NAME LAST NAME GENDER AGE BIRTHDATE SCHOOL GRADE COMPLETED
T-SHIRT SIZE (CIRCLE ONE): Youth S Youth M Youth L Youth XL Adult S Adult M Adult L Adult XL Adult 2XL Adult 3XL
PARENT/GUARDIAN INFORMATION
FIRST NAME LAST NAME
MAILING ADDRESS
CITY STATE ZIP PHONE
CONTACT FOR WEEK OF CAMP: NAME AND PHONE NUMBER
SIGNATURES
IF ACCEPTED TO THE 2012 SUMMER ARTS INSTITUTE, I AGREE TO ABIDE BY THE INSTITUTIONS REGULATIONS AND TO COOPERATE WITH THE ADMINISTRATION ON FURTHERING THE INSTITUTE’S IDEALS. I GIVE MSAI PERMISSION TO USE PHOTOS/VIDEOS OF MY CHILD’S
LIKENESS FOR PROMOTIONAL PURPOSES.
Application for Admission PLUS CAMP
Ages 5-12
July 9-14, 2012 • $200
PARENT/GUARDIAN’S SIGNATURE
SPACE IS LIMITED! We cannot hold a space for your child without the $200 camp fee.
No refunds after June 25, 2012.
Checks should be dated 7/1/2012 and made to BPAC PLUS.
Mail to: MSAI, DSU Box 3213, 1003 W. Sunflower Road, Cleveland, MS 38733
Contact Laura Howell with any questions, 662-846-4844 or [email protected].