Playgroup Registration Form

Playgroup Registration

Camp Dates 2010: June 28th - August 20th

We offer two registration options this year:
1) You can register online and pay by credit card.
2) You can fill out this application form online, print and mail along with your check.

Child's Name:
Male Female Age: Birth Date:

Child's Name:
Male Female Age: Birth Date:

Name of Parent/Guardian:

Permanent Address:

City: State: Zip:

Email: (required)

Permanent. Home Phone: Cell Phone:

Emergency Phone: Summer Phone:

	Child's First Name	Group Name	# Days/ week	# Weeks	Start Date	Tuition
First Child:
Second Child:

Tuition:
	2 days a week	3 days a week	5 days a week
1 week	$120	$180	$300
2 weeks	$240	$360	$600
3 weeks	$360	$540	$900
4 weeks	$480	$720	$1200
5 weeks	$600	$900	$1500
6 weeks	$720	$1080	$1800
7 weeks	$840	$1260	$2100
8 weeks	$960	$1440	$2400

GROUP NAMES (Children must be 2 by July 1st)

TADPOLES: Ages 2 - 3 Hours: 9:30 - 11:30

BUMBLE BEES: Ages 2 - 3 Hours: 1:30 - 3:30

Deposit and Refund Policy

There is a $50 fee per child for all cancellations before May 1st.
There will be a $25 service fee per chlid applied to all changes.
There are no refunds given for any cancellations after May 1st.
There is a $15 fee for each returned check.
A 50% deposit is due at the time of registration to reserve your child's space. If you pay by credit card the balance due will be automatically charged on May 1st. If you pay by check/cash we must receive the balance due by May 1st. In the event of serious illness or accident during or before camp, a prorated refund will be given when accompanied by a physician's letter minus the $150 service fee.
In the event that your balance has not been received by the deadline of May 1st your child's registration will be reduced to the amount of time equal to the deposit received. This will be calculated from week one of camp. Refer to the tuition page for these amounts if necessary.

TERMS AND CONDITIONS

No refunds will be granted for sick or absent days.
The legal guardian hereby gives approval and consent for the child's participation in the activities of The Art Farm.
The legal guardian understands and acknowledges that his/her child's participation in the activities is completely voluntary and has familiarized him/her with the activities in which hazards and/or dangers are inherent. Accordingly, the Art Farm has taken safety measures to minimize the risk of injury to the participants in such activities.
The Art Farm cannot ensure or guarantee that the participants, equipment, premises and/or activities will be free of hazards, accidents and/or injuries.
The child and legal guardian agree to abide by the rules and regulations established by the Art Farm for the health, safety and welfare of everyone involved.
If in the judgment of the program director it is deemed necessary to use medical, surgical or dental aid for the child's health, the legal guardian hereby permits the program director to do so.
All photos taken during the course of camp activities are the property of The Art Farm and can be used as deemed necessary.
I wish to enroll my child in the above session(s) with the understanding that I or my child’s caregiver is responsible for my child’s behavior in class and during animal time. This is crucial in order to maintain a fun, safe environment for both the children and the animals.

I Have read and fully understand the above terms and policies.

I would like to pay 50%. I would like to pay in full.

Parent's Signature: Date:

NEW ... Register Online! Enter credit card information to pay your camp tuition online:

Name on card:

Credit Card Number(M/V/AX):

Card Expiration: Month Year: CCV#:

To register by mail, please fill out this form online, print, sign and date. Send this form along with a check paid in full.

Make payable to:
The Art Farm • P.O. Box 1976 • Bridgehampton, NY 11932
Phone 631.537.1634 • Fax 631.537.2295 email: info@theartfarms.org