Teen Camp - Ceramics "*" indicates required fields Student's InfoStudent's Name* First Last Birthdate* Month Day Year Membership & Scholarship InformationAre you a member?* Yes No Member Number Add a MembershipNot a Member? Join or renew now and save! Don't forget to change your status to "member" above to get your discount! $40 Individual Membership (teen only) $65 Family Membership (entire household) Scholarship Discount CodeIf you have applied for a scholarship and have been approved, enter the code you received in the award letter here. Membership Add-on (Individual) Price: Membership Add-on (Family) Price: Subtotal Member Price: $0.00 Subtotal Non Member Price: $0.00 Scholarship Discount 25% (Member) Price: $0.00 Scholarship Discount 25% (Non-Member) Price: $0.00 Scholarship Discount 33% (Member) Price: $0.00 Scholarship Discount 33% (Non-Member) Price: $0.00 Scholarship Discount 50% (Member) Price: $0.00 Scholarship Discount 50% (Non-Member) Price: $0.00 Scholarship Discount 75% (Member) Price: $0.00 Scholarship Discount 75% (Non-Member) Price: $0.00 Scholarship Discount 75% (Non-Member) Price: $0.00 Scholarship Discount 100% (Member) Price: $0.00 Scholarship Discount 100% (Non-Member) Price: $0.00 Scholarship Discount 100%+ (Member) Price: $0.00 Scholarship Discount 100%+ (Non-Member) Price: $0.00 Total Credit Card* Billing Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Parent Information & Emergency ContactsParent 1 Name* First Last Parent 1 Address (if different than billing address) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Parent 1 Cell Phone*Text Me RemindersYes! I would like to receive text reminders about this activity and information about other activities like it. I consent to receiving SMS messages from Arts & Education at the Hoyt. Standard Message and data rates apply. Parent 1 Work PhoneParent 1 Email* Parent 2 Name First Last Parent 2 Cell PhoneParent 2 Work PhoneParent 2 Email Parent 2 Address (if different) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Additional InformationAllergies and Special NeedsIs there anything we need to know about your child(ren)?Emergency ContactsPlease list the names and phone numbers of up to three people, besides the parents listed above, who we could contact in an emergency.Authorized Pick UpList anyone, besides the parents listed above, who your child(ren) can be released to.Photo Release*I give my permission for Arts + Education at the Hoyt and the Hoyt Center for the Arts to use images and videos of my child for use on their organization’s website, social media pages, and other marketing materials for children’s programs at Arts + Education at the Hoyt. Yes, I give permission for my child(ren) to be photographed. No, I do NOT give permission for my child(ren) to be photographed. How did you hear about us?Check all the apply. Returning Camper Mailed Postcard Email Social Media Newspaper Flyer at School From a friend Other CAPTCHA
