KEITH ECCLES ILLUSTRATION & DESIGN STUDIO
EIN 20-0676938
2010 WESTBANK SUMMER ART CAMP
Drawing, Painting, Cartooning, Working with Clay, Animation, & More
(Ages 5 an older)
906 Derbigny Street, Gretna LA 70053 (504) 227-2785
Please complete separate form for each child.
CHILD’S NAME
AGE
BIRTHDATE
MALE/FEMALE
Male
Female
SCHOOL:
PARENTS:
ADDRESS:
CITY:
STATE:
ZIP:
(ZIP Code)
HOME PHONE:
WORK PHONE:
CELL PHONE:
EMAIL ADDRESS:
(E-mail)
EMERGENCY CONTACT NAME:
EMERGENCY CONTACT RELATIONSHIP:
EMERGENCY CONTACT PHONE:
PLEASE SELECT THE DESIRED CAMP DATES (Hrs 8:30 – 3:30) – NO BEFORE/AFTER CARE
Please see the "Activities" page for pricing, dates, times and more important information.
June 1 - 4:
June 7 – 11:
June 14 – 18:
June 21 – 25:
June 28 – July 2:
July 12 - 16:
July 19 – 23:
July 26 – 30:
Have not decided:
PAYMENT TYPE:
By mail
By phone
Credit Card Online
GENERAL CAMP POLICIES :
The children will be working in various media – please send them in clothes appropriate
for painting, etc.
Campers should bring a bag lunch and drink each day. No electronic devices allowed.
3) Mid-morning and mid-afternoon snacks/drinks will be available to purchase. Please send
your children with change if you would like them to have anything other than what you
pack for lunch. All snacks will cost 50 cents each.
4) Campers will be expected to abide by all rules. Any discipline problems will be
communicated to you timely. There will be NO TOLERANCE for any camper touching
another camper or any belongings/artwork of other campers.
5) All Fees
MUST be paid in full at least 2 weeks prior to the scheduled camp session;
otherwise, your space may be forfeited to someone on the waiting list.
6) You are not considered registered until you receive confirmation of the receipt of
your application and payment in full.
7) Rescheduling is allowed ONLY if we are notified at least 2 weeks prior to the
originally scheduled camp session – and is only allowed if space is available for
desired session.
8) Refunds of weekly fees are available ONLY if notified at least 2 weeks in advance
AND we are able to fill the spot left vacated.
9) There is NO makeup of partially attended weekly sessions.
10) Registration for Daily attendance is only available one week prior to the desired camp
session and ONLY IF we have not reached maximum capacity.
11) There is no before or after care offered. Drop off between 8:15 and 8:30 and pick up
between 3:30 and 3:45.
12) A $25 fee will be charged on any returned/NSF checks.
THANK YOU FOR YOUR FULL COOPERATION!
I have read and fully understand the above policies:
SIGNATURE:
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