Are you a member of the Holter Museum of Art?*

Yes
No

Summer Passport Attendance

Price:

non-member

Summer Passport Attendance

Price:

member

Camper's Name*

First Last

Camper's Age*

Camper's Gender Identification

Non-binary
Female
Male
Trans
Cis
If you do not see an option here that fits your child’s identification, please make a note under “Social Emotional Well-being”

Select as many as you would like!

Parent-Guardian's Name*

First Last

Parent-Guardian's Email*

Parent-Guardian's Phone Number*

Second Parent-Guardian's Name

First Last

Second Parent-Guardian's Contact Information

Allergies

If camper has allergies describe all allergens, all allergic reactions and any medication (i.e. epipen, benadryl) that need to be administered.

Physical / Medical Conditions

Does the participant have any physical or medical conditions that could result in an emergency or preclude them from engaging in certain activities?

Medications

Please list all medications (including over-the-counter or nonprescription drugs) taken routinely.

Social Emotional Well-being

Is there anything else our instructors need to know about the participant that would help us provide the best experience for them?

Photo Release

I agree to the Photo Release outlined below.

I hereby grant to the Holter Museum of Art the right to use and publish photographs of myself and/or my children, or in which we may be included, for website design, editorial, trade, merchandising display and advertising for the purpose of promoting the activities of Holter Museum of Art; to alter the same without restriction and to copyright the same. I hereby release Holter Museum of Art from all claims and liability relating to said photographs.

REFUND Policy*

I have carefully read this agreement and understand it to be an acknowledgement on my part of the Holter Museum of Art’s refund policy.

Preregistration is required for all Holter educational programs. Full tuition will be refunded on any cancellation up to four weeks prior to beginning of class with the exception of a $14 processing fee, after that 40% of tuition will be refunded upon cancellation up to two weeks prior to beginning of class. Cancellation within two weeks of beginning of class will not be refunded.

Total

$0.00

Contact Email*

SC Summer Passport Registration (Manicke)

Edu: SC Summer Passport; June 11-13 (Manicke) sign-up

Give

Membership

Contact Us

SC Summer Passport Registration (Manicke)

Edu: SC Summer Passport; June 11-13 (Manicke) sign-up

Give

Membership

Contact Us

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