ONLINE ART CAMP REGISTRATION
Modern Art Museum of Fort Worth
3200 Darnell Street
Fort Worth, TX 76107
U.S.A.
 Fax
(817) 840-2104
Phone
(817) 738-9215
 Art Camp e-mail

Art Camp 2008
Summer Art Study 2008
Certain fields, marked with an asterisk (*) are required.
Failure to complete these fields will result in us not being able to process your registration.
All information submitted to the Modern Art Museum is confidential.
(To mail a check with registration or fax registration click here for a printable form.)
Fees are nonrefundable.

Art Camp for Ages 9 to 12
Session 1 $175.00
 $250.00
Session 2 $175.00
 $250.00
Art Camp for Special Needs Ages 8 to 10 $125.00
 $200.00
Summer Art Study for Ages 13 to 15 $225.00
 $285.00

Student Information:

    *Participant's Name 
*Participant's Age    *Date of Birth  
*Parent's Name      
*Address            
*City/State/Zip     
*E-mail Address     
*Telephone          
*Cell Phone         

*Emergency contact person 

*Emergency contact daytime phone number

*Name of child's physician

*Physician's phone number

*Allergies

Payment Information:

       *Charge Card:  Visa Visa
                  MasterCard MasterCard
                  American Express American Express
    
                        (no spaces or dashes)
            *Card Number 
          *Name on Card  
       *Billing Address  
*Billing City/State/Zip  
            *Valid Thru
I hereby certify this applicant is in good health and may participate in all activities.
In case of emergency in which the above designates cannot be notified, I give permission for my child to be given any necessary emergency medical treatment.
I understand that during the camp, photographs may be taken by the Museum staff for archival and promotional purposes.
*Please check box (in checking box I have read and understood the above terms)


    

Please check your information to make certain it is accurate.
If you need to re-enter your information click the Clear Form button.
Press the Send Registration button when you have completed the form.

If you have any questions or comments about your membership please contact the Education Department.

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©2008 The Modern Art Museum of Fort Worth