Summer Day Camp Registration Form

For Cultural Arts Center in Glen Allen and Dominion Arts Center ONLY.

Name *
Date of birth
Date of birth
Phone *
Best way to contact you
Parent Name *
Parent Name
Address *
Which location will you be attending?
We would love to hear how you heard about us!
Please list any health condition that we need to be made aware of, ie. asthma, past injury, etc.
Other Important Information
Emergency Contact *
Emergency Contact
Emergency Contact Information *
Emergency Contact Information