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Burkesville Academy of Fine Arts
2015 SUMMER DAY CAMP
Pre-School Registration Form
Camper’s Name _________________________________________ Boy ______Girl______
Physical Address: Street ____________________________________________________
City _______________ State _____ Zip _______
Mailing Address (If Different): Street ____________________________________________
City _______________ State _____ Zip _______
E-Mail Address: ___________________________________________________________
Age ______________
T-Shirt Size ____________________
Dates: Pre-School - June 1st – 5th, 2015 (8:00am-11:30am) $50 tuition + $15 supply fee
Mother/Guardian ______________________________ Best Phone # ________________
Father/Guardian _______________________________ Best Phone # ________________
In the event of an emergency, whom do we call if we cannot reach you?
Name ________________________ Relation ______________ Phone # _______________ Name
________________________ Relation ______________ Phone # _______________
Medical or other information we need to know: (include food allergies)
________________________________________________________________________________
____________________________________________________________________
Who may pick up this child at the end of each day?
Name ________________________________________ Phone #_______________
Name ______________________________________________ Phone # _______________
Written notice is required if your child is to leave with persons other than ones designated
above. Registration Fee: $50.00 + $15 supply fee (supply fee is non-refundable) PAID: $_____
Method of payment (please circle): CASH/CHECK # ________ (Payable to BAFA)
1. I hereby give permission for my child to participate in this program.
2. Appropriate behavior and respect for
staff, property, and other children must be demonstrated by participants
at all times. Failure to behave appropriately will result in dismissal from the program.
3. Your signature also gives Burkesville Academy of Fine Arts approval to use photos of your children in promotional
brochures, news articles, or other literature published by or for BAFA.
4. Students will be expected to attend final SHOWCASE on the Friday evening of their camp week.
5. My signature below is indicative of the fact that I have read and understood the information contained herein and
agree to comply with same. In consideration of the opportunity afforded to the undersigned to participate in any
BAFA activity, the undersigned hereby knowingly, freely, and voluntarily waives any right or cause of action
against BAFA, its officers, agents, and/or employees arising out of any claim whatsoever as a result of any
injuries to body, life, limb, or property arising from participation in the hereinafter described activity. The
undersigned shall save harmless BAFA from and against all judgments, orders decrees, attorney’s fees, costs,
expenses, and liabilities arising from or out of such claim, investigation, or defense thereof which may be entered,
incurred, or assessed as a result of the foregoing.
Signature __________________________ Parent of _____________________ Date ____________
Return form to: P.O. Box 7131, Burkesville, KY 42717 * (270) 459-2727 [email protected]
Pre-school Camp Schedule of Classes
8:00-9:00
Visual Arts – Students will receive an introduction in Painting, Drawing, Sculpture and other Art forms.
9:05-9:35
Drama – Students will receive an introduction to characterization, storytelling and theatre basics.
9:35-9:55
SNACK TIME
9:55-10:55
Dance – Students will receive an introduction in Ballet, Tap and Hip-Hop.
11:00-11:30
Music – Students will receive an introduction to music, rhythms and instruments.
Return form to: BAFA
P.O. Box 7131, Burkesville, KY 42717
(270) 459-2727 * [email protected]