Are You a Member of the Museum?*- Select -YesNo* 10% discount for parents registering more than one child.How Many Children Are You Registering Today?*- Select -OneTwoThreeFourHow Many Children Are You Registering Today?*- Select -OneTwoThreeFourChild's Name*Age*Child's Name*Age*Child's Name*Age*Child's Name*Age*Parent Name*Email* Address*Cell Phone*Work PhoneEmergency Contact Name*Emergency Contact Phone*Does your child have any allergies? If yes, please list them below.*How did you hear about us?*By entering my name in the box below, I acknowledge that during camp, my child will be using art tools and supplies. I release the Wiregrass Museum of Art and employees from all liability for personal injury, illness, or property damage occurring on or off the museum’s premises while attending camp. I authorize the Wiregrass Museum of Art to seek medical treatment at the nearest medical facility and they may call paramedics and discharge my student to an ambulance if I am not able to authorize it in the case of a medical emergency. I hereby give permission to the Wiregrass Museum of Art to take and use photographs and videotapes during camp for promotional and/or educational purposes for the museum (including publications, presentation or broadcast via newspaper, internet or other media sources. I understand that payment is not refundable.Parent Signature*Date*Registration is required before the start of camp to hold a spot.Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Please do not leave this page or try to resubmit registration information while your order is processing. This iframe contains the logic required to handle Ajax powered Gravity Forms.