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Art Museum of South Texas
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Toggle Navigation
Art Museum of South Texas
VISIT
Admission & Hours
Accessibility
Parking & Directions
At the Museum
Café
GROUP TOURS
Rentals & Special Events
Art
Exhibitions
Permanent Collection
Education
School Programs
Adult Programs
Kids and Family Programs
Teen Programs
Join & Give
Membership
Make a Donation
Volunteers, Docents, & Internship
Sponsors
Feedback
Events
ARTball: Flora Fantasia
Kids and Family Programs
Calendar
Adult Programs
artRageous 2024: Rococo Ranch
SHOP
About
Mission & History
Architecture
Rentals & Special Events
In the Press
Contact
AMST Strategic Plan Questionnaire
Holiday Camp Parent Questionnaire
Holiday Camp Parent Questionnaire
Required information for students participating in Holiday Camp
Child's Name
*
First
Last
Gender
*
Male
Female
Non-binary/third gender
Prefer to self-describe
Prefer not to say
Current Age
*
Grade Level
*
School
*
Home Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Father's Name
*
First
Last
Father's Daytime Phone
*
Mother's Name
*
First
Last
Mother's Daytime Phone
*
Other Emergency Contact
*
First
Last
Other Emergency Contact Daytime Phone
*
In case of emergency, notify first:
*
Father
Mother
Other Emergency Contact
In case of emergency, notify second:
*
Father
Mother
Other Emergency Contact
Name of Child's Physician
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Physician's Phone Number
*
Special Instructions / Limitations / Allergies to foods, medications or other that we should know about?
*
Medical Authorization
*
Is camper taking any medication that must be given at camp?
Yes
No
If yes, please complete the following. Please administer to:
First
Last
the following medication(s):
Dosage:
Time:
Vaccinations
*
Is your child up-to-date on his/her vaccinations?
Yes
No
Is there anything that would be beneficial for us to know about your child that would help us to make his/her experience the best it can be? (ie: ADHD, autism, shyness, etc.) Please keep in mind that we do not have the staff available for one-to-one assistance.
*
First Person Authorized to Pick Up My Child
*
Besides parent names listed above, who else has permission to pick up your child?
First
Last
Daytime Phone Number of First Authorized Person
*
Second Person Authorized to Pick Up My Child
*
Besides parent names and first authorized person listed above, who else has permission to pick up your child?
First
Last
Daytime Phone Number of Second Authorized Person
*
Photo Permission
*
Does the Art Museum of South Texas have permission to photograph your child while participating in the Fine Art of Summer Camp activities? Photographs may be used on the AMST website, in the AMST newsletter or other Museum advertisements for promotion purposes.
Yes, I do give permission
No, I do not give permission
Outdoor Participation Permission
*
Can you child participate in outdoor activities, weather permitting?
Yes, I do give permission
No, I do not give permission
Drinks/Snacks Permission
*
Can your child partake in drinks and snacks which may occasionally be provided by camp personnel?
Yes, I do give permission
No, I do not give permission
Consent
*
I will notify the Art Museum of South Texas if my child is exposed to any communicable diseases during the 3 weeks prior to camp. In case of medical emergency, I understand that every effort will be made to contact a parent/guardian of my child. In the event that I cannot be reached, I hereby give permission to the physician selected by the AMST to hospitalize, secure proper treatment for, and/or order injection, anesthesia or surgery for my child. I also understand that authorized personnel and/or volunteers of the Art Museum of South Texas will have the care and custody of my child named above during the camp hours of 9:00am - 4:00pm and/or during Pre/After Care hours in the following camp sessions (press CTRL and click to select more than one session):
Select All
Monday, Dec 19: DECORATIONS
Tuesday, Dec 20: HANDMADE GIFTS
Wednesday, Dec 21: GIFT WRAP GALORE
Thursday, Dec 22: ORNAMENTS
Friday, Dec 23: GINGERBREAD HOUSES
*
I agree to hold the Art Museum of South Texas and its authorized personnel and/or volunteers harmless against any and all liabilities arising from any activities described above.
*
I certify that I have read and understand the information provided to me in the Parent Information Packet.
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