2015 Summer Camp Registration Form

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Jack Zheng Art Studio

2015 Summer Camp
Registration Form
Address: 3869 Cheryl Ct, Aurora, IL 60504
Phone: (630) 618 - 8715 Email : [email protected]

Student Information

* Indicates required field

Todate's Date *

Student Name *

First

Last

School *

Grade *

Age *

Years of Studying Art *

Never < 1 year 1 year 2 years 3 years >3 years

Address *

Line 1

Line 2

City

State

Zip Code

Country

Gender *

Male Female

How do you hear about us? *

Internet Friend School Other

Parent/Adult Contact

Primary Name *

First

Last

Primary Phone Number *

Name *

First

Last

Phone Number *

Primary Email *

Email *

Primary contact *

Mother Father Other Adult

Optional Contact *

Mother Father Other Adult

Select Scheduled Plan
Each Session: 2 weeks, 5 day/week, 2 hours/day
Fee: $300/session

Summer Camp Session (please choose at least one session) *

6/8-6/19 Morning 10:00am-12:00pm 6/8-6/19 Afternoon 2:00pm - 4:00pm 6/22-/7/3 Morning 10:00am-12:00pm 6/22-/7/3 Afternoon 2:00pm - 4:00pm 7/6-7/17 Morning 10:00am-12:00pm 7/6-7/17 Afternoon 2:00pm - 4:00pm 7/20-7/31 Morning 10:00am-12:00pm 7/20-7/31 Afternoon 2:00pm - 4:00pm

Please check one session

Submit