ArtLab 2012 Registration Form

Camper Name *

First Last
Best Camper Home Address (street, city, state, zip) *
Camper T-Shirt Size *
Parent #1 Name *

First Last
Parent #1 Best Phone Number *
Parent #2 Name

First Last
Parent #2 Best Phone Number
Best E-Mail: *
Other Authorized Pick-Up Person #1 *

First Last
Other Authorized Pick-Up Person #2

First Last

Program Elections *

Supplies ($50 per child)

June 4-8 Program ($300)

June 4-8 Extended Day ($100)

June 11-15 Program ($300)

June 11-15 Extended Day ($100)

June 18-22 Program ($300)

June 18-22 Extended Day ($100)

Please add up the total amount due and mail a check (made out to Mitch Pengra) to: Mitch Pengra, 1310 Castle Court, Houston, TX 77006
PLEASE include the camper’s name(s) on the memo line of the check.

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Independence Art Studios, Houston, Texas | ArtLab Summer Art Camp for Kids

ArtLab 2012 Registration Form

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