Application → Confirmation → Submission

Summer Camp 2024 Tuition Assistance Form

Please consult your child’s school calendar to ensure the school term ends prior to the start date of the camp session. If you are registering multiple children for Space One Eleven Summer Camps, please complete a separate registration form for each child.

* Required Fields

Guardian Information

Today's date (mm/dd/yyyy)

Title (Mx., Ms., Mrs., Mr., etc.)

Guardian first name

Guardian last name

What is your relationship to the young artist?

Address

Address 2

City

State/Province

Zip/Postal Code

Primary phone

How did you hear about us?

Young Artist Information

Young artist first name

Young artist last name

Preferred name

Date of birth (mm/dd/yyyy)

Gender

Ethnicity

Grade level in Fall 2024

Name of school the young artist will attend in Fall 2024

Young artist t-shirt size

Please check if this is the first class or camp the young artist has attended at Space One Eleven

Camps meet Monday through Friday, 9am - 3pm.

Please select the camp for which you are registering:

I'm an Alabama Artist, Too! camps are divided into groups. If you would like your young artist to be grouped with another camper, please enter their name here:

The young artist may be released to the following people (in addition to the Guardian who is completing the registration). Please include full name, phone number, and relationship to young artist:

Emergency and Medical Information

Emergency contact #1 - Name

Emergency Contact #1 - Phone

Emergency Contact #2 - Name

Emergency Contact #2 - Phone

In the event of an emergency and the guardian and emergency contacts are not available, does Space One Eleven have your permission to secure emergency medical treatment?

YesNo

* In the event of an emergency and the guardian and emergency contacts are not available, does Space One Eleven have your permission to secure emergency medical treatment? is required.

If your child has physical or medical conditions or learning differences that might affect their participation in camp, please list them here. Please also list any food allergies.

Application for Tuition Assistance

Fees are based on a sliding scale. Through the generosity of foundations and private contributors, your family may qualify for free or reduced tuition. All income information provided here is voluntary and confidential. Full or partial assistance is available based on financial need, according to federal income guidelines. You will be notified if your family qualifies for tuition assistance and of the tuition rate required if applicable. If you wish to apply, please provide the information below.

Including you, how many people reside at your address?

Total Annual Household Income

Privacy Act Statement This explains how SOE uses the information you share. You are NOT required to give out your financial information, however, SOE cannot consider your child for free or reduced tuition if you choose not to provide the necessary information. SOE will use your information to determine if your child is eligible for free or reduced tuition art programs. SOE may share your information with education, health, and nutrition programs to help evaluate, fund, or determine benefits for their programs, auditors for program reviews, funders, and law enforcement officials to help look into violations of program rules.

Agreements and Waivers

Seats in Space One Eleven's studio art classes and art camps are limited. I understand that completion of this application does not guarantee enrollment in the camp until verified by Space One Eleven staff.

Refund Policy Payments will be fully refunded if the student’s registration is withdrawn at least 14 days before the start of the camp. Refunds will not be given if the student fails to show up for camp or in instances where the child is dismissed from the camp including, but not limited to, repeated misbehavior or excessive absences.

Attendance Policy Regular attendance is expected! If your child will miss a day or portion of a day, please let us know so our teaching artists can plan accordingly. A lack of communication when your child is absent, or an excess of absences may result in your child’s dismissal from the class or camp, and may jeopardize their eligibility to enroll in future classes or camps at SOE.

Drop-off and Pick-up Policy I understand that my child may be dropped off as early as 8:45 a.m. for camp which begins promptly at 9:00 a.m. I agree to pick up my child when camp concludes at 3:00 p.m. I understand that excessive late drop-offs and/or pick-ups may result in my child’s dismissal from the program. I understand that SOE staff may use videorecorders during the carpool pick-up process.

Cell Phone Policy I understand that my child may not use their cell phone during art camp except in case of emergency. I further understand that my child may not take photographs or videos of themselves or other students while on SOE premises, unless as part of a camp assignment as requested by the teaching artist.

Behavior Policy In the event that my child is disruptive during camp, I understand that SOE may contact me and that it is my responsibility to pick up my child. I understand that if my child is disruptive and asked to leave, they will be allowed to return the following day as long as they understand that they must practice good behavior.

Illness Policy SOE is committed to the health and wellness of our visitors, young artists, teaching artists, and staff. I agree that I have read and will abide by SOE’s illness policy which is posted on the Summer Art Camp page of our website.

Artwork Waiver I understand that any artworks produced by my child in any of SOE's art programs will be disposed of if not collected within 30 days of the end of the program.

Guardian Consent for Media Release I hereby consent to allow my child to be photographed, videotaped, audio taped, and/or interviewed by the news media during the City Center Art program. Further, I understand that the photograph, videotape, audiotape, or interview transcript may be posted online and/or may be used for publicity purposes in the future. I agree to release and hold harmless SOE, its members, officials, agents, and employees from and against any and all claims, demands, actions, complaints, suits, or other forms of liability that shall arise out of, or by reason of, or be caused by, the use of the image of my child on television, radio, in motion pictures, or in print.

I have read the above terms regarding consent for media release, and:

Yes, I consent and ALLOW my child to be photographed, recorded, or interviewed by SOE or news media.No I DO NOT CONSENT. My child MAY NOT be photographed, recorded, or interviewed by news media.

* I have read the above terms regarding consent for media release, and: is required.

By entering my name below, I certify that all information on this application is true and that all income is reported. I understand that if I purposely provide false information, my child may lose all program benefits.

Electronic Signature

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