Child's Information

First Name

Last Name

Birthdate -select- January February March April May June July August September October November December -select- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -select- 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Child's Grade (entering in Fall '08) -select- 1st 2nd 3rd 4th 5th 6th 7th 8th

My child has allergies, medical, and/or special needs

Please Explain

Parent / Guardian Information

Name

Address

City

State

Zip Code

Email

Home Phone  (example: 888-888-8888)

Work Phone

Cell Phone

Emergency Person

Emergency Phone

Select Session
(Note: You may register your child for a full session and be put on a waiting list. Please click the link below to view availability. )
-select- Session 4 (Aug 4 – 8) Session 6 (Aug 18 – 22)

Registration Type
Early Bird $90 (by April 18th, 2008)
Museum Member $100
Regular $115
Camp Bangor Scholarship

Method of Payment
Cash (will deliver in-person)
Check (pay to Museum of Art, send to 40 Harlow St., Bangor ME 04401)
Credit Card (call 561-3352 to provide credit card information)
Camp Bangor Voucher (mail or deliver in-person)

Note: If you would like to register more than one child, please use a separate form for each. Please note: this form provides registration information only. Your child's enrollment is secured once payment is received. There is a limit of 10 students per camp session.