HEALTHY RHYTHM COMMUNITY ART GALLERY

4th ANNUAL ART CAMP Registration Form

Campers Name: ______________________________________________ Boy ________ Present School Grade: _______________ Home Address & Contact Information: Street: ________________________________________________________ City & Zip: _____________________________________________ Girl ________ Age ________

E-Mail Address: ________________________________________________________ Parent/Guardian: ______________________________________________________ Home Phone: __________________________________________ Work Phone: __________________________________________

In the Event of an Emergency, Whom Do We Call if We Cannot Reach You? Name: ________________________________________________________ Relation: _______________________________________________

Phone Number: ______________________________________________________ Medical or Other Information We Need to Know About Your Child: (include food allergies)

Who may pick up this child at the end of each day? Name: ______________________________________________________________ Relation: ____________________________________________ Phone Number: ____________________________________________________________ Name: ______________________________________________________________ Relation: ____________________________________________ Phone Number: ____________________________________________________________ *Written Notice Required if Your Child is to Leave with Persons Other Than Ones Designated Above*

HEALTHY RHYTHM COMMUNITY ART GALLERY

ART CAMP FEE: $175 per ART CAMP (Includes ALL art supplies, instructor fees and light snacks) HOURS: 12 Noon to 5 PM, Monday-Friday ART CAMP 1 (June 23-27) _______ PAYMENT METHOD (Please Circle One): I. II. III. CASH CHECK (made payable to "KEN VAIL") CREDIT CARD (3% Fee) ART CAMP 2 (July 21-25) _______ BOTH CAMPS _______

PAID: $_________________.00 1. I hereby give permission for my child to participate in this program. 2. Appropriate behavior and respect for staff, instructors, property, and other young people must be demonstrated by Campers at all times. Failure to behave appropriately may result in dismissal from ART CAMP. 3. Your signature also gives HEALTHY RHYTHM COMMUNITY ART GALLERY approval to use photos of your children in promotional brochures, news articles, or other literature published by/for the ART CAMP. Check here if you DO NOT want your childs photo used for promotional purposes related to the Gallery and/or ART CAMP _______ My signature below indicates I have read and understand the information contained herein and agree to comply with al information. In consideration of the opportunity afforded to the undersigned to participate in any ART CAMP activity, the undersigned hereby knowingly, freely, and voluntarily waives any right or cause of action against HEALTHY RHYTHM COMMUNITY ART GALLERY, its owners, instructors, and volunteers arising out of any claim whatsoever as a result of any injuries to body, life, limb, or property arising from participation in the hereinafter described activity. The undersigned shall hold harmless HEALTHY RHYTHM COMMUNITY ART GALLERY from and against all judgments, orders decrees, attorneys fees, costs, expenses, and liabilities arising from or out of such claim, investigation, or defense thereof that may be entered, incurred, or assessed as a result of the foregoing.

Parent/Guardian Signature: _____________________________________________________

Parent/Guardian of: ______________________________________________________

Date: ________________________________

HEALTHY RHYTHM COMMUNITY ART GALLERY 2014 ART CAMP INSTRUCTORS

Denise McAdams Denise McAdams enjoys working with children and teaching art. Her teaching philosophy is that art is a safe place to create and there are no mistakes. Denise loves to see that little light bulb come on in a students head and hear them say, Oh, I can do that! She received her BFA from the University of Arlington and is a certified EC- 4, ESL and all level Art Instructor. Denise has worked in Teague, Dallas, and Irving, Texas, teaching Art, Spanish, and Drama with Elementary, Jr. High, and High School students. She was chairman for the Art Program at the Potters House during their Summer School. Denise loves illustration, photography, and multi-medium art. She and her husband, Kevin, and their four sons, have lived in Fairfield since 1996. Donna M. Strait Donna M. Strait designs and handcrafts Jewelry, primarily using Sterling Silver, Semi-precious Stones, Glass, Polymer Clay and Leather. Ms. Strait was trained at the Craft Guild of Dallas in the Art of Jewelry Design and Craftsmanship. She has experience with Glass Beads, Enamel on Copper Beads, Enameled Jewelry, Fused Glass, Metal Jewelry Casting, Metal Jewelry Fabrication, Stone Setting, Wax Molds, PMC Metal Jewelry, Polymer Clay Jewelry, Leather Work and Stamping. Ms. Strait is a resident of Freestone County and has lived in Streetman, Texas for more than a decade Breeding, Raising, Training and Selling Quarter Horses, Quarter Ponies and Paint Ponies (D.A.M. Strait Quarter Horses), Producing and Selling Hay, and raising her 11 year-old daughter, Callie. Her work can be purchased thru Hippie Hick Chick Designs and she can be reached at (903) 879-3511.