AKey West Art & Historical Society
ArtCamp Summer 2010 Registration Form

COST: $150 per week
$135 KWAHS members.

Student Info:
First Name: _____________________________Last Name: ___________________________________
Age:_________ Grade: ______ School: ____________________________________________________
Address:_________________________________________ City _________State_____ Zip__________
May we photograph your child (please circle)
Yes No
Parent / Guardian Info:
First Name_____________________________ Last Name____________________________________
Phone/Home__________________ Work___________________ Cell___________________________
Email Address_________________________________________________________________________
Emergency Contact ____________________________________Phone_________________________
Method of Payment (Please circle one)
Check Visa Mastercard Amex Cash
CC# ____________________ __________________ ___________________ ____________________
Expire Date:_____________________ Today’s Date:_______________ Amt Paid_________________
Signature on Card:____________________________________________________________________
Make checks payable to KWAHS
Send to: KWAHS, 281 Front Street, Key West, Fl 33040
Attention: Suzanne Pereira Education
Contact; Suzanne Pereira 305-295-6616 Ext 27 Fax # (305)-295-6649

Class Selection (please circle class)
Week 1 Grade K -1 June 7-11 Time 9:30 -12:30 Blue Elephants Rule!
Week 2 Grade 1-2 June 14-18 Time 9:30 -12:30 What’s Your Line
Week 3 Grade 3 June 21-25 Time 9:30 -12:30 Babar and Shut-Up-You-Mouth
Week 4 Grade 4 June 28-July 2 Time 9:30 -12:30 Babar USA
Week 5 Grade 5 July 5-9 Time 9:30 -12:30 Strike A Pose
Week 6 Grade 6 July 12-16 Time 9:30 -12:30 A Pinhole with a View