Printable Summer Camp Registration Form

Instructions: Please print this page by selecting – File>Print>OK or by converting to a PDF. Complete the form for each child being registered, and mail it with your payment (check, VISA, or MC) to:

Good Dirt

510 B. North Thomas St.

Athens, GA 30601

Be sure to read the information section carefully and sign the form where indicated. You will receive an e-mail confirmation of your registration as soon as your completed form and payment have been received. Mark your calendar with the dates of your chosen camp, as no further reminders will be sent. In the event that the roster for your chosen week is already full, you will be contacted for an alternate selection.

Parent/Guardian information

First name: Last Name:

Mailing Address:

Daytime Telephone: Alternate Telephone:

E-mail address:

Child’s Name:

Age as of June 1, 08:

Name of requested Camp:

Dates of requested Camp:

Cost of Camp Session:

Total amount of fees being sent: $ ___________

I am aware that my child’s registration is not assured until payment is received, and that spaces are allocated by date of receipt of payment.

Good Dirt is an active and fully functional ceramics studio with hot kilns, pottery wheels, and electrical equipment in constant operation. Because of the inherent hazards of working in the studio environment, I also understand that if my child cannot remain in the designated teaching areas and follow the verbal instructions of camp staff, he/she will not be invited to return for the remainder of camp, and no refund will be given.

Signed: ______________________________