Contact Us Youth Arts Academies coincide with Columbus City Schools spring, summer and winter breaks and include instruction by professional artists in dance, theater, music, visual art, and literature. Field trips and meals provided. Choose a program(Required)After School ProgramSpring AcademySummer CampKwanzaa Youth Winter AcademyFor Summer Academy Only (Optional) Before Care: 7:30 AM - 9 AM ($25/week) Aftercare: 4 PM - 5:30 PM ($25/week) Before and After Care: ($40/week) Payment for Before and After Care are due at the King Arts Complex building.Participant InformationParticipant Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Date Of Birth(Required) MM slash DD slash YYYY Age(Required)Please enter a number from 5 to 13.Participant Cell (Optional)Emergency Contact InformationPrimary Contact Name (For Emergency Contact)(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Primary Contact Relationship(Required)MotherFatherAuntUncleGrandmotherGrandfatherSiblingOtherIf relationship is other, please explain: Primary Contact Cell(Required)Primary Contact Work Phone(Required)Primary Contact Email(Required) Primary Contact Address (if different from participant address above) Street Address City State / Province / Region ZIP / Postal Code Secondary Contact (For Emergency) (if available)Secondary Contact Name Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Secondary Contact RelationshipMotherFatherAuntUncleGrandmotherGrandfatherSiblingOtherIf relationship is other, please explain: Primary Contact CellSecondary Contact Work PhoneSecondary Contact Email Secondary Contact Address (if different from participant address above) Street Address City State / Province / Region ZIP / Postal Code Authorized Pickup ContactsPrimary Contact Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Primary Contact Relationship(Required)MotherFatherAuntUncleGrandmotherGrandfatherSiblingOtherIf relationship is other, please explain: Primary Contact Cell(Required)Primary Contact Work Phone(Required)Secondary Contact Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Secondary Contact Relationship(Required)MotherFatherAuntUncleGrandmotherGrandfatherSiblingOtherIf relationship is other, please explain: Secondary Contact Cell(Required)Secondary Contact Work Phone(Required)Third Contact Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Third Contact Relationship(Required)MotherFatherAuntUncleGrandmotherGrandfatherSiblingOtherIf relationship is other, please explain: Third Contact Cell(Required)Third Contact Work Phone(Required)Fourth Contact Name (Optional) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Fourth Contact Relationship (Optional)MotherFatherAuntUncleGrandmotherGrandfatherSiblingOtherIf relationship is other, please explain: Fourth Contact Cell (Optional)Fourth Contact Work Phone (Optional)Medical InformationAllergies (if none, leave blank) Other (bee stings, latex, etc... if none, leave blank) Is an Epi-pen required for any allergy?(Required) Yes No List any Special Needs: Mobility (Wheelchair, walker, etc... if none, leave blank) Dietary Restrictions (Vegetarian, Vegan, etc… if none, leave blank) List any other information that you think would be valuable the King Arts Complex Youth staff to be aware of (if none, leave blank) ConsentPhoto Release I agree to the photo release termsChecking the box above gives permission to The King Arts Complex to use photographs and audio and/or video recordings of the program participant for fundraising and/or marketing purposes. On occasion, participant photographs may be included in the King Arts Complex’s promotional videos, website, albums, fliers, social media and newsletters. The King Arts Complex respects the privacy of its Youth Participants and does not allow unauthorized visitors to photograph or video the camp or its Participants.Field Trip Participation Consent I agree to the field trip participation termsChecking the box above gives permission for the Participant to be actively involved in any and all activities, including transportation to and from field trips.Type Name (Signature)(Required) Date(Required) MM slash DD slash YYYY Δ
