ART AND NATURE CAMP

> > > Engaging Students in Contemporary Issues and Civic Action Through Ar t

Join us for a 3-day Art & Nature Camp

Mon, July 8 - Wed, July 10, 2013 9:30 am - 2:30 pm daily at Solano Canyon
871 Academy Road, LA (Lincoln Park). Activate and beautify a vacant lot as a native garden and community space. Learn techniques in native gardening, clay, and spraycan art. Create art pieces to beautify the neighborhood on recycled wood. Meet new people and have fun!

Participation involves attending ALL THREE DAYS of camp Offered by the Art & Nature Collective

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To register: 1. Fill out the application at https:// webformsrig02bo3.blackbaudhosting.com/51145/Art --Nature-Camp 2. Scan and email or fax the Participation Contract in this packet to Carolina Couto Cervera at (323) 761-8356 or Carolina@youthink.org by Mon, July 2 .

Engaging Students in Contemporary Issues and Civic Action Through Art

youTHink Art & Nature Camp STUDENT REGISTRATION FORM Art & Nature Camp will meet for three consecutive days. To participate, you must attend ALL 3 sessions. The dates are Monday, Tuesday, Wednesday, July 8, 9 and 10, 2013. Each session will be from 8:30 am- 2:30 pm at Solano Canyon, 871 Academy Road, LA (Lincoln Park). This camp has a limited number of openings. The openings will be filled on a first come, first served basis, and then we will create a waiting list. Please submit your Registration Form NOW to ensure your spot in the workshop. Application is due Tuesday, July 2, 2013. Please scan and send to Carolina Couto Cervera at Carolina@youthink.org or via fax to 323.761.8990 or via paper mail to 6505 Wilshire Blvd. Suite 100, LA, CA 90048. NAME: Parent/ guardian contact name: Phone: Cell phone:

If I am not available, please call this person in an emergency: Phone number: Relationship to student: ****************************** Participation Contract: I am registering to participate in youTHink Art & Nature Camp. My parent/ guardian and I understand and agree to the following : We understand that the workshop is three days (9:30 am 2:30 pm), and that I must attend all the sessions to participate. We understand that youTHink can provide transportation to and from camp. We understand that if we request transportation, we are committing to be present and prompt at the shuttle stop. We understand that although we are not being charged to participate in this camp, it is valued at $300/ student.
A program of the Zimmer Childrens Museum 6505 Wilshire Boulevard, Suite 100, Los Angeles, CA 90048 Tel.: (323) 761-8311 Fax: (323) 761-8990 www.youthink.org

We also understand that there are limited openings in Art & Nature Camp, so we agree to call Carolina Couto Cervera at (323) 761-8356 IMMEDIATELY, if I (student) become unable to attend, so another student can be offered the opportunity. I (parent/guardian) give permission for photos/ video of my child taken while participating in youTHink programs to be used in promotional materials for youTHink and the Zimmer Childrens Museum. I understand that transportation will be by: Shuttle / Car .

I understand that adequate and appropriate supervision will be provided. I recognize, however, that unanticipated situations and problems can arise on any trip, which situations or problems are not reasonably within the control of the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers). In such instances, I agree that the Zimmer Childrens Museum and the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers) are not to be held legally responsible in the event of accident or injury and I will hold the Zimmer Childrens Museum and the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers) harmless from any costs, liability, or related expenses. I give permission for emergency medical attention to be administered should that be necessary while on this fieldtrip. I also give my permission for photos of my child taken while participating in youTHink programs to be used in promotional materials for youTHink and the Zimmer Childrens Museum, which may include an institutional video, website, or brochures. _______________________________ PRINT Parent/Guardian Name

________________________ PRINT Student Name

_________________________ Student Signature and Date

________________________________ Parent/Guardian Signature and Date

A program of the Zimmer Childrens Museum 6505 Wilshire Boulevard, Suite 100, Los Angeles, CA 90048 Tel.: (323) 761-8311 Fax: (323) 761-8990 www.youthink.org