QCA Summer Experiences Registration

To register a child in the Superior Sculptors or Art Forms & Functions Summer Experiences programs, please complete and submit the form below.

Summer Experience Selection

Please Select the Desired Experience*

Aug. 11 — Art History Expedition
Aug. 17 & 18 — Art Tools & Techniques
Aug. 22 & 23 — Art Forms & Functions

* PLEASE NOTE: Each experience requires a separate registration form.

Participant Information

Participant's First Name:

Participant's Last Name:

Participant's Age:

Participant's Address:

City:

State:

ZIP Code:

Phone Number:

May we use your child's photo in publicity materials?

Yes
No

Guardian Information

Guardian 1 First Name:

Guardian 1 Last Name:

Guardian 1 Address:

City:

State:

ZIP Code:

Cell Phone Number:

Work Phone Number:

Email Address:

If desired, add information for second guardian

Guardian 2 First Name:

Guardian 2 Last Name:

Guardian 2 Address:

City:

State:

ZIP Code:

Guardian 2 Cell Phone:

Guardian 2 Work Phone:

Guardian 2 Email:

Emergency Notification

In case of emergency, please contact the following person first.

First Name:

Last Name:

Emergency Contact Phone Number:

Generate New Image

Type the code from the image

Please note: Upon submission of this form you will be taken to an acknowledgment page with additional information regarding payment and required waiver and medical forms. If you experience any trouble submitting the form, please contact Evelyn Penman, interim executive director and senior curator.

Email Evelyn

St. Bonaventure University

QCA Summer Experiences Registration

Summer Experience Selection

Participant Information

Guardian Information

If desired, add information for second guardian

Emergency Notification