Summer Camp Online Registration

2 Comments

KEITH ECCLES ILLUSTRATION & DESIGN STUDIO
EIN 20-0676938
2012 WESTBANK SUMMER ART CAMP
Drawing, Painting, Cartooning, Working with Clay, Animation, & More
(Ages 5 an older)
906 Derbigny Street, Gretna LA 70053 (504) 227-2785

CHILD’S NAME
Age
Birthdate
Male/Female
School
Parents
Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email Address
Emergency Contact name
Emergency Contact name Relationship
Emergency Contact name Phone
PLEASE SELECT THE DESIRED CAMP DATES
Payment Type
GENERAL CAMP POLICIES
Signature
Comments

2 Responses to “Summer Camp Online Registration”

  1. Angela Gremillion Says:
    April 17th, 2012 at 10:39 am

    Hey Keith…mailing payment. Thanks

  2. admin Says:
    April 17th, 2012 at 1:58 pm

    okay – thanks. We received your online registration.

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