bunn’s museum of east texas art camp 2016 · 2 museum of east texas art camp 2016 welcome to the...

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Museum of East Texas 503 North Second Street Lufkin, Texas 75901 (936) 639-4434 www.metlufkin.org Art Camp Faculty Marsha Blount Stanley Bohon Sarah Bunn Stephanie Carcano Richard Carnley Jessica Chaney Heather Gann Lisa Lalumandier Julia Lott Alison Lovell Jesucita Menz Rachel Molandes Alex Morris Melanie Moses Gary Parker Ann Phifer Reyes Barb Richert Connie Welch Adult Art Camp Faculty Lisa Lalumandier Rachel Molandes Ann Phifer Reyes MUSEUM ● OF ● EAST ● TEXAS ART CAMP 2016 Wee Art May 31-June 3 July 5-8 August 15-19 9:30 am 11 am Art Camp June 6-July 1 July 11-August 12 9 am -12 pm 1 pm - 4 pm Adult Classes May 31-June 3 1:00-3:00 pm Painting 6:30-8:30 pm Quilting July 5-8 • 1:00-3:00 pm Crochet Drawing Painting August 15-19 • 1:00-3:00 pm Painting NONPROFIT ORGANIZATION U.S. POSTAGE PAID LUFKIN, TEXAS PERMIT NO. 34 16 Fiber Fun Stephanie Carcano’s students will learn where wool comes from and what we can do with it. Explore how fluffy bits of softness can be transformed into something durable and practical. Make felt, spin yarn, weave and create other fun projects from the world of fibers. Fun with Tempera Discover many ways to paint with Tempera. Melanie Moses’ class will learn to mix colors and use tempera with other media to create one of a kind paintings. Create a Tempera Batik and learn how to use tempera like watercolors. Hooks & Needles (AGES 10 & Up) Stephanie Carcano’s students will learn how to stitch with knitting needles or crochet hooks and open a world of creative design. Learn the basics of chaining, casting on, and the basic stitches, and finish a small project. Manga “Whimsical Drawing” Barb Richert’s class will cover the basics of Japanese style cartooning. Students will practice large expressive eyes, spiky hair, strong facial expressions, foreshortening, and action lines. Drawings in manga style are typically produced in black and white with different patterns to compensate for the lack of color. Mixed Media In this class, Marsha Blount’s students will combine a variety of techniques and materials to create art. Paint, ink, newsprint, fabrics, etc., will be used in this class. For example, you may draw something in ink, add fabrics or cut paper or paint that's mixed media! Mosaic Collage Richard Carnley's students will learn techniques used with mosaic collage. They will learn the importance of planning and material selection for their designs. Students will create multiple art works of their own. Paper Crafts Lisa Lalumandier’s students will explore many different ways you can create beautiful things with paper. This is not a class in Origami, however we will take a day to try our hand at the ancient art of paper folding! Photography (AGES 10 & Up) (class limited to six students) Sarah Bunn’s students will explore capturing various elements of art through a digital camera. Elements covered in this class are lighting, depth of field, negative and positive space, patterns, lines, symmetry, and texture. Students will never see their worlds the same after this class. Alex Morrisstudents will explore storytelling in pictures. By either capturing or designing a series of pictures they will learn to group and stage photos. Printmaking Richard Carnley's students will learn to create images in duplicate using a variety of printmaking techniques and processes. They will develop an understanding of the printing process and create editions of their own works. Quilting Step back in time and learn to piece a quilt by hand! Lisa Lalumandier’s students will start from scratch…cutting out our pieces and completing a small one block quilt to hang on the wall!. Sculpture Stanley Bohon’s class will emphasize 3-D design and experimental aspects of sculpture. The projects will include assemblage of found and repurposed objects. Students will be encouraged to think “outside the traditional box.” Richard Carnley’s students will be introduced to sculpture-making materials and techniques. They will create sculpture using a variety of materials such as clay, paper, wood, and found objects to make their 3-D works of art. Toys & Dolls Barbie can’t compare with a doll you make yourself! Lisa Lalumandier’s students will sew a cloth doll and fashion it some clothes. We will explore other homemade toys as well. No batteries needed! Watercolor Marsha Blount’s students will have a brief drawing lesson and then use watercolor paints to complete their art. Students will learn to use a variety of subjects and watercolor techniques in their paintings, including architectural drawings and still lifes. Zen Doodling Barb Richert’s class will create beautiful, structured patterns and designs known as zen doodles. This is a focused, relaxing and calming form of art. The Zentangle Method is an easy to learn, fun and relaxing way to create beautiful images by drawing structured patterns.” Heather Gann’s students will draw unplanned, abstract, black and white art beginning first with an experiment on a 6x6 tile of paper. The final project will include the Zentangle process and an inspiring quote over a colorful background.

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Page 1: Bunn’s MUSEUM OF EAST TEXAS ART CAMP 2016 · 2 Museum of East Texas Art Camp 2016 Welcome to the 19th Annual Summer Art Camp at the Museum of East Texas! We have an exciting summer

Museum of East Texas 503 North Second Street Lufkin, Texas 75901 (936) 639-4434 www.metlufkin.org

Art Camp Faculty Marsha Blount Stanley Bohon Sarah Bunn Stephanie Carcano Richard Carnley Jessica Chaney Heather Gann Lisa Lalumandier Julia Lott Alison Lovell Jesucita Menz Rachel Molandes Alex Morris Melanie Moses Gary Parker Ann Phifer Reyes Barb Richert Connie Welch

Adult Art Camp Faculty Lisa Lalumandier Rachel Molandes Ann Phifer Reyes

MUSEUM ● OF ● EAST ● TEXAS ART CAMP 2016

Wee Art

May 31-June 3 July 5-8

August 15-19 9:30 am – 11 am

Art Camp June 6-July 1

July 11-August 12 9 am -12 pm 1 pm - 4 pm

Adult Classes

May 31-June 3 1:00-3:00 pm Painting 6:30-8:30 pm Quilting

July 5-8 • 1:00-3:00 pm

Crochet Drawing Painting

August 15-19 • 1:00-3:00 pm Painting

NONPROFITORGANIZATIONU.S. POSTAGE

PA I DLUFKIN, TEXASPERMIT NO. 34

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Fiber Fun Stephanie Carcano’s students will learn where wool comes from and what we can do with it. Explore how fluffy bits of softness can be transformed into something durable and practical. Make felt, spin yarn, weave and create other fun projects from the world of fibers. Fun with Tempera Discover many ways to paint with Tempera. Melanie Moses’ class will learn to mix colors and use tempera with other media to create one of a kind paintings. Create a Tempera Batik and learn how to use tempera like watercolors. Hooks & Needles (AGES 10 & Up) Stephanie Carcano’s students will learn how to stitch with knitting needles or crochet hooks and open a world of creative design. Learn the basics of chaining, casting on, and the basic stitches, and finish a small project. Manga “Whimsical Drawing” Barb Richert’s class will cover the basics of Japanese style cartooning. Students will practice large expressive eyes, spiky hair, strong facial expressions, foreshortening, and action lines. Drawings in manga style are typically produced in black and white with different patterns to compensate for the lack of color. Mixed Media In this class, Marsha Blount’s students will combine a variety of techniques and materials to create art. Paint, ink, newsprint, fabrics, etc., will be used in this class. For example, you may draw something in ink, add fabrics or cut paper or paint – that's mixed media! Mosaic Collage Richard Carnley's students will learn techniques used with mosaic collage. They will learn the importance of planning and material selection for their designs. Students will create multiple art works of their own. Paper Crafts Lisa Lalumandier’s students will explore many different ways you can create beautiful things with paper. This is not a class in Origami, however we will take a day to try our hand at the ancient art of paper folding! Photography (AGES 10 & Up) (class limited to six students) Sarah Bunn’s students will explore capturing various elements of art through a digital camera. Elements covered in this class are lighting, depth of field, negative and positive space, patterns, lines, symmetry, and texture. Students will never see their worlds the same after this class. Alex Morris’ students will explore storytelling in pictures. By either capturing or designing a series of pictures they will learn to group and stage photos. Printmaking Richard Carnley's students will learn to create images in duplicate using a variety of printmaking techniques and processes. They will develop an understanding of the printing process and create editions of their own works. Quilting Step back in time and learn to piece a quilt by hand! Lisa Lalumandier’s students will start from scratch…cutting out our pieces and completing a small one block quilt to hang on the wall!. Sculpture Stanley Bohon’s class will emphasize 3-D design and experimental aspects of sculpture. The projects will include assemblage of found and repurposed objects. Students will be encouraged to think “outside the traditional box.” Richard Carnley’s students will be introduced to sculpture-making materials and techniques. They will create sculpture using a variety of materials such as clay, paper, wood, and found objects to make their 3-D works of art. Toys & Dolls Barbie can’t compare with a doll you make yourself! Lisa Lalumandier’s students will sew a cloth doll and fashion it some clothes. We will explore other homemade toys as well. No batteries needed! Watercolor Marsha Blount’s students will have a brief drawing lesson and then use watercolor paints to complete their art. Students will learn to use a variety of subjects and watercolor techniques in their paintings, including architectural drawings and still lifes. Zen Doodling Barb Richert’s class will create beautiful, structured patterns and designs known as zen doodles. This is a focused, relaxing and calming form of art. The Zentangle Method is an easy to learn, fun and relaxing way to create beautiful images by drawing structured patterns.” Heather Gann’s students will draw unplanned, abstract, black and white art beginning first with an experiment on a 6x6 tile of paper. The final project will include the Zentangle process and an inspiring quote over a colorful background.

Page 2: Bunn’s MUSEUM OF EAST TEXAS ART CAMP 2016 · 2 Museum of East Texas Art Camp 2016 Welcome to the 19th Annual Summer Art Camp at the Museum of East Texas! We have an exciting summer

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Museum of East Texas ● Art Camp 2016 Welcome to the 19th Annual Summer Art Camp at the Museum of East Texas! We have an exciting summer planned with a large selection of classes and talented instructors. We want to do all we can to ensure that you are a part of it! Enclosed, you will find one copy of all that you need to register for Art Camp 2016:

Course Descriptions and Class Schedule, by age Registration Forms Student Health Form Arrival/Departure Form Photo Release/Exhibition Form

All forms are available at the Museum or can be downloaded and printed from the Museum’s web site: www.metlufkin.org Detailed information about this year’s Art Camp and the registration process are below, but please do not hesitate to call, email, or stop by the Museum with any questions or for further details about Art Camp. We are happy to hear from you! Our number is (936) 639-4434 and we are located at 503 N. Second Street, Lufkin, TX. REGISTRATION POLICIES AND PROCEDURES

To enroll in Art Camp, each participant must have: 1. Completed Registration Form (both sides) 2. Completed Student Health Form, Photo Release, Invitation List 3. Signed Arrival/Departure Form 4. Payment (cash, check, credit card)

Notes: Registration is NOT accepted over the phone or online. Payment must be received to hold a spot in the

session. To ensure enrollment in first choice classes, register early as spots fill quickly. To keep fees low, each Art Camp participant will only receive one t-shirt, regardless of number of sessions

enrolled. Though there is no registration deadline for Art Camp, all expenses are paid from registration fees.

Therefore, NO REFUNDS will be given except for classes that are cancelled by the Museum. Museum members are eligible for a tuition discount for their children and grandchildren. To receive this

discount, participants MUST write the name of the qualifying member on their registration form in the MEMBERS section.

Scholarships are available through the generosity of the Museum Guild from funds raised through their annual Festival of Trees and through private donations; please contact the Curator of Education for more information. We regret that awarded scholarships will be forfeited and returned to the scholarship fund if recipients do not attend the first day of their scheduled session(s).

SESSION INFORMATION

A complete session of Art Camp meets for one half day (9:00 am – 12:00 pm OR 1:00 pm – 4:00 pm) from Monday through Friday. Sessions are labeled by the Week Number, followed by the time (either morning-AM or afternoon-PM). Wee Art Sessions meet from 9:30 am – 11:00 am. See pg. 5 for information about Creative Song Writing, and pg. 6 for information about Adult Classes.

ART CAMP SESSIONS

Week 1 Wee Art May 31-June 3

Week 7 AM/PM July 11-15

Week 2 AM/PM June 6-10

Week 8 AM/PM July 18-22

Week 3 AM/PM June 13-17

Week 9 AM/PM July 25-29

Week 4 AM/PM June 20-24

Week 10 AM/PM July 1-5

Week 5 AM/PM June 27-July 1

Week 11 AM/PM August 8-12 1

Week 6 Wee Art July 5-8

Week 12 Wee Art August 15-19

Age/Group Member Non-Member

Wee Art $20 $25 (Age 3) – May 31-June 3, 4 days only Wee Art $20 $25 (Age 3)—July 5-8, 4 days only

Wee Art $25 $30 (Age 3) - August 15-19

Multimedia/ $40 $45 Art Smart (Ages 4-6)

Ages 7-14 $50 $55

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WEE ART ● AGE 3 OFFERED 9:30-11:00 AM, WEEKS 1, 6, AND 12 The very young at art and a parent, grandparent, or adult friend will delight in this hour and a half morning class that begins the journey to discover the world of art through lines, shapes, textures, and colors. A snack period with stories provides diversity for young attention spans. Instructors: Stanley Bohon, Alex Morris MULTIMEDIA ● AGE 4-5 OFFERED: AM and PM, WEEKS 2-5, 7-11 This three-hour class for the curious pre-K or kindergartner explores the fun of self-expression, introducing the formal elements of art through a variety of media processes including clay, collage, painting, drawing, and sculpture. Instructors: Stanley Bohon, Richard Carnley, Jessica Chaney, Alison Lovell, Jesucita Menz, Rachel Molandes, Alex Morris ARTSMART ● AGE 6 OFFERED: AM and PM, WEEKS 2-5, 7-11 This three-hour class seeks to further nurture the seed of artistry planted in the budding first grade mind by honing introductory skills and developing basic knowledge of the formal elements of art, incorporating them into a variety of projects from papier mâché to clay to drawing. Instructors: Stanley Bohon, Richard Carnley, Jessica Chaney, Lisa Lalumandier, Julia Lott, Jesucita Menz, Rachel Molandes, Alex Morris ART CLASSES ● AGE 7-14 OFFERED: AM and PM, WEEKS 2-5, 7-11 Students choose two classes per half-day session, offered AM or PM, WEEKS 2-5, 7-11. Course descriptions are below. Acrylic Painting Ann Phifer Reyes ’students will create a painting each day while learning the basics and the sheer joy of acrylic painting. Beads & Knots (AGES 10 & Up) Melanie Moses’ students will create jewelry using techniques of macramé, weaving, and wrapping. They will learn to make bracelets, key rings, necklaces, and more. Beads of all different kinds will be incorporated into their work. Bookmaking Richard Carnley's bookmaking class will be devoted to making one-of-a-kind sculptural and traditional book models. The student will learn about paper and its multiple characteristics and uses in bookmaking. Chalk Art Barb Richert’s students will review composition and value in charcoal, then study color and its characteristics: hue, value, and temperature and learn to make strokes with those brilliant sticks of color! There will be a lesson each day, then time for students to work on a piece of their own choosing. We well do landscape, still life and portrait work. Rachel Molandes’ students will learn comprehensive technical details for lettering, layout, color, brush skills, & cartooning to help create great chalk art drawings. Clay Melanie Moses conducts basic and intermediate instruction in clay. Returning students will work at their own pace on individual projects. Students will learn pottery techniques as well as additive and subtractive sculptural processes. Over the course of this class, Julia Lott’s students will learn and experiment with the basic techniques of ceramic art- including pinch pots, coil building, and slab work. They will also be introduced to glazes and sculptural elements. Drawing Lisa Lalumandier – Do you like to draw? Would you like to learn about different styles of drawing? Perhaps make your drawings more realistic? Are you interested in animation? Sign up here!!! Rachel Molandes’ students will learn drawing techniques and develop visual perception skills. A variety of subjects and drawing materials will be used. Embroidery Stephanie Carcano’s class will learn to embellish clothing and make your own pillows and bags using needle and thread and basic hand sewing stitches. Students will learn basic embroidery and knotting techniques and sew beads and buttons on paper, fabric and plastic canvas. Expressive Painting Rachel Molandes’ students will utilize a different paint medium to create projects that combine traditional and culturally inspired art while encouraging self-expression and imagination.

Page 3: Bunn’s MUSEUM OF EAST TEXAS ART CAMP 2016 · 2 Museum of East Texas Art Camp 2016 Welcome to the 19th Annual Summer Art Camp at the Museum of East Texas! We have an exciting summer

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Museum of East Texas ● Art Camp 2016

Individual registration is required for each participant. Please fill out this form completely (front and back) and return with payment along with a completed Student Health Form. ______________________________________________ ___________ ____ Participant’s Name Date of birth Age ___________________________________________________________________ Parent/Guardian Name(s) __________________________________________ _______________ _______ ___________ Mailing address* City State Zip Home Ph. ( ) _________________ Work Ph. ( ) _________________ Cell Ph. ( ) _________________ Email address _________________________________________________________________________________ *This address will be used to mail an invitation to the Art Camp Exhibition Closing Reception. Each participant also may submit up to three additional addresses to receive invitations by filling out the address form (see pg. 8) at the Museum or by submitting addresses via email to [email protected]. Payment and Fees Although there is no registration deadline, Art Camp is paid for through registration fees. Therefore, there will be NO REFUNDS except for classes that are cancelled by the Museum.

Total Due $_____________ Payment Method: ___Check ___Cash ___Credit Card: ___Visa ___MC

Number__________________________________________ Exp.________________ CCV___________

Name as it appears on card: ____________________________________________________________

Authorized Signature _________________________________________________________________ Members Current Museum members receive a discount on Art Camp Fees for their children and/or grandchildren. To receive this discount, please write name of eligible member(s) here: _______________________________________.

Scholarship (Please check) ______

Please return to: Art Camp 2016 ● Museum of East Texas ● 503 N. Second Street ● Lufkin, TX 75901

Participant’s T-shirt Size Youth XS S M L Adult S M L XL

Age/Group Member Non- Member # of sessions Amount Due

Wee Art (Age 3) $20 $25 _____ $__________ May 31-June 3, 4 days only

Wee Art (Age 3) $20 $25 _____ $__________ July 5-8, 4 days only

Wee Art (Age 3) $25 $30 _____ $__________ August 15-19

Multimedia/ $40 $45 _____ $__________ Art Smart (Ages 4-6) Ages 7-14 $50 $55 _____ $__________

OFFICE USE ONLY ACCT__________ MEM__________ EDU__________ HEALTH__________ RCVD__________

Page 4: Bunn’s MUSEUM OF EAST TEXAS ART CAMP 2016 · 2 Museum of East Texas Art Camp 2016 Welcome to the 19th Annual Summer Art Camp at the Museum of East Texas! We have an exciting summer

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Art Classes • Ages 7-14 • Choose TWO classes per half-day session. Classes in BOLD are for Ages 10 and up ONLY.

Multimedia • Ages 4-5

Week 2: JUN 6-10: AM A. Lovell Week 3: JUN 13-17: AM R. Carnley Week 4: JUN 20-24: AM J. Chaney Week 2: JUN 6-10: PM J. Chaney Week 3: JUN 13-17: PM R. Carnley Week 4: JUN 20-24: PM J. Chaney Week 5: JUN 27-JUL 1: AM A. Lovell Week 7: JUL 11-15: AM A. Lovell Week 8: JUL 18-22: AM R. Molandes Week 5: JUN 27-JUL 1: PM R. Molandes Week 7: JUL 11-15: PM S. Bohon Week 8: JUL 18-22: PM R. Molandes Week 9: JUL 25-29: AM J. Menz Week 10: AUG 1-5: AM A. Lovell Week 11: AUG 8-12: AM A. Morris Week 9: JUL 25-29: PM A. Morris Week 10: AUG 1-5: PM A. Morris Week 11: AUG 8-12: PM A. Morris

Wee Art • Age 3

Week 1: MAY 31-JUN 3: AM (9:30-11AM) S. Bohon Week 6: JUL 5-8: AM (9:30-11AM) A. Morris Week 12: AUG 15-18: AM (9:30-11AM) S. Bohon

ArtSmart • Age 6 Week 2: JUN 6-10: AM R. Carnley Week 3: JUN 13-17: AM J. Chaney Week 4: JUN 20-24: AM R. Molandes Week 2: JUN 6-10: PM R. Carnley Week 3: JUN 13-17: PM J. Chaney Week 4: JUN 20-24: PM A. Morris

Week 5: JUN 27-JUL 1: AM J. Chaney Week 7: JUL 11-15: AM S. Bohon Week 8: JUL 18-22: AM J. Menz Week 5: JUN 27-JUL 1: PM J. Chaney Week 7: JUL 11-15: PM L. Lalumandier Week 8: JUL 18-22: PM J. Lott

Week 9: JUL 25-29: AM J. Lott Week 10: AUG 1-5: AM R. Carnley Week 11: AUG 8-12: AM R. Molandes Week 9: JUL 25-29: PM R. Carnley Week 10: AUG 1-5: PM R. Carnley Week 11: AUG 8-12: PM J. Lott

Week 2: JUN 6-10

AM SESSION

Clay………………...…..M. Moses Quilting…………..L. Lalumandier Acrylics………………….A. Reyes Mixed Media..…………M. Blount

PM SESSION

Beads & Knots………M. Moses Paper Crafts…….L. Lalumandier Zen Doodling…………B. Richert Watercolor…………….M. Blount

Week 3: JUN 13-17

AM SESSION

Fun with Tempera…….M. Moses Sculpture……………….S. Bohon Drawing………….L. Lalumandier Watercolor……………..M. Blount

PM SESSION

Clay…………………….M. Moses Sculpture……………....S. Bohon Chalk Art……………….B. Richert Toys & Dolls…….L. Lalumandier

Week 4: JUN 20-24

AM SESSION

Clay…………………….M. Moses Bookmaking………….R. Carnley Sculpture……………….S. Bohon Photography…………A. Morris

PM SESSION

Beads & Knots………M. Moses Mosaic Collage………R. Carnley Manga………………….B. Richert Expressive Painting....R. Molandes

Week 5: JUN 27-JUL 1

AM SESSION

Fun with Tempera…….M. Moses Sculpture……………..R. Carnley Chalk Art…………...R. Molandes Photography…………...S. Bunn

PM SESSION

Clay…………………….M. Moses Printmaking…………..R. Carnley Manga………………….B. Richert Photography…………...S. Bunn

Week 7: JUL 11-15 AM SESSION

Clay…………………….M. Moses Mosaic Collage………R. Carnley Expressive Painting…R. Molandes Paper Crafts…….L. Lalumandier

PM SESSION

Beads & Knots………M. Moses Bookmaking………….R. Carnley Drawing.…………...R. Molandes Acrylics………………….A. Reyes

Week 8: JUL 18-22 AM SESSION

Beads & Knots………M. Moses Toys & Dolls…….L. Lalumandier Acrylics………………….A. Reyes Mixed Media…………..M. Blount

PM SESSION

Clay…………………….M. Moses Drawing……….....L. Lalumandier Watercolor……………..M. Blount Photography…………..S. Bunn

Week 9: JUL 25-29 AM SESSION

Clay…………………….M. Moses Drawing…………L. Lalumandier Photography………….A. Morris Printmaking…………..R. Carnley

PM SESSION

Fun with Tempera…….M. Moses Quilting………….L. Lalumandier Zen Doodling…………...H. Gann Watercolor……………..M. Blount

Week 10: AUG 1-5 AM SESSION

Fun with Tempera…….M. Moses Photography………….A. Morris Acrylics………………….A. Reyes Fiber Fun…………….S. Carcano

PM SESSION

Clay…………………….M. Moses Expressive Painting…..G. Parker Zen Doodling……………H. Gann Embroidery………..…S. Carcano

Week 11: AUG 8-12

AM SESSION

Clay………………………...J. Lott Toys & Dolls…….L. Lalumandier Fiber Fun…………….S. Carcano Watercolor……………..M. Blount

PM SESSION

Drawing………….L. Lalumandier Hooks & Needles....S. Carcano Mixed Media.………….M. Blount Expressive Painting….R. Molandes

Page 5: Bunn’s MUSEUM OF EAST TEXAS ART CAMP 2016 · 2 Museum of East Texas Art Camp 2016 Welcome to the 19th Annual Summer Art Camp at the Museum of East Texas! We have an exciting summer

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Museum of East Texas ● Art Camp 2016 Creative Song Writing Class (Ages 10 – 14)

Connie Welch – Creative writing is a great way to enhance communication skills and confidence in anyone. Planting these skills at an early age is a brilliant idea. Our writing class is designed to not over think the process and jump right in. We will start as a group by writing lyrics to the melody of a familiar song. Then break off individually or in groups and write as the ideas are unleashed. Students may bring their acoustic instruments to class, but there will be no instruction on individual instruments.

Registration for Creative Song Writing (Ages 10-14)

Class is dependent on minimum enrollment.

Individual registration is required for each participant. Please fill out this form completely and return with payment along with a completed Student Health Form. ______________________________________________ ___________ ____ Participant’s Name Date of birth Age ___________________________________________________________________ Parent/Guardian Name(s) __________________________________________ _______________ _______ ___________ Mailing address* City State Zip Home Ph. ( ) _________________ Work Ph. ( ) _________________ Cell Ph. ( ) _________________ Email address _________________________________________________________________________________ *This address will be used to mail an invitation to the Art Camp Exhibition Closing Reception. Each participant also may submit up to three additional addresses to receive invitations by filling out the address form at the Museum or by submitting addresses via email to [email protected]. Payment and Fees Although there is no registration deadline, Art Camp is paid for through registration fees. Therefore, there will be NO REFUNDS except for classes that are cancelled by the Museum.

Creative Song Writing _____ July 18-22, & July 25-29, 9:30 – 11:00am Member $50 Non-Member $55

Total Due $___________ Payment Method: ___Check ___Cash ___Credit Card: ___Visa ___MC

Number__________________________________________ Exp.______________ CCV____________

Name as it appears on card: ___________________________________________________________

Authorized Signature ________________________________________________________________

Members Current Museum members receive a discount on Art Camp Fees for their children and/or grandchildren. To receive this discount, please write name of eligible member(s) here: _______________________________________.

Scholarship (Please check) ______

Please return to: Art Camp 2016 ● Museum of East Texas ● 503 N. Second Street ● Lufkin, TX 75901

Participant’s T-shirt Size Youth XS S M L Adult S M L XL

OFFICE USE ONLY ACCT__________ MEM__________ EDU__________ HEALTH__________ RCVD__________

Page 6: Bunn’s MUSEUM OF EAST TEXAS ART CAMP 2016 · 2 Museum of East Texas Art Camp 2016 Welcome to the 19th Annual Summer Art Camp at the Museum of East Texas! We have an exciting summer

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Museum of East Texas ● Art Camp 2016 Adult Classes (Age 15 – Adult)

Painting (acrylic or oil) — Ann Phifer Reyes: Basic instruction for the beginner, individualized for the advanced student. The Museum will supply all materials, or you may bring your own. Quilting — Lisa Lalumandier: Have you always wanted to learn a little of the old ways? Put down the technology and make something the way our grandmothers did? Hand quilting is one relaxing and addicting hobby! Come learn the basics and leave with a lovely wall hanging! Crochet — Lisa Lalumandier: Have you always wanted to learn to crochet? Does it look too complicated? Learning the basics is fun and easy! Come learn a new craft that you can take with you just about anywhere. What can you make with crochet? The possibilities are endless! Drawing — Rachel Molandes: Students will learn the development of perceptual and descriptive skills through an introduction to a variety of drawing media, techniques and subject matter. _________________________________________________________________________________

Registration for Adult Classes (Age 15 – Adult) Name: __________________________________________________ Address: ________________________________________________ City: ___________________________________ Zip: _____________ Home Ph. ( ) ________________ Work Ph. ( ) ________________ Cell Ph. ( ) ________________ E-mail Address: ___________________________________________________________________

Please check the class/classes you wish to take. Classes are dependent on minimum enrollment. Painting:

_____ May 31-June 3, 1:00-3:00 pm Member $50 Non-Member $55 _____ July 5-8, 1:00-3:00 pm Member $50 Non-Member $55 _____ August 15-18, 1:00-3:00 pm Member $50 Non-Member $55

Quilting:

_____ May 31-June 3, 6:30-8:30 pm Member $50 Non-Member $55

Crochet: _____ July 5-8, 1:00-3:00 pm Member $50 Non-Member $55

Drawing:

_____ July 5-8, 1:00-3:00 pm Member $50 Non-Member $55

Total Due $_____________ Payment Method: ___Check ___Cash ___Credit Card: ___Visa ___MC

Number_______________________________________ Exp._____________ CCV__________

Name as it appears on card: _____________________________________________________

Authorized Signature __________________________________________________________ Please return to:

Art Camp 2016 ● Museum of East Texas ● 503 N. Second Street ● Lufkin, TX 75901

Participant’s T-shirt Size Youth XS S M L Adult S M L XL

OFFICE USE ONLY ACCT__________ MEM__________ EDU__________ HEALTH__________ RCVD__________

Page 7: Bunn’s MUSEUM OF EAST TEXAS ART CAMP 2016 · 2 Museum of East Texas Art Camp 2016 Welcome to the 19th Annual Summer Art Camp at the Museum of East Texas! We have an exciting summer

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Museum of East Texas ● Art Camp 2016 Arrival/Departure Information

Art Campers with special needs will enter and exit using the front doors on the Plaza or the south entrance on Paul Ave. Parking is provided in the north parking lot and on Paul Ave. Please see map. The front doors will be open with limited parking in front (Paul Ave.) of the Convention Center. The Museum highly recommends that, unless accompanied by an adult, all other children enter and exit the door located next to the loading dock on the north side of the building. Parking is available in the new lot north of the Museum. Please see map. Designated entries will be marked with signage. For questions or concerns, contact: J.P. McDonald, Director, 936.639.4434, [email protected] The Museum does not open until 8:30 a.m. Therefore, this is the earliest time you may drop off your children for Art Camp. All children attending classes in the 4-6 age group must be escorted to the classroom by their parent/guardian. Participants may not wait outside the Museum, but must be picked up inside no later than 30 minutes after class. Please call the Museum if you will be late picking up your child. The safety of your child is very important to us. Therefore, we require that Art Camp participants be picked up at the Museum ONLY by parents/guardians or those designated below. Name of Art Camper _________________________ Name/Relationship _________________________ Date ____________ Name/Relationship _________________________ Date ____________ Name/Relationship _________________________ Date ____________

_______________________ ______________ Parent/Guardian Date

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Media Release By enrolling in the program, students and their guardians acknowledge and agree that any photos, videos, pictorial images, voice recordings, or quotations including those taken by a student or created by the Museum of East Texas (including without limitation those taken by any photographer or videographer paid by or volunteering for the Museum of East Texas) during or related to attending courses at the Museum of East Texas are the sole property of the Museum of East Texas and may be used in future publications, web pages, promotions, advertisements, and exhibits of the Museum of East Texas (or any other person authorized to use such images by the Museum of East Texas) without the need of any additional permission from or consideration to the student or guardian. By enrolling in the program, students and their guardians agree to release and waive for the student, and anyone claiming through the student, all claims based on the right of privacy, right of publicity, moral rights, or any other intellectual property rights related to the rights granted by the student to the Museum of East Texas. I Agree I Do Not Agree Signature of Parent/Guardian_______________________________ Date ______________

Art Camp Exhibition Art Campers, parents, and guests will be invited to a special reception to view their children’s artwork on Sunday, August 28, 2016 from 2:00 to 4:00 pm. Work displayed during the Art Camp Exhibition will be collected during Art Camp and stored at the Museum until the Art Camp Reception Closing Exhibition, when it can be collected. Please indicate below if you would like your child’s artwork to be displayed during the Art Camp Exhibition. _____ Yes, please display my child’s artwork during the Art Camp Exhibition. In addition to my address, also mail invitations to the following: Name ____________________________

Address __________________________ City, State, Zip _____________________________

Name ____________________________

Address __________________________ City, State, Zip _____________________________

Name ____________________________

Address __________________________ City, State, Zip _____________________________ _____ No, we will not be participating in the Art Camp Exhibition; therefore, do not keep any of my child’s artwork.

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2016 Museum of East Texas Art Camp Guidelines and Policies

Please read this section carefully before registering. No exceptions to these policies! Art Camp is a part of the Museum of East Texas and as such complies with all policies and procedures from the Museum of East Texas for the proper administration and management of Art Camp. The Museum of East Texas reserves the right to amend, add, and delete policies and regulations as necessary, as well as the right to change programs, dates, personnel, and fees noted in this schedule. Note: Art Camp IS NOT a licensed day care facility or childcare center. Admission Guidelines All students must register for classes within their age group. Age requirements are nonnegotiable and are strictly enforced for each class. There are no exceptions. Registration Guidelines Registration forms must be filled out completely. Enrollment cannot be processed without complete information and payment in full. Registration forms must include a parent/guardian signature acknowledging and agreeing to the Museum of East Texas Art Camp policies. Registrations will not be processed without this signature. Please review your form for accuracy before submitting. The Museum of East Texas is not responsible for incorrect information, including incorrect course names, submitted on registration forms. Registrations are processed in the order they are received, on a first-come, first served basis. All students are encouraged to register early as classes fill very quickly. The Museum of East Texas is not responsible for faxed or mailed registrations not received. Registration Procedure Registrations are accepted by mail, fax, or in person during Museum of East Texas business hours, 10:00 a.m. - 5:00 p.m. Tuesday through Friday,1:00 p.m. - 5:00 p.m. Saturday and Sunday. Scholarships for Art Camp are available, courtesy of the Museum Guild, with funds raised through their annual Festival of Trees and through private donations. To request a scholarship, please contact the Curator of Education at (936) 639-4434. Mail your completed registration form and payment to: Art Camp Museum of East Texas 503 North Second Street Lufkin, TX 75901

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Cancellations, Changes, and Refunds No refunds are issued after registration, including for “no-shows,” with the exception of classes cancelled by the Museum of East Texas. Valuables The Museum of East Texas encourages its students to leave all valuables and all personal or sentimental items at home. The Museum of East Texas is not responsible for loss of or damage to a student’s valuables or personal items. All electronics must be turned off and left at the front desk. Electronics may be used during lunch time. Discipline/Dismissal The Museum of East Texas reserves the right to remove students from classes for behavior that is deemed to be rude, disruptive, inappropriate, dangerous, or in violation of health and safety regulations. The Curator of Education and Museum Director maintain the right to dismiss a student from a class with a prior warning, and to remove a student permanently from a class for repeated offenses. Illness In order to protect the health of all, Museum of East Texas prohibits students from attending class when ill with a communicable disease or condition such as chicken pox, the flu, head lice, pink eye, or strep throat. Museum of East Texas reserves the right to notify parents/guardians regarding any student who becomes ill during class and to request that said student be picked up immediately. Museum of East Texas also reserves the right to request a physician’s authorization for return to class. Information Release Photographs and other personally identifiable information, such as age or name, may be published by the Museum of East Texas in any future publications, web pages, promotions, advertisements, or release the Museum of East Texas Art Camp and its agents and waive for the student all claims based on right of privacy or publicity and any other intellectual property rights. Students with Special Needs The Museum of East Texas is happy to provide reasonable accommodations for children with qualifying special needs upon completion and submission of the Request for Accommodation form at least two weeks before the start of classes. The Request for Accommodation forms are available at the Art Camp office. Medications The Museum of East Texas prohibits Art Camp faculty and staff from administering medication to children and does not permit medication (OTC or prescription) on campus with the exception of emergency medications. Emergency medications are defined as (1) Epi-pens and (2) asthma inhalers. Please notify the Curator of Education

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Cancellations, Changes, and Refunds No refunds are issued after registration, including for “no-shows,” with the exception of classes cancelled by the Museum of East Texas. Valuables The Museum of East Texas encourages its students to leave all valuables and all personal or sentimental items at home. The Museum of East Texas is not responsible for loss of or damage to a student’s valuables or personal items. All electronics must be turned off and left at the front desk. Electronics may be used during lunch time. Discipline/Dismissal The Museum of East Texas reserves the right to remove students from classes for behavior that is deemed to be rude, disruptive, inappropriate, dangerous, or in violation of health and safety regulations. The Curator of Education and Museum Director maintain the right to dismiss a student from a class with a prior warning, and to remove a student permanently from a class for repeated offenses. Illness In order to protect the health of all, Museum of East Texas prohibits students from attending class when ill with a communicable disease or condition such as chicken pox, the flu, head lice, pink eye, or strep throat. Museum of East Texas reserves the right to notify parents/guardians regarding any student who becomes ill during class and to request that said student be picked up immediately. Museum of East Texas also reserves the right to request a physician’s authorization for return to class. Information Release Photographs and other personally identifiable information, such as age or name, may be published by the Museum of East Texas in any future publications, web pages, promotions, advertisements, or release the Museum of East Texas Art Camp and its agents and waive for the student all claims based on right of privacy or publicity and any other intellectual property rights. Students with Special Needs The Museum of East Texas is happy to provide reasonable accommodations for children with qualifying special needs upon completion and submission of the Request for Accommodation form at least two weeks before the start of classes. The Request for Accommodation forms are available at the Art Camp office. Medications The Museum of East Texas prohibits Art Camp faculty and staff from administering medication to children and does not permit medication (OTC or prescription) on campus with the exception of emergency medications. Emergency medications are defined as (1) Epi-pens and (2) asthma inhalers. Please notify the Curator of Education

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Cancellations, Changes, and Refunds No refunds are issued after registration, including for “no-shows,” with the exception of classes cancelled by the Museum of East Texas. Valuables The Museum of East Texas encourages its students to leave all valuables and all personal or sentimental items at home. The Museum of East Texas is not responsible for loss of or damage to a student’s valuables or personal items. All electronics must be turned off and left at the front desk. Electronics may be used during lunch time. Discipline/Dismissal The Museum of East Texas reserves the right to remove students from classes for behavior that is deemed to be rude, disruptive, inappropriate, dangerous, or in violation of health and safety regulations. The Curator of Education and Museum Director maintain the right to dismiss a student from a class with a prior warning, and to remove a student permanently from a class for repeated offenses. Illness In order to protect the health of all, Museum of East Texas prohibits students from attending class when ill with a communicable disease or condition such as chicken pox, the flu, head lice, pink eye, or strep throat. Museum of East Texas reserves the right to notify parents/guardians regarding any student who becomes ill during class and to request that said student be picked up immediately. Museum of East Texas also reserves the right to request a physician’s authorization for return to class. Information Release Photographs and other personally identifiable information, such as age or name, may be published by the Museum of East Texas in any future publications, web pages, promotions, advertisements, or release the Museum of East Texas Art Camp and its agents and waive for the student all claims based on right of privacy or publicity and any other intellectual property rights. Students with Special Needs The Museum of East Texas is happy to provide reasonable accommodations for children with qualifying special needs upon completion and submission of the Request for Accommodation form at least two weeks before the start of classes. The Request for Accommodation forms are available at the Art Camp office. Medications The Museum of East Texas prohibits Art Camp faculty and staff from administering medication to children and does not permit medication (OTC or prescription) on campus with the exception of emergency medications. Emergency medications are defined as (1) Epi-pens and (2) asthma inhalers. Please notify the Curator of Education

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or Museum Director of emergency medications at the time of registration. Please note: The Museum of East Texas will not accept medications without a prescription or medications that have expired. Parents/Guardians are always welcome to remain on site and may visit their child at any time to administer necessary medications. The Museum of East Texas also encourages you to consult with your child’s physician to adjust medication dosages appropriately to accommodate the class schedule. For students with food allergies, please note that Museum of East Texas faculty and staff do not monitor what other children bring on campus for snacks and cannot guarantee a nut-free environment. Waiver and Release of Liability Although the Museum of East Texas hopes that no student is ever injured or hurt, injuries are a possibility of participation in Art Camp. The risk of injuries is a risk that the students and/or their legal guardian voluntarily agree to assume in exchange for the privilege of participating in the Museum of East Texas Art Camp. The students and/or their legal guardian understand and agree that this risk is not a risk that the Museum of East Texas assumes and that the Museum of East Texas is not responsible for any injuries to the students. Accordingly, the student and their legal guardian voluntarily release, discharge, and waive the right to sue the Museum of East Texas and its directors, trustees, officers, employees, volunteers, agents and all persons acting by, through, under, or in concert with the Museum of East Texas for any and all losses, demands, claims, suits, causes of action, liability, costs, expenses, and judgments whether arising in equity, at common law, or by statute, under the law of contracts, torts, or property, for personal injury (including without limitation emotional distress), arising in favor of the guardian, the student, or anyone claiming through us based upon, in connection with, relating to or arising out of, directly or indirectly, the student’s participation in Museum of East Texas Art Camp EVEN IF ANY SUCH CLAIMS ARE DUE TO THE RELEASED PARTIES’OWN NEGLIGENCE, STRICT LIABILITY WITHOUT REGARD TO FAULT, VIOLATION OF STATUTE, OR OTHER FAULT, INCLUDING ANY NEGLIGENT ACT,OMISSION, OR INTENTIONAL ACT INTENDED TO PROMOTE MY CHILD’S SAFETY OR WELL-BEING. The student and/or legal guardian hereby grants permission to the Museum of East Texas to obtain emergency medical treatment for the student if the Museum of East Texas deems in its discretion that such emergency medical treatment is necessary.

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or Museum Director of emergency medications at the time of registration. Please note: The Museum of East Texas will not accept medications without a prescription or medications that have expired. Parents/Guardians are always welcome to remain on site and may visit their child at any time to administer necessary medications. The Museum of East Texas also encourages you to consult with your child’s physician to adjust medication dosages appropriately to accommodate the class schedule. For students with food allergies, please note that Museum of East Texas faculty and staff do not monitor what other children bring on campus for snacks and cannot guarantee a nut-free environment. Waiver and Release of Liability Although the Museum of East Texas hopes that no student is ever injured or hurt, injuries are a possibility of participation in Art Camp. The risk of injuries is a risk that the students and/or their legal guardian voluntarily agree to assume in exchange for the privilege of participating in the Museum of East Texas Art Camp. The students and/or their legal guardian understand and agree that this risk is not a risk that the Museum of East Texas assumes and that the Museum of East Texas is not responsible for any injuries to the students. Accordingly, the student and their legal guardian voluntarily release, discharge, and waive the right to sue the Museum of East Texas and its directors, trustees, officers, employees, volunteers, agents and all persons acting by, through, under, or in concert with the Museum of East Texas for any and all losses, demands, claims, suits, causes of action, liability, costs, expenses, and judgments whether arising in equity, at common law, or by statute, under the law of contracts, torts, or property, for personal injury (including without limitation emotional distress), arising in favor of the guardian, the student, or anyone claiming through us based upon, in connection with, relating to or arising out of, directly or indirectly, the student’s participation in Museum of East Texas Art Camp EVEN IF ANY SUCH CLAIMS ARE DUE TO THE RELEASED PARTIES’OWN NEGLIGENCE, STRICT LIABILITY WITHOUT REGARD TO FAULT, VIOLATION OF STATUTE, OR OTHER FAULT, INCLUDING ANY NEGLIGENT ACT,OMISSION, OR INTENTIONAL ACT INTENDED TO PROMOTE MY CHILD’S SAFETY OR WELL-BEING. The student and/or legal guardian hereby grants permission to the Museum of East Texas to obtain emergency medical treatment for the student if the Museum of East Texas deems in its discretion that such emergency medical treatment is necessary.

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or Museum Director of emergency medications at the time of registration. Please note: The Museum of East Texas will not accept medications without a prescription or medications that have expired. Parents/Guardians are always welcome to remain on site and may visit their child at any time to administer necessary medications. The Museum of East Texas also encourages you to consult with your child’s physician to adjust medication dosages appropriately to accommodate the class schedule. For students with food allergies, please note that Museum of East Texas faculty and staff do not monitor what other children bring on campus for snacks and cannot guarantee a nut-free environment. Waiver and Release of Liability Although the Museum of East Texas hopes that no student is ever injured or hurt, injuries are a possibility of participation in Art Camp. The risk of injuries is a risk that the students and/or their legal guardian voluntarily agree to assume in exchange for the privilege of participating in the Museum of East Texas Art Camp. The students and/or their legal guardian understand and agree that this risk is not a risk that the Museum of East Texas assumes and that the Museum of East Texas is not responsible for any injuries to the students. Accordingly, the student and their legal guardian voluntarily release, discharge, and waive the right to sue the Museum of East Texas and its directors, trustees, officers, employees, volunteers, agents and all persons acting by, through, under, or in concert with the Museum of East Texas for any and all losses, demands, claims, suits, causes of action, liability, costs, expenses, and judgments whether arising in equity, at common law, or by statute, under the law of contracts, torts, or property, for personal injury (including without limitation emotional distress), arising in favor of the guardian, the student, or anyone claiming through us based upon, in connection with, relating to or arising out of, directly or indirectly, the student’s participation in Museum of East Texas Art Camp EVEN IF ANY SUCH CLAIMS ARE DUE TO THE RELEASED PARTIES’OWN NEGLIGENCE, STRICT LIABILITY WITHOUT REGARD TO FAULT, VIOLATION OF STATUTE, OR OTHER FAULT, INCLUDING ANY NEGLIGENT ACT,OMISSION, OR INTENTIONAL ACT INTENDED TO PROMOTE MY CHILD’S SAFETY OR WELL-BEING. The student and/or legal guardian hereby grants permission to the Museum of East Texas to obtain emergency medical treatment for the student if the Museum of East Texas deems in its discretion that such emergency medical treatment is necessary.

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or Museum Director of emergency medications at the time of registration. Please note: The Museum of East Texas will not accept medications without a prescription or medications that have expired. Parents/Guardians are always welcome to remain on site and may visit their child at any time to administer necessary medications. The Museum of East Texas also encourages you to consult with your child’s physician to adjust medication dosages appropriately to accommodate the class schedule. For students with food allergies, please note that Museum of East Texas faculty and staff do not monitor what other children bring on campus for snacks and cannot guarantee a nut-free environment. Waiver and Release of Liability Although the Museum of East Texas hopes that no student is ever injured or hurt, injuries are a possibility of participation in Art Camp. The risk of injuries is a risk that the students and/or their legal guardian voluntarily agree to assume in exchange for the privilege of participating in the Museum of East Texas Art Camp. The students and/or their legal guardian understand and agree that this risk is not a risk that the Museum of East Texas assumes and that the Museum of East Texas is not responsible for any injuries to the students. Accordingly, the student and their legal guardian voluntarily release, discharge, and waive the right to sue the Museum of East Texas and its directors, trustees, officers, employees, volunteers, agents and all persons acting by, through, under, or in concert with the Museum of East Texas for any and all losses, demands, claims, suits, causes of action, liability, costs, expenses, and judgments whether arising in equity, at common law, or by statute, under the law of contracts, torts, or property, for personal injury (including without limitation emotional distress), arising in favor of the guardian, the student, or anyone claiming through us based upon, in connection with, relating to or arising out of, directly or indirectly, the student’s participation in Museum of East Texas Art Camp EVEN IF ANY SUCH CLAIMS ARE DUE TO THE RELEASED PARTIES’OWN NEGLIGENCE, STRICT LIABILITY WITHOUT REGARD TO FAULT, VIOLATION OF STATUTE, OR OTHER FAULT, INCLUDING ANY NEGLIGENT ACT,OMISSION, OR INTENTIONAL ACT INTENDED TO PROMOTE MY CHILD’S SAFETY OR WELL-BEING. The student and/or legal guardian hereby grants permission to the Museum of East Texas to obtain emergency medical treatment for the student if the Museum of East Texas deems in its discretion that such emergency medical treatment is necessary.

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Frequently Asked Questions What should my child wear to art class? Wear comfortable clothes that can get messy. What are the behavior expectations? Students are expected to listen, follow instructions, participate in class activities, respect others, respect property, and have fun! Does Museum of East Texas Art Camp provide before class or after class supervision? Yes. Children may be dropped off no earlier than 30 minutes before their scheduled class time and must be picked up promptly after class. Children who eat lunch at Art Camp are supervised. May I stay in the classroom with my child? This will be addressed as needed on an individual basis. May I register a gifted child for an older age group? No. Age requirements are strictly enforced and are not negotiable. All children must be registered in their correct age groups. A friend/relative is visiting from out of town. May he/she attend class as a guest with my child? This will be addressed on an individual basis due to class enrollment.

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Museum of East Texas 503 North Second Street • Lufkin, Texas 75901 • 936-639-4434 • www.metlufkin.org

MUSEUM OF EAST TEXAS STUDENT HEALTH FORM

One health form required per participant. Please fill out both sides completely. Students must have a completed, current health form to participate in Art Camp.

1. STUDENT INFORMATION PLEASE PRINT NEATLY Student’s Name (Last, first) _______________________________________________________

Date of Birth ____________M/F _______ Contact Parent/Guardian ______________________

Address_______________________________________________________________________

City ________________________ State _________________ Zip Code ___________________

First Emergency Contact ________________________________

Phone 1: __________________ Phone 2: __________________ Phone 3: _________________

Second Emergency Contact______________________________ Phone 1: __________________ Phone 2: __________________ Phone 3: _________________

Third Emergency Contact________________________________ Phone 1: __________________ Phone 2: __________________ Phone 3: _________________

2. EMERGENCY MEDICATIONS Allergies*

____ No known allergies ____ This student is allergic to: ____ Food ____ Medicine

____ Environment ____Other (use line below):

______________________________________________________________________________

If your child has special dietary needs, you must provide their food.

Please describe what the student is allergic to and known reactions: ______________________

______________________________________________________________________________

Please indicate desired action to be taken and any medication to be administered in case of

mild or severe allergic reactions ___________________________________________________

______________________________________________________________________________

Does the student have an EpiPen? YES __________ NO ____________

*Note: If you have answered that the student has an allergy, please see the Director and/or

Curator of Education of the Museum of East Texas.

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Asthma*

Does the student have asthma? YES __________ NO ____________

Does the student require an emergency inhaler? YES __________ NO ____________

*Note: If you have answered YES to either question, please see the Director and/or Curator of

Education of the Museum of East Texas.

3. SPECIAL NEEDS*

Does the student have any special needs? YES __________ NO ____________

*Note: If you have answered YES to this question, please see the Director and/or Curator of

Education of the Museum of East Texas.

4. Immunizations including DPT or Tetanus current as of date _________________ 5. PARENT/GUARDIAN AUTHORIZATION FOR EMERGENCY CARE: This health history is correct and accurately reflects the health status of the student to whom it pertains. Student has permission to participate in all camp activities except as noted by me/or an examining physician. If I (or my subsequent emergency contacts) cannot be reached in an emergency I give permission to the Museum of East Texas and its agents to call 911. I understand the information on this form will be kept confidential and only shared with necessary personnel. I give permission to photocopy this form. I have read, understand, and agree to adhere to all Registration Guidelines and Policies. Registration will not be processed without signature. Signature of Custodial Parent/Guardian _____________________________________________ Date ______________________ Relationship to Student _______________________________