ADIRONDACK EXPRESSIONS ART CAMP 2017 APPLICATION

Art is the universal language of imagination and freedom. Discover your voice at the Adirondack Expressions Art Camp. This weeklong sleepover camp for young adults with learning differences will take place in eight sessions throughout the summer at the Paul Nigra Center for Creative Arts. Campers will enjoy learning from renowned local and guest artists and creating beautiful take-home keepsakes, crafts and works of art.

This is an art camp for high school students entering their junior or senior years and young adults up to age 27 with learning differences.

Cost per week - $1,200
Cost per week for *day scholars (9AM to 5PM) - $595
*(must have own transportation)

Apply in just three easy steps.

Step 1 - Complete application.
Step 2 - Obtain copy of high school/college transcript or individualized service plan (ISP).
Step 3 - Return application, copy of transcript or ISP and $50 nonrefundable application fee.

The Adirondack Expressions Art Camp team will review your application and set up a time for an interview with the camper and parents within one week of reviewing the application.

Applicant's Name *
Applicant's Name
Date of Birth
Date of Birth
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Check which session(s) you want to attend.
Parent/Guardian Information
Parent 1 Name
Parent 1 Name
Parent 1 Address
Parent 1 Address
Parent 1 Home Phone
Parent 1 Home Phone
Parent 1 Cell Phone
Parent 1 Cell Phone
Parent 2 Name
Parent 2 Name
Parent 2 Address
Parent 2 Address
Parent 2 Home Phone
Parent 2 Home Phone
Parent 2 Cell Phone
Parent 2 Cell Phone
(seizure, diabetes, thyroid, etc.)
Does the camper take his/her own meds?
Please list any food allergies, likes, dislikes and/or need for altered meal presentation.
Please list and describe the nature of the camper’s learning difference/ diagnosis.
Please list the camper’s main mode of communication and state if they have hearing deficits.
Briefly describe the camper’s ability to manage personal hygiene and independent living skills (cooking, basic room care, laundry, etc.).
Please provide a description of the camper’s behavioral needs and strategies that are effective in re-directing (the camp will not be able to accept campers who are dangerous to themselves or others).
Check the activities you are interested in doing.
Applicant's Signature (Type Name) *
Applicant's Signature (Type Name)
By typing my name below, I certify that answers given herein are true and complete to the best of my knowledge.
Date
Date
Parent/Guardian Signature (Type Name)
Parent/Guardian Signature (Type Name)
By typing my name below, I certify that answers given herein are true and complete to the best of my knowledge.
Date
Date