SPRING 2005 PERFORMING ARTS CAMPS
Registration form

Please print and complete this form and send it with a check (payable to JMCA) or cc number to:
Kaleidoscope Program | Julia Morgan Center for the Arts | 2640 College Ave. | Berkeley, CA 94704

Student name: ____________________________________________________________________________________

Date of Birth: __________________________

Parent/Guardian Name:_____________________________________________________________________________

Address:____________________________________________________________________________________________

City: ______________________________________________State: ______________Zip: ________________________

Day Phone: _____________________________________ Evening Phone: ___________________________________

Fax: ________________________________________ Email: _______________________________________________

Please put my child in the same class as: ____________________________________________________________

Enrolling in:

Class Title	Dates	Fee
Kaleidoscope Camp 1	Grades 1-6	$250	$__________
Kaleidoscope Camp 2	Grades 1-6	$250	$__________
Rainbow Arts Camp 1	Grades Pre-K & K (min. age 4 yrs.)	$250	$__________
Rainbow Arts Camp 2	Grades Pre-K & K (min. age 4 yrs.)	$250	$__________
	Registration Fee (due each calendar year)	$25	$__________
	Credit Card Fee	$12	$__________
	Would you like to donate $5 to the Kaleidoscope Scholarship Fund?	$5	$__________
	TOTAL ENCLOSED:		$__________

Credit Card: VISA  /  Mastercard

Name on Credit Card: ___________________________________________________________

Authorized Signature: ___________________________________________________________

Credit Card #: ______________________________________________________ Exp: ________________

PHOTO RELEASE: I grant permission to the Julia Morgan Center for the Arts to use photographs taken of me for use on the JMCA web site or other media without notifying me.

Signed: _______________________________________________________________