RCS Art Camp Registration Form

Student Namerequired

First Name

Last Name

Student's Date of Birthrequired

Must contain a date in MM/DD/YYYY format

Grade (Sept 2026)required

Sex (M or F)required

Street Address, Town, State, Ziprequired

Program for which you are registering forrequiredCheck all dates you are registering for.

Summer Art Camp - Week 1 (06/22-06/26/26) - $250/student

Summer Art Camp - Week 2 (06/29-07/03/26) - $250/student

Summer Art Camp - Week 3 (07/06-07/10/26) - $250/student

Check all dates you are registering for.

Please list any special accommodations needed for your child to be successful in our program.

Payment MethodrequiredMail/Drop Off Cash or Checks to Roxbury Community School at 34 N Hillside Ave, Succasunna, NJ 07876

Exact Cash

Check/Money Order - Made Out to Roxbury Community School

Credit Card

Mail/Drop Off Cash or Checks to Roxbury Community School at 34 N Hillside Ave, Succasunna, NJ 07876

Parent/Guardian Information

This information will be used in case of an emergency and for confirmation/update information.

Parent/Guardian Namerequired

First Name

Last Name

Parent/Guardian Email Addressrequired

Parent/Guardian Phone (Primary)required

Parent/Guardian Phone (Secondary)

Parent/Guardian Street Address, Town, State, Ziprequired

Departure Permission:

Is there anyone other than you authorized to pick up your child? Please name them (First & Last Name) below so the instructors can check their IDs upon pickup. We will not release your child to anyone who is not listed here. For this reason, be sure to list yourself and any other parent/guardian to whom your child can be released.

Instructors do not have access to Genesis to pull up your authorized list in that program.

Please check the following box regarding dismissalrequired

My child will be picked up (next question requires authorization list)

My child has permission to walk home (for Grades 5+ only)

Departure Permissionrequired

List all authorized individuals. If your child can walk home (Gr 5+ only) , write N/A.

Disclaimers & Policies:

MEDICAL DISCLAIMER:
For participants needing to self-administer medication, please send in a doctor's note to the Community School. The only medication that can be self-administered are an EPI Pen and/or an inhaler. A school nurse will not be present during this program. In case of an emergency, students will be transported to the nearest medical facility and parents will be contacted. Students and parents agree to abide by all Roxbury School District regulations. The Roxbury Township Board of Education, the Roxbury Community School, and the instructors assumes no liability.

BEHAVIOR ISSUES:
Roxbury Community School reserves the right to dismiss a child from camp because of behavioral issues. No refunds will be issued.

RECEIPTS/REFUNDS:
Confirmations will be sent via email only. There are no refunds once the program begins. Cancellations must be received in writing at least one week prior to the start of camp. There will be no refunds for cancellations after that date. There is a $35 service charge for returned checks. Participation in Community School activities is at your own risk. The Roxbury Township Board of Education, the Roxbury Community School, and this program instructor assumes no liability. To read the full Roxbury Community School policy, please visit www.roxbury.org/RCSpolicies.

COVID-19 DISCLAIMER:
Programs will run as health conditions allow. Parents/Guardians will need to complete Health Screening forms for each child stating the child is not experiencing any COVID-19 related symptoms each day of the program. Participants will need to follow district guidelines in regards to social distancing and masking while on premises.

Disclaimers & Policies Sign Offrequired

I understand and agree to the disclaimers and policies listed above.

Media ConsentrequiredPictures & videos are taken for use in local media and district publications for RCS Programs.

Yes, my child can be photographed

No, my child cannot be photographed

Pictures & videos are taken for use in local media and district publications for RCS Programs.

Would you like to be added to the Roxbury Community School email contact list announcing different programs and trips?

Yes

RCS Art Camp Registration Form - Summer 2026