Student Information

First Name:		Last Name:
Address:		City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	ZIP:
Student DOB:		Gender	M F
Home Phone:		Cell Phone:

What is your child's t-shirt size?	X-Small Small Medium Large X-Large XX-Large
What school district does your child live in? (if Other, please tell us your district)	Dayton Public School District Residents Other
May Stivers School for the Arts please have permission to use your child's work and/or your child's image in future publications, presentations or websites?	Yes No

Parent/Guardian Information

First Name:		Last Name:
Address:		City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	ZIP:
Day phone:		Cell Phone:
Email Addr:

PROGRAM DATES	DEADLINES	CANCELLATION/REFUNDS
Monday, June 11th Check in begins 8:15 am. Please bring appropriate information to assist you in completing emergency medical form and student data form. Friday, June 22nd Students will have work space cleaned and will need to be picked up no later than 2:30am.	Friday, June 8th Completed registration form and full payment of all tuition fees are due.	Please note that cancellations must be in writing. Individuals wishing to cancel may send a letter by postal service to Stivers School for the Arts c/o Summer Arts Program 1313 East Fifth Street Dayton, Ohio 45402 or send email to daytonsummerarts@gmail.com. All correspondence must be received no later than 5pm June 8, 2012. No refunds will be made after Friday,June 8, 2012

TUITION The tuition for this two week summer program is based upon the school district where the student lives. Dayton Public School District Residents $150 (per half day session) $200 (per full day session) $225 (two half day sessions in two different areas) NON-Dayton Public School District Residents $225 (per half day session) $250 (per full day session) $325 (two half day sessions in two different areas) Some programs will have additional material fees. They are noted with each course description for which they apply.

Morning Session 9am - 11:30am

Young Writers Club	Fiddling Around the World	Beginning Painting and Drawing
Children in Musical Theatre/Opera	Beginning Dance (FULL!)	Completely Clay
Design It!	Piano	Stories in Motion
Jazz Collective I	Creative Writing	Painting: A New Perspective
Forming the Tree	Bending Light I	Bending Light II
Romancing the Metal	Recording and Music Engineering	Cityfolk Culture Builds
None

Afternoon Session Noon - 2:30pm

Beginning Painting and Drawing	Completely Clay	Design It!
Piano	Poetry Circle	Crossover Strings
Jazz Collective II	Drawing: Serious Play	Forming the Tree
Bending Light I	Bending Light II	Romancing the Metal
Children in Musical Theatre/Opera	Stories in Motion	Cityfolk Culture Builds
None

All Day Session 9am - 2:30pm

Reader's Theater Workshop

Advanced Dance (FULL!)

None