Art Student Application

Art Camp Student Application 2025

Art Welcome Package

Student Details

Student’s First Name

Student’s Last Name

Student’s Date of Birth

Parent/Guardian Contact Information

Parent's First Name

Parent's Last Name

Parent's Email Address

Parent's Mobile Phone Number

Home Address

Address Line

City

State

Zip Code

Are you receiving SNAP benefits?

Yes

Please provide a most recent (2025) copy of your SNAP card with the award letter from your respective county.

Upload File

Parent or Guardian Photo/Video Recording Consent and Waiver Agreement

Consent

I give permission for my above-named child to participate in the 2024/2025 Hearts of Mercy Tutoring Program.

PHOTO AND MEDIA RELEASE

I grant Hearts of Mercy my permission to photograph, videotape, and/or audiotape my child during activities at H.O.M. These photographs/videos/audios will remain the property of Hearts of Mercy and may be used in advertising or marketing campaigns on Hearts of Mercy’s websites, and for promotional and informational material including, but not limited to, flyers, brochures, newsletters, emails, advertisements, & newspaper articles. I understand my child will not be identified by name unless I give my express permission. I hereby waive and release on behalf of my child any right to compensation for, or ownership of, such images and/or sounds. I have read and agree to the terms and conditions of this Photo, Media and Copyright release

Photo and Media Release Consent

Permission Granted

Enrollment Information

Enrollment Fee

Price Per Student: $25.00

Suggested Weekly Donation

Donation: $100.00

No payment items has been selected yet

Payment Method

Pay with Card (Stripe)

Pay by Check

If you are paying by Check, please drop off or mail your check to

Hearts of Mercy
364 N Main St. Suite 1
Manahawkin, NJ, 08050

Your enrollment is not finalized until your check is received and successfully deposited.

Signature of Parent/Legal Guardian

Sign Here