Summer Camp Registration for Members Before beginning the registration process, please review the Liability and Procedural Agreement by clicking here. If you have any questions, please call the NIC or email Michelle Miller at michelle@thenic.org. Parent/Guardian Name(s) *Email Address *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People’s Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabwePhone *Emergency Contact *In the case of an emergency we will contact parent/guardian first. Please list an alternate contact number in case we cannot reach them.Student NameAgeSummer Camp ChoicesOn the High Seas (7-12 years old)Creativity in Motion (7-12 years old)The Eras Camp (7-14 years old)Sunshine & Sparkles (7-14 years old)Level Up- Video Game Art (7-11 years old)Level Up- Video Game Art (11-15 years old)Student NameAgeSummer Camp ChoicesOn the High Seas (7-12 years old)Creativity in Motion (7-12 years old)The Eras Camp (7-14 years old)Sunshine & Sparkles (7-14 years old)Level Up- Video Game Art (7-11 years old)Level Up- Video Game Art (11-15 years old)Student NameAgeSummer Camp ChoicesOn the High Seas (7-12 years old)Creativity in Motion (7-12 years old)The Eras Camp (7-14 years old)Sunshine & Sparkles (7-14 years old)Level Up- Video Game Art (7-11 years old)Level Up- Video Game Art (11-15 years old)Student NameAgeSummer Camp ChoicesOn the High Seas (7-12 years old)Creativity in Motion (7-12 years old)The Eras Camp (7-14 years old)Sunshine & Sparkles (7-14 years old)Level Up- Video Game Art (7-11 years old)Level Up- Video Game Art (11-15 years old)If any of the students have medical needs, allergies or other special needs, please list details below:Total Camp FeeSignatureStart signing your signature hereYour browser does not support e-Signature field.I have read and agree to the Liability and Procedural Agreements (PDF Linked above this form). I hereby release, hold harmless, defend and indemnify The Nicolaysen Art Museum, from any and all damages, injuries and causes of action which may accrue to or be asserted by me or any minor child of mine arising directly or indirectly from my minor child’s participation in Summer Art Camp at The Nicolaysen Art Museum.I give the Nic permission to release my child to the following people:Please list this person(s) Full Name, Phone Number, and Relationship to the student.I give the Nic permission to release my child (11+ only) to leave camp on his/her own.YesNoPermission for Student (11+) to leave camp on his/her own.Start signing your signature hereYour browser does not support e-Signature field.Liability and Procedural Agreements- By clicking yes you are agreeing to our Liability & Procedural Agreements (above). *Yes, I have read and understand them.No, need to discuss. Send Message