Integral Connections||A Music & Arts Camp for Parents & Children

Integral Steps presents:
Integral Connections:
||Community, Connections & Compassion||
A Music & Arts Camp for Parents & Children
• August 4-8, 2014 • 1:00-4:00 pm • Ages 5-9 •
• Dana V. Music • 901 Front Street • Suite B150 • Louisville, CO •

Begin your school year in balance!
Parents and children will deepen their tools of self-regulation, discipline, listening skills, and age appropriate developmental tasks, through the joy of music, movement, and creative arts. Through understanding the needs of children and families from psychological and brain development perspectives, this camp will provide a stimulating atmosphere for creative learning, helping children and parents to have meaningful intellectual, emotional and physical experiences that support their growth.

Emma Shubin, music & movement
Monica Kovach, creative arts & art therapy
Alejandra Hudon, early childhood specialist & family therapist

***Early-bird discounts available until July 15th!***

Please fill out the form below as completely as possible. If you prefer, you can download a registration form and mail it to:
Emma Shubin, contact for address
Please direct all questions to Emma Shubin, emma.shubin@gmail.com, (585) 704-5751

Parent/Guardian Name *

First

Last

Email *

Today's Date *

Student Name *

First

Last

Sex *

Male Female

Birth Date *

Sibling Name *

First

Last

Sibling Sex *

Male Female

Sibling Birth Date *

Cell Phone *

Home Phone *

Work Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact *

Relation *

Emergency Contact Phone Number *

How did you hear about us? *

(Please specify) *

LIABILITY RELEASE -- PLEASE READ CAREFULLY

I agree to indemnify and hold harmless Integral Steps its officers, employees, agents, consultants, subcontractors, insurers and
representatives (collectively Integral Steps), for any loss, damage, or injury to myself or my property in any way related to my
participation in Emma Shubin Music’s programs. This release of Liability applies to me as well as any of my children, personal
representatives, assigns, heirs, and next of kin. I authorize Integral Steps in a medical emergency to seek
emergency medical assistance at my expense.

Digital Signature of Participant (parent or guardian) *

Date *

I give permission to Integral Steps to use any photographs, videotape, or other media record of my
participation in Integral Steps for any lawful purpose, without compensation.

Digital Signature of Participant (parent or guardian) *

Date *

*Information provided here is for Integral Steps use only. We do not share information with outside sources.

PAYMENT INFORMATION

Course Information
Dates: August 4-8, 2014 (M-F)
Ages: 5-9
Time: 1:00-4:00 PM
Location: Dana V. Music
901 Front Street, Suite B150
Louisville, CO 80027
Cost: Cost:
Early-bird discounts listed below (available until April 15th!):
Registration Hold: $50 (balance due the first day of camp)

Single: $210
Sibling Discount (2 children): $380

Method of Payment *

Check (made out to Integral Steps) Online (follow instructions after submitting this form)

Select Scholarships are available. Please write a statement outlining your need, benefit you feel this course will bring to your child, and submit this with your registration form.

Scholarship Statement (optional) *

Submit

Integral Steps presents: Integral Connections:||Community, Connections & Compassion||A Music & Arts Camp for Parents & Children• August 4-8, 2014 • 1:00-4:00 pm • Ages 5-9 •• Dana V. Music • 901 Front Street • Suite B150 • Louisville, CO •

Emma Shubin, music & movementMonica Kovach, creative arts & art therapyAlejandra Hudon, early childhood specialist & family therapist

Integral Steps presents:
Integral Connections:
||Community, Connections & Compassion||
A Music & Arts Camp for Parents & Children
• August 4-8, 2014 • 1:00-4:00 pm • Ages 5-9 •
• Dana V. Music • 901 Front Street • Suite B150 • Louisville, CO •

Emma Shubin, music & movement
Monica Kovach, creative arts & art therapy
Alejandra Hudon, early childhood specialist & family therapist