Art+Tech July 11-15: Digital Painting Art+Tech Week 2 Students will learn colour theory and digital painting techniques in order to create digital paintings of their own. Student DetailsStudent's Name(Required) First Last Student's Age(Required) This programme is geared towards children ages 11-14. If your child falls outside this age range, but you believe they would be a good fit for the programme, please contact education@bng.bm.Date of Birth(Required) MM slash DD slash YYYY Student's Gender(Required) Male Female Other Contact InformationParent/Guardian Name(Required) Dr.Mr.Mrs.Ms.MissMx. Prefix First Last Parent/Guardian Relationship to Child(Required) Parent/Guardian Phone(Required)Parent/Guardian Email(Required) Parent/Guardian 2 Name Dr.Mr.Mrs.Ms.MissMx. Prefix First Last Parent/Guardian 2 Relationship to Child Parent/Guardian 2 PhoneParent/Guardian 2 Email Emergency Contact Name(Required) Dr.Mr.Mrs.Ms.MissMx. Prefix First Last Emergency Contact Phone(Required)Emergency Contact Relationship to Child(Required) Health & SafetyMedical Conditions(Required) ADHD Allergies Autism Anxiety Disorder Asthma Diabetes Dysgraphia Dsylexia Heat Sensitivity Hearing Impairment Heart Conditions High Blood Pressure Low Blood Sugar Seizures Speech/Language Impediment Other None of the above Please select which of these medical conditions apply to your child.Please provide the relevant details of your child's medical condition:(Required) Does your child require medication?(Required) Yes No Will your child require medication during the summer camp session?(Required) Yes No If yes, please provide the relevant details of your child's medication.(Required) Please provide any additional details regarding your child's allergies.(Required) Does your child require an EpiPen?(Required) Yes No After Camp DismissalPlease provide details as to how your child will be released at the end of the day.(Required) My child will take public transportation and can be dismissed at the end of the day. My child will be picked up daily from camp. If your child will be picked up by someone other than yourself or the emergency contact, please provide their details below. Students will only be allowed to leave with someone other than the parent or emergency contact if given express permission.BNG Programme PoliciesBNG Camp Policies View / Download Camp PoliciesI acknowledge that by submitting this form I have read through, and agree to, the BNG Camp Policies.(Required) I agree.I acknowledge that in the event of cancellation, I will only receive a 50% refund.(Required) I agree.BNG COVID-19 Protocols View / Download COVID-19 ProtocolsI have read and agreed to the BNG COVID-19 Protocols and acknowledge that if I or my child do not conform with these policies, my child may be removed from the programme without a refund.(Required) I agree to the BNG Covid-19 policies.Confidential Demographic InformationDemographic information is required by our donors. All information will be kept anonymous.Bermudian Status(Required) Bermudian Non-Bermudian Other Race(Required) Black White Asian Biracial Prefer not to say Other Annual Household Income(Required) Below $30,000 $30,000-$60,0000 $60,000-$80,000 Above $80,000 Does your child attend private or public school?(Required) Private Public Other School(Required) Year Group(Required) Programme FeeProgramme Fee(Required) Members - $250 Non-members - $325 Non-membership pricing includes an annual BNG Family Membership.Programme Fee(Required) Members - $250 Non-members - $325 I am requesting a needs-based scholarship to assist in paying for this programme Non-membership pricing includes an annual BNG Family Membership.Needs Based Scholarship(Required) $50 Camp Fee Thanks to support from our donors, the BNG is able to offer a reduced camp fee of $50 to those with financial need. This pricing includes an annual BNG Family Membership. We will hold your spot pending review of your application, and then we will be back in touch.T-Shirt Size(Required)The BNG provides one t-shirt to every student who attends camp. T-shirts are required to be worn daily. Please indicate the size t-shirt required below.Adult XSAdult SAdult MAdult LAdult XLAdditional T-ShirtsAdditional t-shirts are available for purchase. If you would like to purchase extra, please indicate the quantity below. Price: $20.00 Quantity: Total. Credit Card(Required) MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name Billing Address(Required) Street Address Address Line 2 City Parish / Province / State ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Address(Required) Same as previous Street Address Address Line 2 City Parish / Province / State ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Security
