Art Camp 2015 Registration Form

Elena and Boris Kuznetsov 

9-10 Saddle River Rd, Fair Lawn, NJ 07410

914-772-6919/ 845-323-1960/ 201-5005-ART(500-5278)


June 29th– August 28th 2015



Thank you for your interest in attending our Art Summer Camp!

We are offering a week of diving into professional Art studio filled with friendly, informal relationship and atmosphere for children age 6-13

It’s really important to us that children who come to our camp feel that they are joining an artistic family for a week and can be a part of ongoing unique process of creativity, which will be in their memory for a whole life.

We will go through the day with different artistic activities which may include drawing, painting, clay sculpting, studying art history, doing plein air work and more! Weather permitting, outdoor recreational activities will be included!



Summer Camp costs $450 a Week, extended hours from 7am till 7pm are $140. If you just need afterhours or mornings, not a complete week- please contact us for prorated tuition. Livingston ( Do-Re-Mi Location) tuition is $425, not including the lunches.

Tuition includes food and art supplies/ materials. Siblings and multi week discounts available upon request.

The payment should be made through paypal to email: or by check made out to Boris Kuznetsov and mailed to 33 johnsontown rd, Sloatsburg, NY 10974 



Name of Student: _____________________________________

Date of Birth: _____________  Age (at the time of Camp): ______

Name you prefer to be called (if different): ____________________

Name of School: ____________________________________           Grade: _______

Name of Parent/Guardian/Primary Contact: ______________________________________________________________

Name of Parent/ Secondary Contact: ______________________________________________________________

Mailing Address: ________________________________________________________________

City: ______________________________ State: _______________________ Zip Code: ________________________

Home Phone: _______________________ Cell Phone: _____________________ Work Phone_____________________

Email address you check frequently:______________________________________________________

Facebook name if you use it, please :______________________________________

Best way to contact you? ( circle, please)

Home Phone                                Cell Phone                            Email

  1. EMERGENCY CONTACTS (please provide two additional people, different from the parent/guardian listed above, who would automatically be the first person we contact)

First Contact’s Name: ______________________________________ Relationship: __________________________

Home Phone: _____ – ______ – ______ Work/Cell Phone: _____ -______ – ______ ext ______

Second Contact’s Name: ____________________________________ Relationship: __________________________

Home Phone: _____ – ______ – _______               Work/Cell Phone: _____ -______ – ______ ext ______

  1. SAFETY INFORMATION (please list all known conditions so we can accommodate your camper’s needs)

Does your camper have any medical conditions, allergies, or special needs the staff should know about?


Does your camper have any behavioral or emotional issues the staff should know about?

Is your camper taking any medications to treat these conditions?

Other information you think we should know


Refund and Cancellation: For cancellations prior to June 1, a refund minus $200 non-refundable

Deposit will be issued. For cancellation after June 1, the total fee is forfeited. In the event that your child enrolls in camp and withdraws because of homesickness or is asked to leave because of misconduct, there will be no refund, but we may offer a different session in case we have space free of charge.

Camper Dismissal: A camper whose behavior is disruptive to the camp program or harmful to himself/herself, others, or the property of camp or others, will be dismissed at the discretion of Camp Owners, with no refund of fee.


We, the undersigned parents (or guardians) of the camper named on this application, acknowledge that we are fully aware that certain elements of danger are inherent in the activities sponsored by Art Studio 5005, which are beyond the control of the agents, the land owners and employees of Art Studio 5005, and that participation in any program activities may entail unavoidable risk of personal injury, death, and loss of or damage to property. We are aware of the types of activities in which the child will be participating during his/her stay and have been given ample opportunity to ask any questions which we may have about the environment the child will live and the activities that he or she will participate in. We are aware of the dangers that are inherent in the operation of any child’s camp and in the child’s participation in all camp activities on or off premises of said camp including, but not limited to, hiking, athletics, including bodily contact, use of tools and equipment, backpacking, swimming, outdoor-living skills, and vehicular travel.

We grant permission to use any photograph or video for promotional use, knowing it will be done in good taste.

We have read and understand the terms and conditions of this Agreement/Waiver and we agree to subscribe to them.


Parent/Guardian Name_____________________________________ Date: _______________

(if only one signature, consent is implied from other parent)


I verify that all the information I have provided in this document is true to the best of my knowledge.



Your signature


Camp is Monday-Friday, 9:00-3:00, with a possible after-hours at All Bright Summer camp for an additional fee. Camp provides all the necessary instruments, equipment, and teachers 🙂 , as well as a snack and a hot lunch. Campers may bring lunch box just in case.

You should also have a change of comfortable summer wear, clothing suitable for art and messy paints (an old tee is perfect!), shorts, swim wear, sun block, hats as we will be outdoors a lot. We won’t over-use AC- it won’t be cold! Please do not bring mp3 devices, players, notebooks, game-boys and other electronics…including the cell phones.

About Art Studio 5005

Art Studio 5005- offers studio art classes and workshops in NJ/NY/CT area for children, teens & adults of all levels, taught by Lena Kruchkova and Borya Kuznetsov -experienced art educators who are also professional artists. In the Blog you can find our schedules and locations and also you can see our students recent art works / video presentations. To sign up for a class please call us @ 914-772-6919 or 201-5005-ART (5005-278) Our email We will be glad to receive comments and reviews.
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