Northwest Summer MUSIC CAMP Registration

For use by counselors when at camp.
example: Powell Middle School
Numbers only

CLASS SELECTION

Please select the main group that you will attend, and then select your first, second, and third choice for the classes you would like to take during the "elective" hours (11 AM, 2 PM, and 4 PM).

Parent/ Guardian Information

Default will be Parent/Guardian if this section is left blank.

Emergency Divider

Informed Consent and Acknowledgement

I, the undersigned, hereby authorize Yellowstone Summer Music Camp officials to act for me according to their judgement in any emergency requiring medical attention for the student named above, if camp officials are unable to contact me. He/She also has my permission to participate in all camp activities. I give my consent for administration of cough drops, Ibuprofen or Tylenol, and Tums as needed.

I grant to Northwest College (photographer) and its legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs/videos of the minor names above, or in which the minor may be included, for editorial, tradee, advertising and any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. I release Northwest College (photographer) and its legal representatives and assigns from all claims and liability relating to said photographs/videos.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.