Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1234Camper's Name *FirstLastCamper's Email Address *Address *City *State *Zip Code * List Parent/Guardian’s Card Parent's Email Address *Parent's Home Phone *School Name *Age *Gender IdentityMaleFemaleNon-BinaryPrefer to self describeTrack *Drum Major (DM)Field Tech (FT)Color Guard (CG)Collegiate (COLL)T-Shirt Size SMLXLXXLDietary RestrictionsGluten IntoleranceVegetarianVeganOtherIf "Other," please describe:NextMEDICAL RELEASE FORM & LIABILITY WAIVER Please complete the fields below. Each camper must have this form on file with the camp director. MEDICAL RELEASE STATEMENT: I hereby authorize the camp officials to have my son or daughter or myself treated by local medical personnel for any medical problems which may arise white attending any Alan Keown, Scott Reese or Scott Reese Leadership Summer Camp. I also authorize the appropriate medical personnel to admit my son or daughter or myself to the local hospital. PARENT OR GUARDIAN SIGNATURE or CAMPER SIGNATURE (IF OVER 18) * Clear Signature Date *Name of person attending camp: *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome Phone *Insurance Carrier *Work Phone *Group Number: *Medical conditions or allergies:List any medications:LIABILITY WAIVER I agree to hold Scott Reese and Camp Serene free from any liability for any injury, accident, or property loss of any kind while my son or daughter or I am in attendance at Scott Reese Leadership Camp. I give permission to have my son/daughter treated medically. PARENT OR GUARDIAN SIGNATURE or CAMPER SIGNATURE (IF OVER 18) * Clear Signature Date *NextScott Reese Leadership Camp Photo Release I hereby grant Scott Reese Leadership Camp permission to use my likeness in a photograph, video, or other media in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of the Scott Reese Leadership Camp. I hereby authorize the Scott Reese Leadership Camp to edit, alter, copy, exhibit, publish or distribute any photos, video, or other media obtained during the week of camp for purposes of publicizing theScott Reese Leadership Camp’s programs. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release. Signature * Clear Signature Printed Name *Date *If the person signing is under age 18, there must be consent by a parent or guardian, as follows: I hereby certify that I am the parent or legal guardian of the camper above, and do hereby give my consent without reservation to the foregoing on behalf of this person. Parent/Guardian’s Signature Clear Signature Parent/Guardian’s Printed Name (copy)Date (copy)NextCamp Rules & Regulations Below are the general rules and policies of the camp. Violation of these may result in expulsion from camp and forfeiture of all tuition and fees. Please read carefully and sign to signify your acceptance of these rules. The parent/guardian and camper should sign if the camper is under 18, just the camper is required to sign if over 18. Observe nightly curfew (11:00 pm). Respect the sleep, study, and privacy of others. Campers must attend all rehearsals, performances, and scheduled events unless cleared by a counselor. Maintain a good, cooperative, and constructive attitude at all times. Do not tamper with firefighting equipment or engage in behavior that constitutes a fire hazard. Observe the noise curfew. (10 pm-8 am). No disorderly conduct. This includes pranks No possession or consumption of alcoholic beverages, illegal drugs, tobacco, vapes, or weapons. No damaging or theft of other’s belongings or camp property No indecent or unacceptable conduct. Campers are expected to demonstrate modesty and respect, especially in cabins, tents, and shower rooms, as well as the entirety of the camp. No abuse or improper conduct toward others. This includes bullying and hazing. No unauthorized use of personal vehicles. No unauthorized swimming. The Scott Reese Leadership Camp will not tolerate discrimination on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, disability, age, or genetic information (including family medical history). Any incidents should be reported to a counselor immediately. We have read these rules, fully understand them, and agree not to violate any of them while at any camp administered by Scott Reese. Parent or Guardian Signature if the camper is under 18. Signature Clear Signature Camper or Parent/Guardian’s Printed NameCamp Registration Fees *Price: $650.00DateScholarship or Discount Code Apply Pay by Credit Card *Submit Registation
