Summer Camp Release – Face Academy of Music

Face Academy’s A capella

Summer Camp 2021

Information, Medical, and Video/Image Release

Please read the form carefully, input all required information,

and enter your name as a digital signature.

Must be submitted no later than 2 weeks prior to the start of camp!

Hello everyone!

We are excited to have an opportunity to be able to offer our 2021 Colorado A Cappella Summer Camp! We continue keeping a close eye on the government’s directives and we are excited to be able to offer our A cappella Summer Camp in a format that offers as much safety as we are able to provide for all of our campers!

Parents/guardians or participants over the age of 18, please fill out the information and release forms below. Once these are completed, you should be all set. We can’t wait to see you soon!

Thanks so much,

Cody, Stephen, Mark, Diana and Face Vocal Band

PARTICIPANT INFORMATION

PARTICIPANT Name *

First

Last

Gender *

Male
Female

PARTICIPANT Birthdate *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

PARENT/GUARDIAN & EMERGENCY CONTACT

PARENT/GUARDIAN Name *

First

Last

PARENT/GUARDIAN PHONE: Best Phone to reach you if needed (cell preferred) *

PARENT/GUARDIAN Email *

EMERGENCY CONTACT Name (If parent cannot be reached) *

First

Last

EMERGENCY CONTACT PHONE: To be used if Parent cannot be contacted (cell preferred) *

MEDICAL HISTORY

MEDICAL HISTORY (Check all that apply) *

None
ADHD
Asthma or other Breathing Disorder
Bleeding/clotting disorder
Convulsions/Seizures
Diabetes
Hearing problem
Heart defect/disease
Hypertension
Wears glasses/contact lenses
Other

Please provide any additional information related to medical history necessary

Restrictions or special needs related to PHYSICAL ACTIVITY? If none, please enter n/a. *

NOTE: We will not be providing any food or snacks. if your child needs food/snacks during their time at camp, they will need to bring their own.

Allergies? If none, please enter n/a. *

NOTE: If your child requires medication to manage allergies, please ensure that your child's medications are brought to camp each day.

Current Medications? If none, please enter n/a. *

NOTE: If any medications are or could be required during their time at camp, please ensure your child has their medication with them.

ADDITIONAL INFO. If none, please enter n/a. *

MEDICAL CONTACT

Physician/Caregiver Name *

First

Last

Physician/Caregiver Phone *

Family Medical Insurance Carrier *

Policy or Group Number *

PHOTO RELEASE: Please read the following very carefully, and enter your name in the box below as your e-signature.

PHOTO RELEASE: I give permission to Face Academy of Music to use any photographs, videotape, recording, or other media record of my/my child's participation in Face Academy of music programs for any lawful purpose without compensation. Entering my legal name in the box below constitutes my valid e-signature release and authorization. *

WAIVER OF LIABILITY: Relating to Coronavirus/COVID-19. Please read the following, check the box, and enter your legal name as your e-signature.

Face Academy of Music (FAM) and its assigns cannot prevent you or your child(ren) from becoming exposed to, contracting, or spreading COVID-19 while utilizing FAM’s services or premises in which programs are held. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize FAM’s services and/or enter onto premises where FAM programs are held, you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. *

ASSUMPTION OF RISK: I have read and understood the above warning and associated risks of participation concerning COVID-19 and I hereby forever release and waive my right to bring suit against FAM and its assigns in connection with exposure, infection, and/or spread of COVID-19 and knowingly assume the risks. I waive my rights concerning liability as described. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.

COVID-19 Release and Waiver: Entering my legal name in the box below constitutes my valid e-signature of liability release and waiver. *

LIABILITY RELEASE: Please read the following very carefully, and enter your name in the box below as your e-signature.

LIABILITY RELEASE: I am the parent or legal guardian of the participant, or I am the participant over the age of 18 years of age. I agree to indemnify and hold harmless Face Academy of Music, its officers, employees, agents, consultants, subcontractors, insurers, and representatives (collectively Face Academy of Music), for any loss, damage, or injury to myself or my property in any way related to my participation in Face Academy of Music 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 Face Academy of Music in a medical emergency to seek emergency medical assistance at my expense. By entering my legal name in the box below, I attest that the above information entered is true and correct, and entering my name in the box below constitutes my valid e-signature release and authorization. *

Date of form completion and all e-Signatures *

Comment

Thank you for participating in our A cappella Summer Camp with Face Academy of Music!