Designer Camp Parent / gUARDIAN Permission and Release Form 2018

 

Dear Parent or Guardian,

To finalize your child’s registration, please complete the form below.

By digitally signing, you acknowledge the Terms & Conditions and Authorization for Medical Care. 


Child's Name *
Child's Name
Registered for the the following camp: *
Child's Address *
Child's Address
Child's Date of Birth *
Child's Date of Birth
Child's Cell Phone (if available)
Child's Cell Phone (if available)
Parent 1 Name *
Parent 1 Name
Parent 1 Cell Phone *
Parent 1 Cell Phone
Parent 1 Address *
Parent 1 Address
Parent 2 Name
Parent 2 Name
Parent 2 Cell Phone
Parent 2 Cell Phone
Parent 2 Address
Parent 2 Address
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Health Insurance
Health Insurance? *
Subscriber Name
Subscriber Name
Child's Doctor Phone
Child's Doctor Phone
I have read this Parent/Guardian Agreement & Release Form. I understand and agree to the Terms and Conditions as stated above. By typing my name below I agree voluntarily and with full knowledge of its significance. *
I have read this Parent/Guardian Agreement & Release Form. I understand and agree to the Terms and Conditions as stated above. By typing my name below I agree voluntarily and with full knowledge of its significance.
Date *
Date

I. TERMS & CONDITIONS:

  • I understand that as part of the Designer Camp program at the Leica Store Los Angeles, campers will participate in events both in and out of the Designer Camp Studio.

  • I understand that my camper will go on walking tours, visiting different retail stores, restaurants, showrooms and outdoor venues. On these tours, campers will be escorted and chaperoned by Designer Camp Directors and staff. They must wear their Designer Camp lanyards at all times and follow the rules of the tour.

  • I understand that all campers going on these walking tours shall be deemed to have waived any and all claims against Designer Camp and Leica Camera Inc., their subsidiaries, affiliates, owners, officers, employees, contractors, agents and tour operators, for injury, accident, illness or death occurring for any reason. 

  • This notice also absolves Designer Camp and Leica Camera Inc., their subsidiaries, affiliates, owners, officers, employees, contractors, agents, staff and tour operators of blame or responsibility for any injury my child may incur while participating in class or tour functions.

  • I further agree to allow my child to be used in any promotional photographs, video, and I agree that all written & produced materials are the property of Designer Camp.

  • I agree to allow Designer Camp and/or Leica Camera Inc. to publicize my child’s creative work for promotional purposes. I hereby grant a free irrevocable license now and in the future for Designer Camp and Leica Camera Inc., its subsidiaries, industry partnerships and affiliates to use my child's works or other projects she/he creates while attending Designer Camp workshops.

  • I understand and will direct my child to fully cooperate with the instructions and conduct requested by Designer Camp and/or Leica Akademie.  I hereby agree to indemnify and hold Designer Camp and Leica Camera Inc., their subsidiaries, affiliates, owners, officers, employees, contractors, agents and tour operators, harmless from any and all claims (including reasonable legal fees) that may be brought against Designer Camp and/or Leica as a result of my or my child's actions causing injury to others during the course of the Photography Camp.

  • I understand that my child will be picked up by 3pm each day. I understand that Designer Camp and Leica Akademie do not accept responsibility for my child after 3:00 pm each day.

  • I understand that all fees are non-refundable. No refunds or make-ups will be offered for days absent from camp.

  • Lunch and snacks will be provided by Designer Camp each day of camp. I understand that my child is responsible for bringing their own food if they have special food preferences outside of the Designer Camp food selection. Please note that vegetarian food options will be included.

  • In the event that my child will not be attending Designer Camp due to illness or absence for personal reasons, it is my responsibility to inform the Designer Camp Directors via phone call or text.


Please Note: If your child’s behavior is deemed disruptive to the daily activities or to the other campers, Designer Camp will notify you immediately. If the disruption continues, Designer Camp will give you a second notice, at which at this point Designer Camp reserves the right to terminate your contract/attendance without a refund. The purpose of this policy is to ensure that the camp experience is comfortable and encouraging for all of the campers in attendance. 

II.  AUTHORIZATION FOR MEDICAL CARE

  • In the event that my child should need medical care, I hereby authorize Designer Camp Staff to transport my child to a hospital or medical facility for the purpose of medical treatment.

  • Designer Camp and Leica Camera assumes no responsibility for medical care administered to my child during or after the hours of the Designer Camp program.

  • I understand that I give Designer Camp permission and authorization for medical treatment and hospital care, which is deemed advisable by and is to be rendered under the general or special supervision of any physician or surgeon led under the best judgment may deem advisable.

  • I am aware of the possible dangers and injuries that may arise during my child’s participation in the Designer Camps workshops and tours. I hereby affirm that my child is in good physical condition and does not suffer from any disabilities that would limit or prevent their participation in this program.