Designer Camp STUDENT

INFORMATION & release Form

Registered for the the following camps:

OC Designer Camp: July 8 - 12, 2024

LA Designer Camp: July 15 - 19, 2024

STUDENT CONTACT INFORMATION

Student Name

First Name

Last Name

Student Phone

Country

(###)

###

####

Student Email

Student Date of Birth

YYYY

Student Gender

Student Primary Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's school & grade next school year:

PARENT / GUARDIAN CONTACT INFORMATION

Parent / Guardian 1 Name

First Name

Last Name

Parent / Guardian 1 Phone

(###)

###

####

Parent / Guardian 1 Email

Parent / Guardian 2 Name

First Name

Last Name

Parent / Guardian 2 Phone

(###)

###

####

Parent / Guardian 2 Email

How did you hear about Designer Camp?

Other

Is your student a returning camper?

Does your student have any friends attending camp this year? If so, please list.

Name(s) of person(s) authorized to pick up student from camp. Please provide relation and phone:

EMERGENCY INFORMATION

Emergency Contact Name :

First Name

Last Name

Emergency Contact Phone:

(###)

###

####

Emergency Contact Relation:

STUDENT HEALTH

Does you child have any food allergies or special preferences?

Please describe medical conditions, medications, allergies, or any other special needs our staff needs to know about:

Health Insurance?

Yes

Name of Insurance Provider:

Subscriber Name:

First Name

Last Name

Subscriber ID#

Student's Doctor:

First Name

Last Name

Student's Doctor Phone:

(###)

###

####

I have read this Parent/Guardian Agreement & Release Form. I understand and agree to the Terms and Conditions as stated below. By typing my name below I agree voluntarily and with full knowledge of its significance.

First Name

Last Name

PARENT PERMISSION AND RELEASE FORM

I. TERMS & CONDITIONS:

I understand that as part of the Designer Camp program, campers will participate in events both in and out of the Designer Camp Studio.
I understand that my camper will go on walking tours around the camp location, visiting different retail stores, restaurants, showrooms and outdoor venues. On these tours, campers will be escorted and chaperoned by Designer Camp directors and staff. Students must wear their Designer Camp lanyards at all time, and follow the rules of the tour.
I understand that all campers going on these walking tours shall be deemed to have waived all claims against Designer Camp for injury, accident, illness or death occurring for any reason of the on or off site camp activities and tours.
This notice also absolves Designer Camp and staff 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 to photograph my child’s creative work for promotional purposes. I expressly grant a free license now or in the future for Designer Camp, it’s industry partnerships, and affiliates to use my child’s work or other projects she/he creates while attending Designer Camp workshops.
I understand and will direct my child to cooperate with the instructions and conduct requested by Designer Camp.
I understand that my child will be picked up by 3pm each day. I understand that Designer Camp accepts no responsibility for my child after 3:00pm each day.
I understand that all fees are non-refundable. No refunds or make-ups will be offered for days absent from camp.
Lunch 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 to transport my child to a hospital or medical facility for the purpose of medical treatment.
Designer Camp 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.