Student Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Phone *

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Permission for Involvement *

I, (parent/ guardian name printed), give permission for my child to be involved with The REES Summer Camp.

Yes

No

Program Selection *

My child will be attending:

July 8-12

July 15-19

Both

Name of Doctor *

First Name

Last Name

Doctor Phone *

(###)

###

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Program Authorization *

I, the undersigned, hereby declare and affirm that: I am the parent/legal guardian of the youth named above (hereinafter referred to as "Child"), who is under my care and responsibility. I hereby consent and give authority to the participation of my Child in the scheduled youth activities of The REES Summer Camp (“Camp”), and all other activities which are supervised and customarily associated with the Camp. I hereby declare and affirm that my Child is physically fit to take part in the Camp's activities and my Child has no known illness or adverse medical condition that would render him/her unfit to participate therein, other than the information specified in the medical information above. I shall immediately advise the organizers in writing, should I discover any illness, adverse medical condition, or any other physical defect that would render my Child unfit to participate in any of the activities of the Camp. I agree to indemnify and hold harmless The REES Theater INC. and its agents, employees and volunteers for any and all liability, loss, damage or expense sustained in connection with my child’s participation in the activities and performances of the Camp.

Yes, I authorize

No, I do not authorize

Medical Authorization *

Authorization for Medical Treatment I understand that in case of medical emergencies involving my Child, I shall be notified immediately. In case any of my provided contact information is unreachable, I authorize the organization to call the doctor indicated above. In case that the doctor is not available, I authorize the organizers to call any doctor to provide the necessary medical attention to my child. I understand that the camp shall not be responsible, and shall be reimbursed, for any medical expenses incurred by them over this authorization.

Yes, I authorize

No, I do not authorize

Parent Signature Name *

First Name

Last Name

Parent Phone *

(###)

###

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Photo Release *

I authorize The REES Theatre to use any photo or recording of my Child taken during the Camp and related performances for promotional purposes without compensation to my Child or me. Such use may include publication on social media, news media, and other promotional materials such as fliers or playbills.

I DO NOT authorize The REES Theatre to use any photo or recording of my Child taken during the Camp or related performances for promotional purposes without compensation to my Child or me.

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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