LEVEL UP REGISTRATION
WHEN: July 30, 2019 from 9:00am - 4:00pm
WHERE: CAMP AGAWAM 1301 Clarkston Rd, Lake Orion, MI 48362
CONTACT: noccmi@noccmi.org
Email address *
LEVEL UP DAY CAMP REGISTRATION
Level Up Camp is for students entering 6th-9th grades. Students will have activities and discussions that will strengthen their decision making skills as they prepare to "level up" to a new grade at school. They will also have the opportunity to create a PSA for our community with ONTV! Registration is FREE and includes lunch, t-shirt and more!
Student's Name *
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2019-2020 School Grade *
Required
Parent/Guardian's Name *
Your answer
Address *
Your answer
Emergency Contact & Phone *
Your answer
Dietary Restrictions *
Allergies/Special Concerns/Health Needs
Your answer
LEVEL UP CAMP WAIVER (Please read and sign below)
By signing this form, I, as parent/guardian, permit the North Oakland Community Coalition and ONTV to use video and pictures of my child as a program participant in promotional literature, videos, website, and any ONTV broadcasts. I understand my child’s name will not be published.

I, as parent/guardian, hereby assume all risks and hazards incidental to the conduct of the activities at NOCC Level Up Camp. My child is fit for the program(s) in which I have enrolled him/her.

I ACKNOWLEDGE THAT, BY SIGNING THIS DOCUMENT, I AM RELEASING NOCC, CAMP AGAWAM, ONTV, AND THEIR REPRESENTATIVES, AGENTS, EMPLOYEES, VOLUNTEERS, MEMBERS, SPONSORS, PROMOTERS, AND AFFILIATES (COLLECTIVELY “RELEASEES”) FROM LIABILITY. I HAVE READ THIS RELEASE CAREFULLY BEFORE SIGNING. I UNDERSTAND WHAT THIS RELEASE MEANS AND WHAT I AM AGREEING TO BY SIGNING.

I understand that no insurance coverage for participants in these activities is provided by the NOCC. By registering for this program, I understand that no refunds or proration will be given.

I HAVE READ AND AGREE TO THE 2019 LEVEL UP WAIVER/RELEASE OF LIABILITY. (please enter signature below) *
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DATE *
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A copy of your responses will be emailed to the address you provided.
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