Songwriting Camp 2023 Sign Up!

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We're thrilled to be offering this camp for teens this summer! This will be an inclusive, supportive, and hopefully very fun and informative camp for students aged 13-18. You can find the bulk of the camp details in the image below.

Students will come each day July 24th-28th 9am-4pm. Please accompany your teen into the building for both check in and check out, if you will be driving your teen. If your teen will be driving themselves or is over the age of 16, no need to accompany them into the building. Our address is 2906 Beacon Street, Colorado Springs CO, 80907, and our front door code is 2389. We must sign in and sign out each camper, each day.

Total cost is $350.

This sign up form contains critical information on medical safety, bodily safety, emergency contact information, payment, and cancellation policies. Please read in its entirety. We cannot wait to have your teen with us this summer!

Bodily autonomy and safety are extremely important to us. All staff member have been vetted, passed a background check, and will prioritize your teen's safety at all times.

Student's Name and Age:

We need at least 2 local emergency contacts. Please list their first and last name and phone number: *

MEDICAL RELEASE FORM AND EMERGENCY PROCEDURES

EMERGENCY MEDICAL RELEASE:

If medical care is deemed necessary and I cannot be contacted, I authorize Resonate Music Therapy (“RMT”) staff to act on my behalf in deciding the proper course of action for my camper. This includes but is not limited to permission for RMT to render any emergency medical treatment that RMT staff deem appropriate and/or necessary for the well- being of my camper, including, but not limited to First Aid, CPR, calling emergency ambulance transportation and hospitalization, if necessary.

I understand and agree that any and all actions taken by RMT for the benefit of my camper comes at my cost, including but not limited to, emergency medical treatment or care and ambulance transportation. I promise to hold RMT harmless and indemnify RMT for any and all costs associated with any medical treatment it has deemed necessary and/ or appropriate for the well-being of my camper, including, but not limited to, any and all costs associated with emergency room visits, hospital care, and ambulance services.

I specifically release RMT from any and all claims, loss, costs, damage, or expenses arising out of or from the exercise of their discretion in seeking medical treatment on behalf of my camper as RMT may deems necessary and/or appropriate, and also release RMT from any and all claims, losses, costs, damages, and/or expenses associated with any negligent treatment or medical malpractice committed by any medical professional, which I might otherwise pursue against RMT in whole or part, including joint or several liability.

MEDICAL CONCERNS, ALLERGIES, BEHAVIORAL CONCERNS: (Please list all medical concerns, allergies, and/or behavioral concerns here. It is *highly* important to us that we are aware of any and all medical concerns and/or allergies and/or behavioral concerns. PLEASE NOTE that students will be bringing in their own lunch).

If your teen has no medical concerns, allergies, or behavioral concerns, please write "Not applicable".

ATTENDANCE PROCEDURES

SIGN IN: Please accompany your teen into the building for both check in and check out. Our address is 2906 Beacon St, and our front door code is 2389. We must sign in and sign out each camper, each day.

SIGN OUT: I understand that my student must be picked up by the time camp ends promptly at 4pm.

If my camper is not picked up on time, program staff will attempt to contact me first and then attempt to contact all emergency contacts. I understand that there is a charge if I do not pick my camper up by the above stated time. This charge is $25 per 30 minutes and will be charged by a Venmo request that must be paid prior to the next camp day. I understand that multiple late pick-ups may result in my student being dismissed from the program with no refunds.

ABSENCES: I will contact staff by texting them at 719-492-5282 to notify them when my camper will be absent from the program.

TARDINESS: I understand that if tardy to camp, there will be no adjustment of fees. Please text 719-492-5282 if the student will be late.

I understand and agree to the above procedures.

Please list all individuals who will be picking up the student, and who are authorized to do so. We absolutely cannot release a student to anyone who is not on this list.

Please list each individual by first name, last name, and phone number.

Is there anything we should know about your teen in terms of how they connect with others, what they benefit from in a group setting, potential triggers or things for our staff to be aware of? What's their learning style?

If you don't have details to share, perfectly fine. Please write 'not applicable'.

Financial Agreement:

I understand that by signing my student up for this camp, their spot is only reserved once payment has been received. An online invoice sent by email will be sent, that can be paid with a card or bank account.

Refunds will only be processed in the event that the camp is cancelled. If the student is unable to attend the camp for any reason, the total amount paid cannot be refunded, but can be applied to any other service at Resonate! You can apply the total amount to private lessons, another camp, therapy, etc.

If you are attending this camp on scholarship, please just write 'scholarship'. You can make a small donation towards camp/our general fund if you'd like- just write out the amount you'd like to give below.

I understand and agree to the above financial agreement, and the invoice can be sent to this email:

Does the student have any specific needs that should be recognized?

If yes, what special accommodations or modifications are needed?

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This form was created inside of Resonate Music Therapy LLC.