On The Set Celebrity Summer Film Camp - Registration Form (Birmingham)
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Email *
Are you are NEW or RETURNING Camper *
Required
Camper: First and Last Name *
Camper: Date of Birth *
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Camper: Age  *
Camper: Gender *
Camper: School  *
Camper :  Last Grade Completed *
Parent/Guardian 1: First and Last Name *
Parent/Guardian 1: Phone Number  *
Parent/Guardian 1: Email Address *
Parent/Guardian 1: Home Address, City, State, Zip *
Parent/Guardian 2: First and Last Name *
Parent/Guardian 2: Phone Number  *
Parent/Guardian 2: Email Address *
Parent/Guardian 2: Home Address, City, State, Zip *
Emergency Contact: First and Last Name  *
Emergency Contact: Relationship to Camper *
Emergency Contact: Phone Number *
Medical Information -   Does the child take any medications? *
If yes, please list the medications, dosage, and the time they should be taken.
Allergies: Does your child have any allergies? *
Allergies: If yes, please list below
Dietary Restrictions: Does your child have any dietary restrictions? *
Dietary Restrictions: If yes, please list below
Any other medical conditions or special needs:
Learning Developments or Disabilities: Please list any learning developments or disabilities the camper may have:

Film Release Consent: I hereby grant permission for my child to be filmed and photographed during camp activities. I understand that the footage and photographs may be used in the production of a film and for promotional purposes, including but not limited to social media, websites, and marketing materials.

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Film Release Consent: I acknowledge that I will not receive any compensation for the use of my child's image or participation in the film. *

Equipment Use Agreement: I understand that my child will have access to and use various equipment during the camp. I agree that if my child deliberately damages or mishandles any equipment, I will be responsible for covering the cost of repair or replacement.

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Equipment Use Agreement:  I understand that the camp will hold parents responsible for accidental damage to equipment. *

Behavior and Refund Policies: I understand that if my child exhibits behavior that requires constant redirection or becomes disruptive to the camp environment, they may be removed from the camp without a refund.

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Behavior and Refund Policies:   I hereby give my permission for my child to participate in the Film Camp. I understand that participation in the camp involves inherent risks and hazards and that the camp will not be held liable for any injury or harm that may occur during camp activities. *
Behavior and Refund Policies: I acknowledge that I have read and understand the camp's policies, including the no-refund policy. By signing this form, I commit to 100% participation and understand that no refunds will be given under any circumstances. *
Behavior and Refund Policies: I agree to release and hold harmless the Film Camp, its staff, volunteers, and affiliates from any claims, liabilities, or expenses arising from my child's participation in the camp. *
Behavior and Refund Policies: I understand that it is my responsibility to inform the camp of any changes in my child's medical condition or contact information. *
Consent and Signature: Parent/Guardian Name (Printed) *
Consent and Signature: Parent/Guardian Signature: *
Consent and Signature:  Camper Signature: *
Consent and Signature: Date *
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A copy of your responses will be emailed to the address you provided.
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