MCLA Registration Form 2023
Metro-Capitol Leadership Academy Registration
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Email *
Student First Name *
Student Last Name *
Primary Marching Instrument *
What is your T-shirt size (adult sizes)? *
What school will the student attend in the fall? *
List name of school and then HS (Examples: Mountainside HS, Grants Pass HS, Sherwood HS)
What grade will the student be in this coming fall? *
Has the student held a leadership role before? *
What is your primary role for this coming fall? *
Have you attended the MCLA camp before? *
Student Cell Phone Number *
Please enter the number in this format: 555-555-5555.  If the student does not have a cell phone, please type: NA
Personal Student Email *
Please use your personal email as many school email systems reject emails from outside of their school organization.
Primary Parent/Guardian Name *
Primary Parent/Guardian Cell Phone Number *
Please enter the number in this format: 555-555-5555
Primary Parent/Guardian Email *
Please use your personal email as many school/work email systems reject emails from outside of their school/work organization.
Emergency Contact Name *
Emergency Contact Cell Phone Number *
Please enter the number in this format: 555-555-5555
Student Address (number, street, city, state, zip) *
Parent Permission *
I give my child, the aforementioned, permission to participate in the 2023 Metro-Capitol Leadership Academy. I give permission for my child to participate in daily recreational activities, under the supervision of a licensed physical educator.I am aware of the inherent dangers and risks involved in outdoor activities and: I understand that Metro-Capitol Leadership Academy or its parent company Northwest Music and Leadership Academies does not provide any accident or medical insurance for my child. I understand that I am required to provide accident/medical insurance for my child and do so under the policy listed below. I agree that I am financially responsible for any and all medical expenses associated with my child’s participation in this program.
Required
Hold Harmless *
I agree on behalf of myself, my child, and our assigns, executors, and heirs, to indemnify and hold harmless, Metro-Capitol Leadership Academy, Northwest Music and Leadership Academies, and its employees from any and all liability, damage and claims of any nature arising out of or in any way related to my child’s participation in this program except those things caused by the sole negligence of Metro Leadership Academy. I understand that the terms of this agreement are legally binding and certify that I have signed this agreement of my own free will after carefully reading and fully understanding it.
Required
Medical Release *
If necessary, do you grant the directors and staff to administer minor medical treatment and/or if needed to seek additional medical treatment, including transportation to a hospital? Every effort will be made to contact the parent or the emergency contact on file before this step.  
Medical Provider *
Insurance Policy Number *
Any student allergies? *
May staff administer Tylenol or Ibuprofen? *
Student Behavior Agreement *
As a participant in this camp, I agree to the following: 1. To cooperate fully with the staff and high school assistants. 2. To attend all sessions, on time, except in the case of illness. 3. To be respectful of the School Facilities its rooms and equipment.  4. To return all instruments/equipment at the end of the camp. 5. To put forth my best effort in the camp, and to HAVE FUN!  Failure to follow the rules listed above could result in dismissal from the camp. In this case, registration fees will not be refunded.
Required
Photo Release *
On occasion, camp pictures will be taken for promotional materials. Most of these are large group photos or action shots of multiple students.  The permission below is for close-up photo use (without printed names).
Payment Information *
FOR REGISTRATION TO BE COMPLETED ONLINE, YOU MUST PAY ONLINE OR SEND A CHECK. Camp Fee: If paying by check, the camp fee is $260 (if paid by June 10), $300 (if paid on or after June 11). If using the PayPal buttons, the cost is $272 if paid by June 10 and $314 if paid June 11 or after. PayPal buttons are on the MCLA website. Please indicate any school scholarship (please list school, director, and amount you are receiving). Online payment options include Visa/MasterCard. Visit the MCLA Web page to access the PayPal Button. nmla.us/mcla. If you have an odd amount to pay due to a scholarship or your band boosters are paying a portion, log into PayPal and choose the "send money" option and send the amount you need to send to nmlapayment@gmail.com. If you choose this option, be sure to indicate what camp the payment is for and the student name attending the camp in the notes. If paying by check, please mail to the address below, make checks payable to: Northwest Music and Leadership Academies or NMLA. PLEASE SEND CHECK PAYMENTS TO: NMLA • MCLA Payments, PO Box 5488, Salem, OR 97304
Parent Signature and Date *
You are agreeing to the rules, policies, and procedures of the camp by typing your electronic signature below.
Student Signature and Date *
You are agreeing to the rules, policies, and procedures of the camp by typing your electronic signature below.
A copy of your responses will be emailed to the address you provided.
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