"Yes, I can help to provide or prepare food for camp staff during the week."
"Yes, I can help with the Evening Family Events."
Please list names of friends with whom you are trying to coordinate classes.
Yes, I would like to participate in an optional private lesson
Parent(s) or Guardian(s)
Allergies (include food, medicines, animals, insect bites, etc.)
Any other medical or behavioral concerns that you would like the camp staff to be aware of:
Yes, I agree to let "Cordova 4H Bluegrass and Old Time Music Camp" use a photo/s of my child for promotional use. (The child's name and other information will not be released).
No, "Cordova 4H Bluegrass and Old Time Music Camp" may not use a photo/s of my child for promotional use. (The student will not be allowed to be in the end-of-camp photo).
For safety's sake, we have a CLOSED CAMPUS policy. We require that a parent or guardian sign their child out at the end of every day, or provide a handwritten note delivered beforehand. There will be a form and clipboard at the front table for you to sign your child out.
Please select on of the two options:
I agree to sign my child out at the end of every day, or provide a handwritten note beforehand.
My child may leave campus without my signature. I understand that checking this box will release Bluegrass Camps for Kids of any responsibility for my child at the time that is specified as the end of the day on the Camp Form.
My child is 13 or older, and I give him/her permission to go off-campus during lunch. I agree that Cordova 4H Bluegrass and Old Time Music Camp will not be held in any way responsible for my child during this time frame. I agree that my child will sign in and out at lunch every day, and will return to camp in a timely manner. I understand that if these conditions are not met, the privilege will be revoked.
Bands Around Town Release:
A large part of Cordova 4H Bluegrass and Old Time Music Camp is the Bands Around Town activity on Friday afternoon. Students walk around town with their instructor and a volunteer to play music for locals.
I give my permission for my child to attend the Bands Around Town activity, and understand that the medical release signature below extends to the Bands Around Town activity. I also agree that my child will follow instructors' directions, and behave in a way that positively reflects the camp.
4H Code of Conduct Release:
The 4-H Code of Conduct applies to all activities coordinated through UAF Extension 4-H including local, district, state and national activities.
While attending 4-H activities and events, I will:
I have read the 4-H Code of Conduct and I support my child living up to the expectations it outlines. As well, I agree to live up to the expectations of the Code of Conduct while participating in 4-H programs and events. I will support the individual(s) in charge in maintaining appropriate behavior and in the development of good character. I understand that I am responsible for all costs incurred by early departure should my child be sent home and may be asked to forfeit all funds expended upon me and/or my child’s behalf during the event.
If my child is borrowing an instrument, I agree to take full financial responsibility if my child incurs any damage to that instrument while borrowing it. If my child is
using their own instrument, I agree to take full financial responsibility for the instrument that my child is
using. I also agree to release "Cordova 4H Bluegrass and Old Time Music Camp" of any financial responsibility if any damage is done to the instrument. If my child is loaning an instrument to the camp,
I agree to release "Cordova 4H Bluegrass and Old Time Music Camp" of any financial responsibility if any damage is done to the instrument during the camp. I also agree that if there is any damage done to the instrument during the camp, the person using it at the time will be financially responsible for the damage done.
I hereby consent to emergency treatment, hospitalization, or other medical treatment as may be necessary by a physician, qualified nurse or hospital in the event of an injury or illness. On behalf of the above student, I hereby waive any liability for injuries/illness sustained at this event "Cordova 4H Bluegrass and Old Time Music Camp". I also hereby accept legal and financial responsibility for the above student in the event of injury or illness.
By checking this box you agree that you have read the above, and agree to all terms. You also agree that you have read and understand the FAQ page.