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Lights, Camera, BIZ ACTION!
Registration & Parental Consent Form
Camp BizGym Parental Consent
GENERAL: This Consent hereby grants permission for Students listed below to participate in the 2014 Camp BizGym summer camp. Students will make scripts and original videos for a business. Camp BizGym and Mid Pacific Institute will provide continuous supervision during official camp hours. Daily transportation to and from the site is the sole responsibility of respective Parents/Guardians (“Undersigned”). INSURANCE: Camp BizGym activities will take place under the guidance and direction of the BizGym Foundation and Mid Pacific Institute. Event and liability insurance are being provided by the BizGym Foundation. MEDICAL EMERGENCIES: Parents/guardians assume all responsibility for the health of their respective Students. In the event of an emergency, telephone numbers as listed below may be used to contact Parents/Guardians for instructions. IMAGES: Photos and videos taken at various Camp BizGym events may be posted to various publicly disseminated media. The Undersigned hereby grant Camp BizGym and its designees the right to use their respective child’s name, likeness, image, voice, appearance, and performance in Content whether recorded on or transferred to videotape, film, slides, photographs, audio tapes, or other media, now known or later developed. This grant includes without limitation the right to edit, mix, or duplicate and to use or re-use Content in whole or part as Camp BizGym may elect. Camp BizGym or its designee shall have complete ownership of Content, including copyright interests, and the Undersigned acknowledge they have no interest or ownership in Content or its copyright. The Undersigned also grant Camp BizGym and its designees the right to broadcast, exhibit, market, sell, and otherwise distribute Content, either in whole or in part, and either alone or with other content, for commercial or non-commercial television or theater, closed-circuit exhibition, Internet distribution, home video distribution or any other purpose that Camp BizGym or its designees in their sole discretion may determine. This grant includes the right to use Content for promoting or publicizing any of the uses. The Undersigned hereby gives all clearances, copyright and otherwise, for the use of their respective child’s name, likeness, image voice, appearance and performance embodied in the Content. The rights granted Camp BizGym herein are perpetual and worldwide. HOLD HARMLESS & INDEMNIFICATION: The Undersigned agree to remain legally responsible for any and all personal actions taken by their respective Students named below along with team mentors, friends, family and others associated with team entries. The Undersigned agree on behalf of themselves and their respective Students named herein to hold harmless and defend Camp BizGym, its designates, sponsors, officers, committee members, employees, and agents from any and all claims known and unknown arising out of or in any way connected with the event with respect to any and all actions, claims or demands that may be made or brought arising from or in connection with their respective Student attending or participating in Camp BizGym events or in connection with any illness or injury or cost of medical treatment in connection therewith, and agree to compensate Camp BizGym, its designates, sponsors, officers, committee members, employees, and agents reasonable attorney’s fees and expenses arising in connection therewith. The Undersigned herein confirm that each has respective rights to enter into this Agreement, and that each is not restricted by any commitments to third parties. The Undersigned expressly release and indemnify Camp BizGym, its designates, sponsors, officers, committee members, employees, and agents from any and all claims known and unknown arising out of or in any way connected with the above granted uses and representations.
Student Name
*
First
Last
School (Fall 2014)
Grade (Fall 2014)
*
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eight Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Allergies
Medications
Dietary Restrictions
Parent Name
*
First
Last
Parent Email
*
Parent Phone
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Acknowledgement
*
I acknowledge they have read, understand and agree to the foregoing terms.
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