Reel Youth October FILM CAMP Age 13-18 Registration Form

FILM Camp Registration Age 13-18

Inspiring and mentoring young BIPOC Storytellers
Thank you for enrolling your child in Reel Youth October Film Camp!

Age Range: 13-18
Dates: 3-Day Session: Saturdays - Oct 1, 8, 15
Location: Langston Hughes - 104 17th Ave S, Seattle, WA 98144
Time: 10am-3pm.

Please complete the registration form below to register your child.

Contact Information:
Ben Leiataua, Program Director
Reel Youth Film Camp
206-458-2359
info@reelyouthfilmcamp.org
FILM STUDENT Information
Student's Name*

First NameLast Name
Student's Age*

AgeBirthdate
Student's School
School Name
Student's Ethnicity*

Black or African AmericanAlaska Native or Native AmericanNative Hawaiian or Other Pacific IslanderAsian or Asian AmericanHispanic or Latino or Spanish Origin
Film Student T-Shirt Size

Youth XSmallYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult 2XLAdult 3XL
FILM STUDENT Questionnaire
Have you ever attended a film program before? If yes, what level would you say you are? Beginner - Intermediate - Advanced? *
Why are you interested in being a part of a film camp? *
Have you been part of making a film before? If so, what was it about? What was your role?*
If you have your choice of what role you would be on a film set, what would it be?*

Camera OperatorDirectorProducerEditorActorWriter
What is your favorite film, and why?*
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number*

Area CodePhone Number
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship*
Alt. Phone Number*

Area CodePhone Number
What are your students dietary restrictions? Are they allergic to certain foods? If yes, please describe.*
Does the Student have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the Student prescribed an inhaler? If yes, please explain any instructions.*
Participation Release for Youth:

I grant permission for the above-named film student* to participate in this camp by Reel Youth Film Camp.

I hereby hold harmless Reel Youth Film Camp, their employees, officers and agents, and any group leaders, from any and all responsibility and liability of any nature that may arise from the participation of the above-named participant in the program. I understand that the activities may take place both inside the Camp Venue (Langston Hughes - 104 17th Ave S, Seattle, WA 98144) as well as at parks within walking distance of that building. I give my permission for the above-named participant to take part in these activities. It is the responsibility of every individual, their parent, or legal guardian to provide for their own accident and health coverage while participating in all Reel Youth Film Camp activities. I understand that Reel Youth Film Camp does not provide any accident or health coverage for its participants.
Parent or Guardian Initials*

I have read and understand the Participation Release in the above terms. Clear
Medical Authorization:

In the event of an emergency, I give authorization to Reel Youth Film Camp to secure medical treatment for the above-named youth participant if I cannot be contacted immediately. I hereby consent to the administration of any and all medical procedures deemed necessary by the attending authorities.
Parent or Guardian Initials*

I have read and understand the Medical Authorization in the above terms. Clear
Camp Preparation & Safety:

All technologies and supplies are included in the camp cost and provided. Snacks and a hot meal will be provided. Students are welcome to bring their own snacks and lunch. We will practice physical distancing, masking, and health screening according to city and state guidelines at the time of the camp. We anticipate this will include masking and physical distancing in the camp space. While filmmaking is a highly collaborative art form, using shared equipment, this camp is designed to allow for more space and individual equipment for each camper. Each camper will get to work on designing and making their own creations, in a large collaborative space, just like a special effects shop for the big screen!
Parent or Guardian Initials*

I have read and understand the Camp Preparation & Safety in the above terms. Clear
Location, Pickup & Drop-Off Information

– This camp will take place at Langston Hughes - 104 17th Ave S, Seattle, WA 98144
– The location has a parking lot. We provide a drop-off window from 8am-8:45am and a pickup window from 5pm-5:30pm each day. Campers are supervised by staff and provided extra film activities to do during these times.
Parent or Guardian Initials*

I have read and understand the Location, Pick-up and Drop-off in the above terms. Clear
The cost for this program is FREE - Your student will receive a stipend after completing our film camp course

Making our programming financially accessible is one of the core tenets of Reel Youth. If you can, please consider making a donation to our fundraising campaign: https://givebutter.com/reelyouthfilmcamp
Consider Donating Today*

Sorry, I can't donate right nowI'll donate to the campaign by clicking the link above!I'll donate in person
Parent or Guardian Initials*

I have read and understand the Donation in the above terms. Clear
Media Release:

We plan to take photos and videos of our Campers to document the camp program for our work, and to share them with participants. Campers will get a copy of their camp photos, and copies of the projects they created. Please indicate your media release below.

Media of my child may be used by Reel Youth Film Camp for website, print, and social media campaigns, as well as reporting for programs to the community and granting organizations.

Reel Youth Film Camp reserves the rights to all media produced during the Film Camp. *
Parent or Guardian Initials*

I have read the Media Release and understand the above terms. Clear
Confirmation: BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Parent or Guardian Signature*

Clear
Should be Empty:

FILM Camp Registration Age 13-18