Camper Registration – YA/EA – Texas Strings Festival

"*" indicates required fields

Camper Information

Camper Name*

First Last

Instrument*

Have you attended Texas Strings Camp in previous years?*

Yes

What year is this for you?

This tells us which “year” pin to give you for your name tag.

Photo Release*

I agree to the photo release policy.

I hereby authorize The PS Foundation for the Arts (dba, Texas Strings Festival/Texas Strings Camp) to publish the photographs taken of me and/or the undersigned minor children, and our names, for use in the Texas Strings Camp website and for display in their marketing materials. I release Texas Strings Camp from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize Texas Strings Camp to use their photographs and names. I acknowledge that since participation in publications and websites produced by Texas Strings Camp is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participation in any publication and website produced by Texas Strings Camp confers no rights of ownership whatsoever. I release Texas Strings Camp, its contractors and its employees from liability for any claims by me or any third-party in connection with my participation or the participation of the undersigned minor children.

Medical / Emergency

Camper Date of Birth*

MM slash DD slash YYYY

Does the camper have any limiting medical conditions that you or your doctor feel would limit camp participation?

Please explain the limiting medical condition:*

Is the camper currently taking medication that may interfere with ability to safely participate in the camp?*

Please indicate the medication and the condition being treated:*

Does the camper have a history of allergies or reactions to medications, insect stings, or plants?*

Please explain the allergies / reactions:*

Does the camper have a history of, or currently suffer from, medical condition(s) of which we need to be aware?*

Please explain history of medical conditions:*

Does the camper have any food allergies or restrictions?*

None

Vegetarian

Vegan

Dairy Allergy

Nut Allergy

Gluten-Free

Something else

Select all that apply

If food allergy / restriction is "something else" please explain:

Emergency Contact*

First Last

Relationship to Camper:*

Emergency Contact Phone:

Insurance Provider:*

Group ID:

Member or Policy ID:

Consent*

I agree to the medical release as stated below:

As a student, parent or guardian I understand that the information requested on this form is intended to help inform program staff of any pre-existing medical conditions. If “Participant” has a pre-existing medical condition, participation in any strenuous activities or recreational time may not be recommended. This information will be kept in strict confidence and will only be shared with your permission. Texas Strings Camp requests the information below so that, in case of emergency, we will have accurate information so that we can provide and/or seek appropriate treatment for Participant. You are accountable for providing an accurate medical history. If Participant has any medical issue that is not requested below, but which you think is important, please include that information. Please answer all of the questions. If you answer yes to any of the following questions, please explain as indicated. Use back and/or additional paper if needed.

Unless prior arrangements have been made, medical needs will be handled through the Dell Seton Medical Center at the University of Texas. In cases where medical attention is necessary, parents will be contacted for approval when possible. However, before medical treatment can be provided, we are required to have a medical release signed by the parent /guardian. The hospital will not perform services unless this form is presented at the time of treatment.

Participant has my permission to receive medical attention in the event of illness or medical emergency while participating in this Program. I will assume the financial responsibility for any cost of health care for my child that may occur during this Program.

As a participant, parent, or guardian I understand and acknowledge that my failure to disclose relevant information may result in harm to Participant and/or others during this Program. By signing my name I represent and warrant that I have provided all materials and important information to Texas Strings Camp pertaining to my Participant’s medical, mental and physical condition and that it is accurate and complete. I agree to notify Texas Strings Camp of any changes in my mental, physical or medical condition prior Participant’s scheduled Program.

I understand that, if Participant chooses to participate in activities, he/she do so voluntarily and of his/her own accord and the final decision regarding participation is solely the responsibility of myself and Participant.

Parent / Legal Guardian: Signature consenting to medical release:*