Camp Photo/Media Liability Release and Application

Math-A-Matics Tutoring, LLC strives to provide a safe, secure, educational and fun environment for visiting K-12 students.

We ask that all students visiting campus have the following signed by a parent or guardian:

Photo, Media and Copyright Release

I grant Math-A-Matics Tutoring, LLC my permission to photograph, videotape, and/or audiotape my child during activities at Math-A-Matics Tutoring, LLC Spring Break Camp. These photographs/videos/audios will remain the property of Math-A- Matics Tutoring, LLC and may be used in advertising or marketing campaigns on Math-A-Matics Tutoring, LLC’s websites, and for promotional and informational material including, but not limited to, flyers, brochures, newsletters, emails, advertisements, newspaper articles, TV or cable interviews/promotions. I understand my child will not be identified by name unless I give my express permission. I hereby waive and release on behalf of my child, any rights to compensation for, or ownership of, such images and/or sounds.

Please Check Below: *

Liability Release

The undersigned participant and his/her parent/legal guardian do hereby waive, release, absolve, forever discharge, and do further agree to indemnify and hold Math-A-Matics Tutoring, LLC, its employees, trustees, officers, volunteers, and agents harmless from and all claims, damages, losses and/or expenses arising out of participation in Math-A-Matics Tutoring, LLC activities. I/we assume all liability for any and all personal injury, bodily injury, illness or property damage that occurs as a result of participation in such activities. I/we also agree that we will not bring any lawsuits nor make any demands nor pursue any complaints against Math-A-Matics Tutoring, LLC as a result of his/her participation in Math-A-Matics Tutoring, LLC activities. Agreement to this Release also warrants that participation in this activity is voluntary and the participant and undersigned have read and understand the inherent risks involved in the activities. The participant understands that these risks exist despite the safety precautions and procedures implemented by Math-A-Matics Tutoring, LLC. The participant agrees to obey all rules and policies mandated by Math-A-Matics Tutoring, LLC personnel.

I/we, the undersigned parent or guardian, hereby gives my/our consent to his/her participation in all Math-A-Matics Tutoring, LLC activities. The undersigned participant and his/her parent/l

Please Check below: *
Participant Name: *
Parent/Legal Guardian Name: *
Date: *

CAMPER AND PRIMARY CONTACT INFORMATION

Name of Student: *
Date of Birth: *
 /  / 
Age at the time of Camp: *
Name you preferred to be called (if different):
Name of School: *
Name of Parent/Guardian/Primary Contact: *
Mailing Address: *
Home:
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Cell: *
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Work:
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E-mail Adress you check frequently: *
Best way to contact you: *

EMERGENCY CONTACTS (please provide two additional people, different from the parent/guardian listed above, who would automatically be the first person we contact)

First Contact's Name: *
Relationship: *
Home 1:
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Work/Cell 1: *
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EXT 1:
Second Contact's Name: *
Relationship 2: *
Home 2:
Work/Cell 2: *
Ext 2:

SAFETY INFORMATION (please list all known conditions so we can accommodate your camper’s needs)

Does your camper have any medical conditions, allergies, special needs, or dietary restrictions due to beliefs the staff should know about?: *
Does your camper have any behavioral or emotional issues the staff should know about?: *
Is your camper taking any medications to treat these conditions?: *
Word Verification: