AC Summer Music Camp Student Agreement & Authorization

This form must be completed for all students attending the 2023 Austin College Summer Music Camp.

"*" indicates required fields

Student Name:*

First Last

Student age at the start of camp:*

Date of Birth:*

Parent/Guardian Name:*

First Last

MEDICAL HISTORY AND AUTHORIZATIONS

Medical conditions currently being treated:

Current medications:

Medication allergies:

Food allergies:

Please indicate any accessibility accommodations you will need:

Please type your full name to confirm your authorization:

Please type your full name to to confirm your media authorization:

CAR REGISTRATION

Will the participant be parking on campus?

Yes

Car make:

Car model:

License plate number::

WAIVER OF LIABILITY

I hold harmless:

Austin College, its Board of Trustees, officers, agents, employees, and students
Austin College Summer Music Camp
Sherman Symphony Orchestra

from any and all liability including claims, demands, losses, costs, damages, and expenses of every kind and description, including death or damage to persons or property arising out of use of Austin College facilities and services.

Campus Policy Agreement
Austin College or its designated representatives reserve the right to remove from campus any individual who willfully violates College policies.

By signing below, I acknowledge that I have received and understand the Waiver of Liability and all ACSMC & Austin College policies:

Parent/Guardian signature (PLEASE TYPE YOUR FULL NAME)

Student signature (PLEASE TYPE YOUR FULL NAME)

Date*

AC Summer Music Camp Student Agreement & Authorization

MEDICAL HISTORY AND AUTHORIZATIONS

CAR REGISTRATION

WAIVER OF LIABILITY

By signing below, I acknowledge that I have received and understand the Waiver of Liability and all ACSMC & Austin College policies:

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