IDRS Teen Camp Registration Registration I would like to register with a * - Select -Deposit - $75Full payment - $550Remainder After Deposit - $475 Camper Information Camper First and Last Name * Gender * Female Male Birthdate * Year200220032004200520062007200820092010 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Parent/Guardian First and Last Name * Home Address * City * State/Province/Region * ZIP/Postal Code * Country * Two-letter country abbreviation. Email * This will be the email address that all camp communications will be sent to. Preferred Phone Number * Home Cell Home or Cell * Alternate Phone Number Home Cell Home or Cell 2 School (2017-18 academic school year) * Grade (2017-18 academic year) * Instrument * Roommate Request Please fill out the information below to request your roommate for Teen Camp, or to indicate that you have no specific request. Please note that both parties must indicate that they would like to room together. Roommate Request * I have no specific request I would like to room with Roommate First and Last Name * I respectfully request not to be placed with Please put camper's first and last name. Assumption of Risk and Release of Liability This affects your legal rights - read it carefully. I have applied to participate in the International Double Reed Society (IDRS) program described as the IDRS 2017 Teen Camp/Teen Camp Double-Reed Adventure at IDRS 2017 during the period June 19-22, 2017. I acknowledge that the Program is voluntary and may involve certain risks, including those described below. I understand that the Program involves, among other activities, rehearsing, performing, engaging in recreation and, if applicable, traveling off campus and residing in student dormitories. I acknowledge that these activities present certain inherent risks beyond IDRS's control. I choose to participate in the Program understanding its associated risks, and I knowingly and voluntarily assume all risks of injury, illness, death or damage to or loss of my property that may occur while rehearsing, performing, traveling, engaging in recreation or any activities arising out of or related to the Program. My participation in the Program is voluntary, and I understand that I may discontinue my participation at any time in light of the risks I am assuming. I hereby forever release IDRS, its trustees, officers, employees, and agents (the “Released Parties”), from liability for any negligent act or omission arising from my participation in the Program, including related costs, damages, claims or assertions to which I or my family, estate, or heirs may claim against the Released Parties. This Assumption of Risk and Release of Liability shall be construed in accordance with the laws of the State of Wisconsin, which shall be the forum for any lawsuits filed under or incident to this Release or the Program. By checking this box I agree to the Assumption of Risk and Release of Liability. I consent * Teen Camp Student Code of Conduct Please read the Teen Camp Student Code of Conduct. By checking this box you agree to and accept responsibility for the Teen Camp Student Code of Conduct. Teen Camp Code of Conduct 3 * CAPTCHA This question is included to prevent automated spam submissions; it is not presented to logged-in users. Submit
