HU Arizona High School Digital Media Arts Summer Camp

Camper Information

First Name

Last Name

Birthdate

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Any food allergies or sensitivities? Please describe.

Academic Information

College Entry Term

HUAZ Major Interest

Where do you attend high school?

Emergency Contact Information

In the event of an emergency, the emergency contact person below will be contacted. If you have a medical condition to report that our staff should be aware of, please report it in the next section.

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Emergency Contact Email

Emergency Contact Relationship to Camper

In case of an emergency and in the event that the emergency contact/parent or guardian cannot be reached, is a Huntington University staff member authorized to act and seek emergency medical treatment?

Yes

No

In the event of an emergency, is there consent for emergency medical treatment?

Yes

No

Medical Information

Do you have any medical conditions that we should be aware of for your time during camp? If so, please explain below.

If you listed a medical condition above, are there any medications you need to store during your time at camp? Please note that Huntington University will not assist in any administering of medications, just storing.

Liability Waiver, Acknowledgements, and Photo Release

Will you be 18 years old or older at the time of the HUAZ DMA Summer Camp?

Yes

No

In consideration of being allowed to participate in any way in an on-campus or off-campus Huntington University event, program, activity (hereinafter referred to as “Activity”), I do willingly and voluntarily acknowledge, appreciate, and agree to the following:

I acknowledge that within the course and scope of my activities I may be exposed to hazards or risks that may result in my illness, personal injury, or death and I understand and appreciate the nature of such hazards and risks. In consideration of being permitted to participate in the Activity, I hereby accept all risk to my health, including any injury or death and property that may occur while I am acting within the course and scope of the Activity as a PARTICIPANT or otherwise participating in the Activity. To the best of my knowledge, I can fully participate in this Activity.
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation.
I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard or concern during my presence or participation, I will remove myself from participation and bring such to the attention of the University immediately.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Huntington University, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I further understand and acknowledge that HU is not an insurer of my personal safety or property. I UNDERSTAND THAT THE UNIVERSITY WILL NOT BE RESPONSIBLE FOR ANY MEDICAL COSTS ASSOCIATED WITH ANY INJURY I MAY SUSTAIN. I understand that I should and am urged by the University to obtain adequate health and accident insurance to cover any personal injury to myself which may be sustained during the Activity or the transportation to and from said Activity.
I consent to my likeness in a photograph or other digital reproduction in any and all its publications, including website entries, media releases and other promotional materials, without payment or any other consideration. I hereby grant Huntington University permission to use my likeness in a photograph or video or other digital reproduction ("collateral") in any and all of its publications, website entries, social media, media releases and other promotional materials, without payment or any other consideration. I understand and agree that these materials will become the property of Huntington University. I hereby irrevocably authorize Huntington University to edit, copy, exhibit, publish and distribute collateral for any and all purposes. In addition, I waive the right to inspect or approve collateral or finished product created from collateral, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of collateral. I hereby hold harmless and release and forever discharge Huntington University from all claims, demands, and causes of action which I and any heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I also acknowledge:
1. Staff at Huntington University are mandated reporters and must report suspected abuse.
2. Huntington University does not assume the risk for food brought into the facility.
3. This program is not licensed as a child care facility under Arizona law.

I do not consent to my likeness in a photograph or other digital reproduction in any and all its publications, including website entries, media releases and other promotional materials, without payment or any other consideration.

Printed Student Name

Student Signature

Click to Sign...

PARENT LIABILITY WAIVER: In consideration of MY CHILD being allowed to participate in any way in an on-campus or off-campus Huntington University event, program, activity (hereinafter referred to as “Activity”), I do willingly and voluntarily acknowledge, appreciate, and agree to the following:

I acknowledge that within the course and scope of my activities I may be exposed to hazards or risks that may result in my illness, personal injury, or death and I understand and appreciate the nature of such hazards and risks. In consideration of being permitted to participate in the Activity, I hereby accept all risk to my health, including any injury or death and property that may occur while I am acting within the course and scope of the Activity as a PARTICIPANT or otherwise participating in the Activity. To the best of my knowledge, I can fully participate in this Activity.
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation.
I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard or concern during my presence or participation, I will remove myself from participation and bring such to the attention of the University immediately.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Huntington University, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I further understand and acknowledge that HU is not an insurer of my personal safety or property. I UNDERSTAND THAT THE UNIVERSITY WILL NOT BE RESPONSIBLE FOR ANY MEDICAL COSTS ASSOCIATED WITH ANY INJURY I MAY SUSTAIN. I understand that I should and am urged by the University to obtain adequate health and accident insurance to cover any personal injury to myself which may be sustained during the Activity or the transportation to and from said Activity.
I consent to my likeness in a photograph or other digital reproduction in any and all its publications, including website entries, media releases and other promotional materials, without payment or any other consideration. I hereby grant Huntington University permission to use my likeness in a photograph or video or other digital reproduction ("collateral") in any and all of its publications, website entries, social media, media releases and other promotional materials, without payment or any other consideration. I understand and agree that these materials will become the property of Huntington University. I hereby irrevocably authorize Huntington University to edit, copy, exhibit, publish and distribute collateral for any and all purposes. In addition, I waive the right to inspect or approve collateral or finished product created from collateral, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of collateral. I hereby hold harmless and release and forever discharge Huntington University from all claims, demands, and causes of action which I and any heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I also acknowledge:

1. Staff at Huntington University are mandated reporters and must report suspected abuse.
2. Huntington University does not assume the risk for food brought into the facility.
3. This program is not licensed as a child care facility under Arizona law.

I do not consent to my child's likeness in a photograph or other digital reproduction in any and all its publications, including website entries, media releases and other promotional materials, without payment or any other consideration.

Child's Printed Name

Parent's Printed Name

Parent's Signature (signing on behalf of the minor student)

Click to Sign...

Payment Information

The HU Arizona High School Digital Media Arts Summer Camp is $350 for the entire week. This includes all programming, materials, and payment of our faculty and staff running the camp. Meals are provided by Huntington University Arizona.

Full Amount

Amount Due
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HU Arizona High School Digital Media Arts Summer Camp - Film Track