ISUAll-StateSummerChoirCampAugust7-8,2019–Page1of3

IOWASTATEUNIVERSITYOFSCIENCEANDTECHNOLOGYISUAll-StateSummerChoirCamp2019

StudentParticipantandParentalPermissionAgreementAssumptionofRisk,ReleaseandWaiverofLiabilityandEmergencyMedicalInformation

PLEASEREADTHISPARTICIPATIONAGREEMENT,PARENTALPERMISSIONAGREEMENT,ASSUMPTIONOFRISK,RELEASEOFLIABAILITYCAREFULLY.Itisalegalcontractandaffectsanyrightsyou/yourchildmayhaveifyourchildisinjuredorotherwisesuffersdamageswhileparticipatingintheISUAll-StateSummerChoirSummerCampProgram.

ISUDepartmentName

Music

ProgramTitle

ISUAll-StateSummerChoirCampProgram

DatesofParticipation

August 7-8, 2019

Supervisor

Dr. James Rodde

Location(Building,RmNumbers,other)

Music Hall, ISU Campus, Ames, Iowa

PROGRAMDESCRIPTIONDuring the 16th annual All-State Choir Summer Camp Program to be hosted at ISU Music Hall on August 7-8, 2019, camp participants will assist high school singers prepare for their All-State auditions in a choral setting. A team of qualified clinicians will guide the student participants in learning pitch, rhythm, and text in each piece; will give guidance for expressive interpretations; and will offer tools for improving intonation. A healthful approach to singing will be a primary consideration. PARTICIPANTINFORMATION

Participant’sName Participant’s

DateofBirth

PermanentAddress

City,State,ZipCode HomePhone

EmailAddress Sexof

Participant

Ethnicity A–Asian;B–Black;C-Caucasian;H–Hispanic;

I–Indian;M–MiddleEastern;O-Other

TRANSPORTATIONtoandfromthecamp.Selectallthatapplyoronebestchoiceforyourcamper.Asparent/guardian,Igivemypermissionforthepeoplenamedbelowtodropoffandpickupmychildduringthiscamp.

Iunderstandmychildwillnotbereleasedtoanyoneelseunlessachangeismadeinwritingbytheparent/guardian.

_____(NAMEOFDRIVER):______________________________________________willdrop-offmychildforthisevent.

_____(NAMEOFDRIVER):_____________________________________________willpick-upmychildafterthisevent.

Forpickuppurposes,pleaselistanyonewhoisNOTallowedtopickupyourchild______________________________________

_____Mychildispermittedtodrivethemselvestoandfromthiscampexperience.

Page 2 of 3

BEHAVIOREXPECTATIONSOFTHEPARTICIPANT(TOBEREADANDSIGNEDBYPARTICIPANT)ItisimportanttofollowthedirectionsoftheISUMusicDepartmentChoirfacultyandstaffpersonnelinchargeofthiscampexperienceatall

times.YoumustabidebytheUniversity’srulesandconductexpectations.IunderstandthatasaparticipantIhavetheresponsibilitytohelp

makethelearningopportunityasafeexperienceforeveryonethroughmybehaviorandconduct.Ialsounderstandthedangerofnot

followingrulesanddirectionsandagreetofollowthem.

ParticipantSignatureDate

IMAGE/VOICEPERMISSIONDuringactivities,aphotographorvideo/audiorecordingsmaybetakenofyou.Unlessyourequestotherwise,yourinitial

belowwillbeconsideredpermissionforIowaStateUniversityandtheMusicDepartmentChoirfacultyorstaffinchargeto

photograph,film,audio/videotape,recordand/orteleviseyourimageand/orvoiceforuseinanypublicationsorpromotional

materials,inanymediumnowknownordevelopedinthefuturewithoutanyrestrictions.IfyouobjecttoISUusingyour

imageorvoiceinthismanner,pleasenotifytheMusicDepartmentChoirfacultyorstaffpriortoparticipating.

_____initial_____date

MEDICALEMERGENCYCONTACTINFORMATIONPersontoContactFirst: BackupContact(RelativeorFriend):

Name____________________________________________________________ Name_______________________________________________________________

RelationtoParticipant_________________________________________ RelationtoParticipant___________________________________________

DaytimePhone()_________________________________________ DaytimePhone()___________________________________________

EveningPhone()_________________________________________ EveningPhone()___________________________

HealthInformation(PleasePrint)Pleaselistanyhealthcondition,allergiesorprescribedorover-thecountermedicationthatyoubelievetheParticipant

Supervisorshouldbeawareof:

______________________________________________________________________________________________________________________________________________MEDICALEMERGENCYPERMISSIONIunderstandthatImustbehealthyandreasonablyfitinordertosafelyparticipateintheISUAll-StateSummerChoirCampProgramandI

willinformthesupervisor/programleader(s)ofanymedication,ailment,condition,orinjurythatmayaffectmyabilitytoparticipatesafely.

Thehealthhistorystatedaboveiscorrectandcompletetomyknowledge.Ifaninjuryorothermedicalconditionoccursorarises,Ihereby

givepermissiontotheISUMusicDepartmentChoirfacultyandstaffinchargetoprovideroutinefirstaidandseekemergencytreatment

includingX-raysorroutinetests.Iagreetothereleaseofanyrecordnecessaryfortreatment,referral,billingorinsurancepurposes.I

understandthatIamfinanciallyresponsibleforchargesandherebyguaranteefullpaymenttotheattendingphysiciansorhealthcareunit.

IntheeventofanemergencywheretheEmergencyContactlistedabovecannotbereached,Igivepermissiontothephysician/hospital

selectedbytheDepartment’sfacultyandstaffinchargetosecureandadministertreatmentforme,includinghospitalization.*(Ifyou

cannotsignthissectionoftheformforanyreason,contacttheOfficeofRiskManagement[515-294-7711]regardingalegalwaiverinorder

toattendandparticipate.)

_____initial_____date