2020 Multi Blues Kid Form: Blues Camp Online Enrollment + Emergency Form(s) July 5 - 10, 2020

2024 Blues Camp International Enrollment + Emergency Forms for Your Blues Kid:

This year, we are happy to welcome back our old and new Blues Kids to Blues Camp International on the campuses of Columbia College Chicago, Winston-Salem State University, the American Jazz Museum, the B. B. King Museum, and Chicago Public Schools. However, we will adhere to all safety regulations presented by the Center for Disease Control, the City of Chicago, the State of Illinois, and the college campuses where we are in-residence. This form is to be filled out by the supervising parent or legal guardian responsible for the Blues Kid(s) on this application, not the Blues Kid, a minor. By filling out this form you agree that you are "that" parent/legal guardian and are at least 25 years of age and agree to the terms and attendance policies during the Blues Camp sessions for the dates on this form. All info on this form will be kept private and will not be shared with any outside agencies. In the event of an emergency the medical information (you provide) will be shared with our administrative team and medical professionals involved in "that" immediate situation. At the end of Blues Camp this data/file will be deleted with no copies left on any server(s), hard drive or in paper form.
What Blues Camp?

The American Jazz Museum (TBD)Columbia College Chicago 7/7/24 to 7/12/24Las Vegas 6/27/24 to 7/28/24Governors State U 7/25/24 and 7/26/24Winston Salem State U 8/4/24 t0 8/9/24B.B. King Museum + Interpretive Center TBD
Referred to Blues Camp by *
Their Email
example@example.com
Their Phone

Area CodePhone Number
Anything we need to know?*
This is our*

First Blues CampSecond Blues CampThird Blues CampFourth or More

Part A: Parent/Legal Guardian who will supervise the "Blues Kid" during Blues Camp Week.
Your relationship to the Blues Kid(s).*

Parent / FatherGrandfatherParent / MotherGrandmotherLegal Guardian (25 or older)School Administrative Team LeaderLegal Representative These For Blues KidsTeacher
Title*
The Parent or Legal Guardian*

First NameLast Name
Gender Identity*
Cell Phone Number*

Area CodePhone Number
Occupation*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Country*
Other than English, do you speak another language? If so, what language(s)?*
Your Email, not your Blues Kid's*
example@example.com
Confirm Email*
example@example.com
Your Blues Kid's Email
example@example.com
Confirm Email
example@example.com
Blues Kid*

First NameLast Name
Gender Identity*
Birth Date*

MonthDayYear
Age During Blues Camp*

9101112131415161718
Origin of Ethnicity, not skin color . . . examples, Italian-American, African-American, etc.*
Their T-Shirt size (adult sizes listed. Shirts won't shrink)*
Their 2nd T-Shirt size choice (adult sizes listed. Shirts won't shrink)*
Primary instruments played*
Other instruments played well
Type of school the attend*
School Name*
School City and State*
Grade Level entering in the Fall*
Country of Birth*
Our Blues Kid enjoys . . .*

BaseballFootballBasketballWrestlingMartial ArtsSoccerSoftballBandChessNewspaper/YearbookStudent GovernmentCheer/SpiritSwimmingTrack & FieldGymnasticsHockeyWater PoloGolfTennisDebateAuto MechanicsGraphic DesignArcheryBadmitonRugbyFishingSkeet ShootingGame HuntingScoutBeauty PageantsModellingTheatre/DramaMusical TheatreMinistryStand-Up ComedyFilmmakingPhotographyOil/Acrylic PaintingPencil and Marker Sketch DrawingTypographyComputersVideo GamesBoard GamesCheckersSkipping RopeDartsMixed Media ArtBowlingPostage Stamp CollectingDoll CollectingGuitar CollectingMath and ScienceArchitectureCookingHelping Others
Tell us about any of their academic, athletic or arts related achievements.*

Part B: Our Blues Kid's Emergency Medical Information
Does your Blues Kid have a medical concern? If none mark "N/A"*
Will they be taking prescription meds during Blues Camp, on site?*
If so, what kind? And provide a written schedule.
Does your child have a food allergy? Any eating or drinking concerns? If "No," you can write that.*

Part D: Blues Camp Participation Waiver + Photo & Video Release Form
Audio, Photo and Video Release Form for Minors

I grant Blues Kids Foundation, their associated audio engineers, photographers, journalists, social media writers, TV stations and videographers permission to document my child on behalf of Blues Camp. I also give my consent to their direct or indirect licensees and assignees to publish, republish or otherwise transmit the image(s), audio or video content of my child in any medium throughout the world without compensation to me. I understand the image(s) may be used in a composite or altered or modified. I waive any right to inspect and approve any finished product or the text that may be used in connection with the image(s). I release Columbia College Chicago, The American Jazz Museum, Winston-Salem State University, C. Ron Allen, KOP Mentoring Network, Governors State University, Kappa Kamp, Maurice West, The Chicago Blues Festival, Blues Kids Foundation, Blues Kids of America, Fernando Jones, Knotty Luxe Arts Foundation, their officers and agents, and their direct or indirect licensees and assignees from any claims or remuneration associated with any damage, foreseen or unforeseen, associated with the commercial or artistic use of the image(s). I agree that this release is binding on my heirs and assignees. We will not publish or use any distasteful or unflattering photos of your child.
Yes, I have read and agree to the terms above on this form. Parent's or Legal Guardian's signature (below).*

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