Teen Patriots Application Form

Teen Patriots Application Form

Thank you for considering being one of our Teen Patriots. This is available to students entering grades 7 and above. There are many opportunities for consideration. We have many opportunities for your participation. If you have any questions at all, email us at info@LibertyCampForKids.com. Thank you for choosing Liberty Camp for Kids!
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Grade entering in the fall*
Age during camp week*
Gender*

MaleFemale
T-shirt size*

Adult SAdult MAdult LAdult XLYouth SYouth MYouth LYouth XLSize not listed; will email
Hobbies, Interests, Skills*
List all that may apply
Previous Volunteer Experience*
Extra-Curricular Activities*
Emergency Contact*
List name, relationship, and phone number. (This may be changed later if need be.)
What types of roles for camp interests you?*

Supervising younger childrenAssisting group leadersRole playing/acting as a colonist in playsAny of the above
Release Authorizations
Photo and Video Release

PARENT AUTHORIZATION REQUIRED: I hereby authorize the Liberty Camp for Kids to take pictures and videos, reproduce, and/or publish all written and/or visual materials that are made during Liberty Camp for Kids events, including photographs and video that may pertain to me or my child/ren. This material may be used in publications, public affairs releases, social media, or recruitment materials. This authorization is continuous and may only be withdrawn by my specific rescission of the authorization. Liberty Camp for Kids may publish materials, use my name or my child's name, photograph, video, and/or refer to me or my child in any manner that the Liberty Camp for Kids deems appropriate to promote/publicize the event.
Agree?*

I approveI disapprove
Liability Authorization

PARENT AUTHORIZATION REQUIRED FOR ATTENDANCE AT CAMP: The undersigned (parent) hereby request and approve entrant's application and participation in the Liberty Camp for Kids. In consideration of this application, the undersigned hereby agrees that entrant's participation will be at the sole risk of entrant and the undersigned without liability to the Liberty Camp for Kids and their officers, members, and agents, all of whom the undersigned hereby agrees to release, indemnify, and hold harmless from any and all claims and expenses resulting from or relating to entrant's said participation.
Agree?*

I approveI disapprove
Parent Signature*

I have reviewed the application (PARENT)
Should be Empty:

Teen Patriots Application Form

Release Authorizations