Summer Camp Detailed Registration Form

Hello, and thank you for your interest in the 2023 Cardinal Gibbons Broadcast Academy!

We are excited to offer incoming 6th-8th grade students behind-the-scenes access to our new CGTV studio located in the Phil Smith Family Building on campus.

Participants will learn to report, anchor, produce, direct, film, and edit alongside current Cardinal Gibbons High School students involved in the Digital Video Technology program, with guidance from faculty. Through a variety of hands-on projects, participants will learn how to write scripts, record videos, conduct interviews, operate studio and field cameras, and edit their videos as they work together to produce their own newscast for families to view at the end of the week.

All equipment will be provided.

Space is limited and will be reserved on a first come, first served basis. To reserve your student's seat, please complete this registration form and drop off or mail the $250 registration fee to Cardinal Gibbons High School, located at 2900 NE 47th St., Fort Lauderdale, FL 33308.

Cash, checks, and cashier's checks (made payable to Cardinal Gibbons High School) are accepted. Please note: both the registration form AND payment must be received before a space is reserved.

Once your form and payment are received, you will be sent a confirmation email. If necessary, a Wait List will be established for students who register after the academy has met its capacity.

If you have any questions about the Cardinal Gibbons Broadcast Academy or the registration process, please email Mrs. Erin Meyer, Digital Video Technology teacher and Cardinal Gibbons Broadcast Academy director, at meyer@cghsfl.org.

Thank you, and we look forward to seeing your student June 12!

Student Information

Student's Name*

First NameLast Name

Student's Birth Date*

MonthDayYear

Student's Grade (2023-24 School Year)*

Student's School (2023-24 School Year)*

Student's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Cell Number*

Parent/Guardian Email*

example@example.com

Emergency Information

Emergency Contact #1 Name*

First NameLast Name

Relationship to Student*

Phone Number*

Emergency Contact #2 Name*

First NameLast Name

Relationship to Student*

Phone Number*

Emergency Contact #3 Name*

First NameLast Name

Relationship to Student*

Phone Number*

Does your student have any allergies, chronic illness, or medical conditions? If yes, please describe. Additionally, please list any medications your student may need to take while attending the Cardinal Gibbons Broadcast Academy.*

Informed Consent and Acknowledgement As a parent and/or guardian of the student named above, I hereby give my approval for my child’s participation in any and all activities prepared by Cardinal Gibbons High School during Cardinal Gibbons Broadcast Academy.

Media Release As a parent and/or guardian of the student named above, I hereby acknowledge that Cardinal Gibbons High School reserves the right to use student photos and videos in any school or Archdiocesan publication including, but not limited to, print publications, videos, or websites including Facebook, Twitter, and other social media websites. Any parent who does not consent to pictures/videos of their child being used accordingly must notify Mrs. Erin Meyer, Cardinal Gibbons Broacast Academy director, via email prior to June 12.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

2023 Cardinal Gibbons Broadcast Academy Registration Form