TSDC Registration

TSDC Registration
Camper Information
Camper Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Student Phone # *

Area Code Phone Number
Parent/Guardian Information
Name *

First Name Last Name
Home Number

Area Code Phone Number
Cell Number *

Area Code Phone Number
Parent E-mail *
Participation Details
School *
Coach *
Gender *
Event *
Speech event (only if you chose speech for your event)
Extemp, Oratory, Congress, Informative
Interp event (only if you chose interp for your event)
Poetry/Prose, HI/DI and Duo
Will you be commuting every day to camp *
If you commute that means you do not need a room to sleep in at the University.
What size T-Shirt *
Roommate Preference

First Name Last Name

Emergency Information
Emergency Contact's Name *

First Name Last Name
Relationship
Phone Number *

Area Code Phone Number
Alt. Phone Number

Area Code Phone Number
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Does the camper take any medications? If yes, please list *
Upload copy of health insurance card

Browse Files

Cancel of
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Texas Speech and Debate Camp during the selected camp. In exchange for the acceptance of said child’s candidacy by Texas Speech and Debate Camp, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Texas Speech and Debate Camp and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Texas Speech and Debate Camp including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Texas Speech and Debate Camp and its affiliates including Directors and staff to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
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.
Signature

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TSDC Waiver and Photograph Release

Photograph Release
I grant to Texas Speech and Debate Camp, its representatives, staff and employees, the right to take photographs of me and my property in connection with Texas Speech and Debate Camp.
I authorize Texas Speech and Debate Camp, its assigns and transferees to copyright, use and publish the same in print and/or electronically.
I agree that Texas Speech and Debate Camp may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
I have read, agree and understand with the above
Camper Name *

First Name Last Name
Parent/Guardian Name

First Name Last Name
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.
Parent/Guardian Signature (If under age 18)

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TSDC Registration

Participation Details

TSDC Waiver and Photograph Release