Registration GNAT-TV JISP Youth Filmmaker's Club 2023

GNAT-TV 2023 JISP Youth Filmmaker's Club Registration

6378 Vermont Rte 7a #1, Sunderland, VT 05250
Please Select Your Student's JISP Program*

Tuesday JISP: Dorset, Flood Brook, Mountain School at Winhall, Sunderland, Homeschools January 9–March 5 (skips February 20)Thursday JISP: Currier, MEMS, Homeschools January 11–March 7 (skips February 22)
Student Info:
Student Name*

First NameLast Name
Birth Date:*

MonthDayYear
Gender:*

MaleFemaleNon-Binary
What school does your child attend?*
What is your child's current grade level?*
Address:*
City:*
State:*
Zip:*
Parent/Legal Guardian Info:
Parent/Legal Guardian Name(1):*

First NameLast Name
Relation to Student:*
Emergency phone number while JISP is in session:*

Area CodePhone Number
Parent/Guardian (1) email:*
Parent/Legal Guardian Name (2):

First NameLast Name
Relation to Student:
Parent/Guardian (2) email:
Parent/Legal Guardian (2) Emergency Phone Number:

Area CodePhone Number
Health Information/Waivers:
Emergency Medical Waiver: In the event of an emergency, if I cannot be reached, I grant permission for GNAT-TV staff to seek medical treatment for my child.*

Yes
Please list any activities the student should be restricted from. Any health conditions that would require special attention or medication while at JISP. Any known allergies (e.g. bees, peanuts, dairy, eggs, etc).*
GNAT-TV Staff expect students to show the utmost consideration for the feeling for others. We strive for cooperative and joyful interactions. In the event we experience behavioral issues with your child, we may contact you and ask that your child leave the program early. GNAT-TV reserves the right to dismiss from JISP any child whose behavior is inappropriate. In such event, no refund will be given.*

Yes-I agree
I agree that photos/video of my child may be taken and used for television broadcast, promotional purposes, including web and printed media.

Yes
Students Other Information:
How did you hear about GNAT-TV's Youth Filmmakers Club?*
What are your student's interests?*

WritingPerforming ArtsFilm MakingMusicGraphic Art/Photo/Painting/DrawingCookingStorytellingCostume and Set DesignDirecting/ProducingCamera Operator/Lighting/AudioReadingAnimationOther
Is there anything else we should know about this sudent to make the program more fun and accessible? e.g. about learning style, academic needs, social or emotional factors.*
Has the child attended a GNAT-TV workshop/camp in the past?*

YesNo
Payment
Scholarships are available - if you would like to apply for a scholarship please check below

Yes, I would like to apply for a scholarship
Please fill out the following form to apply for a scholarship - GNAT-TV JISP Scholarship
Payment
prevnext( X )
JISP Filmmaker's Club$200.00

Total $0.00
loading smart payment buttons...

The payment is ready! It will be completed once you submit the form.
Parent/Guardian Signature
Electronic signature, please initial:*
Electronic signature, First & Last Name:*
I acknowledge that my initials and name typed here on this form are as legally binding as my printed signature, and, further, that I am the parent and/or legal guardian of the "listed student" and over the age of 18. I also attest to the accuracy of all information entered on this form and authorize qualified personnel to apply general medical treatment to the "listed student." In addition, I agree that the "listed student" will only be released from JISP into the authority of the guardian listed on this form. I, further, certify that the "listed student" has my permission to attend this JISP program and participate in all JISP activities.
Should be Empty:

GNAT-TV 2023 JISP Youth Filmmaker's Club Registration

Student Info:

Parent/Legal Guardian Info:

Health Information/Waivers:

Students Other Information:

Payment

Parent/Guardian Signature