Camp Cue Registration Form

Camper's Contact Information

Camper's *

First NameMiddle NameLast Name

Yes

If yes, please let us know

Example Susan Smith prefers to be called Suzy

Birth Date*

MonthDayYear

Age (on or before 8-9-2026)*

Nightlight Campers ages 8-16

MaleFemale

Camper's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Roommate Request (optional)

Not guaranteed but we will do our best

T-Shirt Size*

Unisex Sizes

NoneSome Dance ExperienceLots of Dance Experience

NoneSome Singing ExperienceLots of Singing Experience

NoneSome Acting ExperienceLots of Acting Experience

Anything you want us to know about this camper?

Parent/Guardian Information

Name*

First NameLast Name

Home Number*

Format: (000) 000-0000.

Cell Number*

Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Email*

Confirmation Emailexample@example.com

Parent/Guardian Information

Name

First NameLast Name

Home Number

Format: (000) 000-0000.

Cell Number

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Email

Confirmation Emailexample@example.com

Emergency Information

Emergency Contact 1*

First NameLast Name

Relationship*

Phone Number*

Format: (000) 000-0000.

Alt. Phone Number*

Format: (000) 000-0000.

Emergency Contact 2*

First NameLast Name

Relationship*

Phone Number*

Format: (000) 000-0000.

Alt. Phone Number*

Format: (000) 000-0000.

Camper's Medical Information

YesNo

Allergies and severity: if none, enter none.*

Please list all known allergies, if none, enter none

Does the camper have any chronic illness, or medical conditions? If yes, please describe. If no, please enter none.*

YesNoPlease contact parent first

Is the camper prescribed an inhaler or other medicines? If yes, please explain any instructions. If no, please enter none.*

YesNo

Medical Release and Authorization

As Parent and/or Guardian of the named camper {campers}, 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 {campers}. 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 {name103} 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 Camp Cue and Lake Tahoe's Shining Stars organization . and its affiliates including Directors, Staff, Coaches and Volunteers to provide the needed emergency treatment prior to the child’s {campers} admission to the medical facility.

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

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.

Signature*

Date*

Date

Waiver and Release of Liability and Imdemnity Agreement

Upon signing this Agreement and forever thereafter, you agree that if you participate in or attend any Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or Lake Tahoe’s Shining Stars or Camp Cue related event, or that of any Lake Tahoe’s Shining Stars or Camp Cue, or are present on Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4_4 camp of Nevada premises or use any Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4-H Camp of Nevada facility, you do so at your own risk and assume the risk of any and all injury and/or damage you might sustain, regardless of whether you are a participant, a spectator, volunteer or otherwise. Your assumption of risk includes but is not limited to the use of any sports or other equipment (mechanical or otherwise) and accessing Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4-H Camp of Nevada premises. You further agree to assume the risk of your participation in or presence at any sporting event, practice, activity, class, program, instruction, or Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe sponsored event. You agree that you are voluntarily participating in the aforementioned activities and assume all risk, known and unknown, associated with same. You agree on behalf of yourself (and your spouse, all your children, personal representatives, heirs, executors, administrators, agents, and assigns) to forever release and discharge Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4-H Camp of Nevada , their owners, employees, agents, representatives, affiliates, successors, and assigns from any and all claims or causes of action (known or unknown) arising out of the negligence of Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4-H Camp of Nevada , whether active or passive, or that of any of its affiliates, employees, agents, representatives, successors, and assigns. This waiver and release of liability includes, without limitation, injuries which may occur as a result of (a) your use of any equipment or facilities which may malfunction or break, (b) Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe, improper maintenance of any and all equipment or facilities, (c) Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe negligent instruction or supervision, including personal training, strength training, refereeing and coaching,(d) you slipping or tripping and falling while at Lake Tahoe’s Shining Stars event or attending Camp Cue Lake Tahoe , including Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4-H Camp of Nevada negligent inspection or maintenance of such premises, and (e) you sustaining personal injuries as a result of the dangerous condition of property on which you are present in relation to any Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe function, including Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe` negligent inspection or maintenance of such premises. By executing this Agreement, you hereby agree to indemnify and hold harmless Lake Tahoe’s Shining Stars and Camp Cue Lake Tahoe and 4_H Camp Nevada from any loss, liability, damage, or cost Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4-H Camp of Nevada may incur due to your presence at any Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4_H Camp Nevada premises or facility. You further expressly agree that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the law of the state in which this agreement is entered into, and that if any portion of this agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release is not intended as an attempted release of claims of gross negligence or intentional acts. You acknowledge that Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4_H Camp Nevada provide a service to their members and is not in the business of selling, leasing, or otherwise placing into the stream of commerce exercise or sports equipment, or other such products, and the use of any such items is incidental to the service provided by Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4_H Camp Nevada. YOU ACKNOWLEDGE THAT YOU HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY, AND EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT. YOU ARE AWARE AND AGREE THAT BY EXECUTING THIS WAIVER AND RELEASE, YOU ARE GIVING UP YOUR RIGHT TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST Lake Tahoe’s Shining Stars or Camp Cue Lake Tahoe or 4_H Camp Nevada FOR THEIR NEGLIGENCE, OR FOR ANY DEFECTIVE PRODUCT ON THEIR PREMISES. YOU HAVE READ AND VOLUNTARILY SIGNED THEWAIVER AND RELEASE AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS,

STATEMENTS, OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAS BEEN MADE. YOU AGREE, FOR YOURSELF AND YOUR SPOUSE, CHILDREN, SUCCESSORS, HEIRS AND ASSIGNS, THAT THE ABOVE REPRESENTATIONS ARE CONTRACTUALLY BINDING, AND ARE NOT MERE RECITALS, AND THAT SHOULD YOU OR YOUR SUCCESSORS ASSERT ANY CLAIM IN CONTRAVENTION OF THIS AGREEMENT, THE ASSERTING PARTY SHALL BE LIABLE FOR THE EXPENSES (INCLUDING REASONABLE ATTORNEYS FEES) INCURRED BY THE OTHER PARTY OR PARTIES IN DEFENDING AGAINST ANY SUCH ACTION.

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*

Date*

Date

Video, Photo and Sound Recording Release Waiver

I hereby grant Lake Tahoe's Shining Stars and Camp Cue Lake Tahoe permission to
use my camper's likeness in a photograph in any and all of its publications, including but not limited to all of LakeTahoe's Shining Stars and Camp Cue Lake Tahoe's printed and digital publications. I understand and agree that any photograph using my camper's likeness will become property of Lake Tahoe's Shining Stars and Camp Cue
Lake Tahoe and will not be returned.
I acknowledge that since my camper's participation with Lake Tahoe's Shining Stars and Camp Cue Lake Tahoe is voluntary, I will receive no financial compensation.
I hereby irrevocably authorize Lake Tahoe's Shining Stars and Camp Cue Lake Tahoe to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing Lake Tahoe's Shining Stars and Camp Cue Lake Tahoe's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my camper's likeness appears.
Additionally, I waive any right to royalties or other compensation arising or related to the use of the photographs.
I hereby hold harmless and release and forever discharge Lake Tahoe's Shining Stars and Camp Cue Lake Tahoe from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Signature*

Date*

Date

Cancellation Policy and Payment Schedule

I understand the cancellation policy as follows: Due at time of registration is $250.00 non refundable deposit. Camp must be paid in full no later than July 9th, 2026. I will have the option to pay in full at time of registration or 2 Payment Installments due May 9th, 2026 and July 9th 2026 $262.50 (Overnight Camp)$162.50 (Day Camp) Full refund (less the deposit) - May 9th, 50% refund (less the deposit)-July 9th, No refunds after July 9th, 2025 Space is limited*

Yes I have read and agree to the cancellation policy

Product Options

Registration Fee Only with two remaining payments due

Pay the non refundable deposit only. Due at time of registration is $250 non refundable deposit. 2 Payment Installments due May 9th, 2026 and July 9th 2026 $262.50 (Overnight Camp) $162.50 (Day Camp) Full refund (less the deposit) -Cancel by May 9th , 50% refund (less the deposit)-Cancel by July 9th No refunds afters July 9th, 2026.

$250.00

Nightlights Full Camp Payment

Open to campers aged 8 to 17 years old*, this exciting program brings together kids from all over for a week of creativity, learning, and fun. Throughout the week, campers will build confidence, develop their talents, and form lasting friendships while engaging in hands-on workshops, rehearsals, team-building activities & lots of beach time. Evenings will be filled with campfire sing-alongs, talent showcases, and special themed events, creating an unforgettable overnight camp experience. The program culminates in a spectacular end-of-camp performance, where campers showcase their hard work in front of family and friends. This final show is a celebration of their dedication, creativity, and newfound skills! Fees include: 4 nights of lodging All meals and snacks All activities, classes, and seminars Camp T-shirt & bag *Must be 8 years old by day one of camp

$775.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

ACH Bank Transfer

Nightlights Camp Cue 2026

Payment Methods