The FSU Summer Music Camps PO Box 3061180 Tallahassee, FL 32306-1180 850-644-9934 https://music.fsu.edu/summermusiccamps

SUMMER 2020 CAMP FORMS PACKET

Dear Camp Family,

We are so excited to have you as part of the FSU Summer Music Camps for 2020. We want your time at camp to be the highlight of your summer, and these forms will help our staff to make that happen for you.

On the following pages you will find required and optional forms. Please be sure to PRINT CLEARLY.

REQUIRED:

• Camper Conduct Agreement • Medical Information and History Form (with Medication Form to be used as needed) • Statement of Voluntary Consent Form • Financial Responsibility Form • Housing, Dining, and Travel Form • Sign-Out Permission Form

OPTIONAL:

• CD and Group Photo Order Form • Shuttle Service Form

These forms should be returned to us as soon as possible, but no later than two weeks before the start of your camp. If you are coming to multiple camps, you only need to do one set of forms. If you have siblings attending camps, each camper needs to have their own set of forms.

Forms can be returned as follows:

BY MAIL TO: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180 If you are filling these forms out less than two weeks before camp begins, DO NOT MAIL THEM. Either email them to us or bring them with you. They won’t reach us in time because of our campus mail system.

BY EMAIL WITH ELECTRONIC SIGNATURES TO: musiccamps@fsu.edu

If you decide you would rather complete these forms online, you can find them at: https://fsumusiccampers-fsu.us.fluidreview.com/

Please feel free to contact us with any questions. We look forward to seeing you this summer.

Sincerely, The Administration Team at the FSU Summer Music Camps

fSU SUMMER MUSIC CAMPS camper conduct contractOFFICE: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180 / PHONE: (850) 644-9934 / EMAIL: musiccamps@fsu.edu

Nothing is more important to us than the well-being of our campers. We are vigilant about emotional safety as well as physical safety; about creating a place where campers feel safe, supported in reaching their goals and accomplishing challenges, and where everyone can have fun. To this end, the FSU Summer Music Camps requires all campers and parents to read and agree to the following Camp Rules and Behavior Policies:

I WILL SHOW RESPECT FOR OTHERS• I will uphold the standards of our community of camp musicians; helping to maintain a safe and welcoming environment,

and helping to foster positive relationships between fellow campers as well as with camp staff and instructors.• I understand that the FSU Summer Music Camps maintains a bully-free environment, and does not tolerate bullying

behaviors in any form including the use of social media. “Bullying” is when one or more people exclude, tease, taunt, gossip, intimidate, stalk, destroy property, hit, kick, or put down another person with the intent to hurt another or at the expense of someone else. Bullying can also happen through cyberspace: through the use of e-mails, the internet, cell phones, text messaging, instant messaging, social media apps, and other less direct methods. Bullying is inexcusable, and campers that are believed to be bullying or participating in bullying behaviors will be subject to immediate disciplinary actions, up to and including dismissal. Anti-semitic racist, and discriminating behaviors and rhetoric will not be tolerated. Campers believed to be participating in discriminating behaviors will be subject to immediate disciplinary actions, up to and including dismissal.

• I will adhere to University rules and regulations and all codes of conduct while on campus.

I WILL USE MY CELL PHONE RESPONSIBLY• I understand that I am allowed to have a cell phone for use during free time. My cell phone and all other devices such as

smart watches, music players, games, tablets, and other similar devices will be TURNED OFF COMPLETELY and PUTAWAY OUT OF SIGHT during all classes, rehearsals, and performances.

• I may not take videos or photos during performances with my phone unless I have received prior approval from the CampDirector, Assistant Camp Director, or Dorm Supervisor prior to the event.

• I understand that if my cell phone is turned on, visible, or being used during class, rehearsals, concerts/performances itmay be confiscated according to the following policy by any member of the camp staff:

First Offense: The cell phone will be confiscated for the duration of the event/class/rehearsal/etc. but will be returned to me at the end of the event.

Second Offense: The cell phone will be confiscated for a period of 24 hours. Third Offense: The cell phone or device will be confiscated for the duration of camp. The item will be returned

to me at camp check-out.If my cell phone is confiscated, my parents will still be able to contact me either through the Camp Office or the Southgate Campus Centre.

I WILL FOLLOW THE RULES OF THE DORMITORY• I will respect the rights, privacy, and property of others. There will be no stealing. There will be no vandalism. Furniture

may not be moved from one room to another. I understand that charges will be made for damages to property. Anydamages will be billed to the camper’s family by the Southgate Campus Center.

• I will take responsibility for my personal property, room key, and meal card (paying for, if lost). I agree to secure my room atall times to protect my property and the property of my roommates.

• I understand that there is no room visitation permitted between members of the opposite gender.• I understand that practicing my instrument is not permitted at the Southgate Campus Center as it is a residence. Practice

rooms are available and monitored in the music buildings.• I understand that only music campers are permitted in the residential areas of Southgate.• I will follow all rules discussed at Orientation, in small group sessions, and as directed by any member of the camp staff.

I WILL TAKE RESPONSIBILITY FOR MY SAFETY AND THE SAFETY OF OTHERS• I will not transport other campers in my personal vehicle. If I do transport other campers in my personal vehicle I do so at

my own risk and I am responsible for anything that happens to the other camper(s) while in my car. I understand that I maynot travel in the personal vehicle of another camper.

• I understand that due to the risk of fire, motorized vehicles such as motorcycles, mopeds, hoverboards, self-balancingscooter boards, two-wheeled scooters, Segways, carts, etc. are not permitted at camp.

• I understand that the possession or use of a firearm, knife, pellet gun, air gun, spring loaded or paintball gun, orother weapons on campus is a violation of FSU policy and not permitted on campus or at the FSU Summer MusicCamps. Weapons include items that are seemingly harmless but may be used as weapons—the so-called “dual use” items.(i.e. pen/utility knives, box cutters, knives of any length or size, sabers, swords or metal scissors with pointed tips). I will notbring any of these items to camp.

I WILL BE RESPECTFUL IN MY USE OF SOCIAL MEDIA AND THE INTERNET• I will be respectful in all communications and blogs related to or referencing the camp, its employees, and other campers.• I may not post photographs or other likenesses of other campers’ or employees without the individual’s explicit consent.• I will not use obscenities, profanity, or vulgar language.• I will not harass, bully, or intimidate other campers or employees of the camp. Behaviors that constitute harassment and

bullying include, but are not limited to, comments that are derogatory with respect to race, religion, gender, sexual orienta-tion, color, body image, or disability; sexually suggestive, humiliating, or demeaning comments; and threats to stalk, haze,or physically injure another person.

• I will not discuss engaging in conduct that is prohibited by camp policies, including, but not limited to, the use of alcoholand drugs, sexual behavior, sexual harassment, and bullying.

• I understand that if I am found to be in violation of any portion of this Social Networking and Internet Policy I amsubject to immediate disciplinary action, up to and including dismissal.

I WILL NOT POSSESS OR USE ANY ALCOHOL, TOBACCO, VAPING, E-CIGARETTES, OR DRUGS DURING THE CAMP (UNLESS PRESCRIBED BY A PHYSICIAN).

• Florida State University is a smoke-free campus. Smoking and use of smokeless tobacco products are prohibited at theFSU Summer Music Camps. I understand that the use or possession of any non-prescribed drug, alcohol, marijuana,tobacco products, or any other controlled substance is grounds for automatic dismissal from the Summer MusicCamps.

I UNDERSTAND THAT IF I VIOLATE THE RULES, REGULATIONS, AND CODE OF CONDUCT FOR THIS CAMP, MY PARENTS WILL BE CONTACTED, AND I SHALL BE SUBJECT TO DISCIPLINARY ACTIONS BY THE DIRECTOR OF CAMPUS LIFE, THE DEAN OF STUDENTS, THE ASSISTANT CAMP DIRECTORS, OR THE CAMP DIRECTOR, UP TO AND INCLUDING DISMISSAL FROM CAMP.

Any camper who persistently violates academic or Southgate Campus Centre regulations, the standards of the FSU Summer Music Camps, or standards of Florida State University makes himself/herself liable for dismissal. The breaking of any civil law or city ordinance is grounds for automatic dismissal from the Summer Music Camps. Should you be dismissed for any of these reasons, your parents or guardians will be notified. They will be responsible for your immediate transportation home. Students dismissed from camp at any time will not be reimbursed any funds paid, including tuition, housing, and food payments.

I, ____________________________________(Camper Signature), have read, understand, and will abide by the rules and guidelines as stated in this Camper Conduct Contract and in the Camper Handbook. Failure to abide by these policies and guidelines may result in my dismissal from the FSU Summer Music Camps.

I, ____________________________________(Parent/Guardian Signature), have read, understand, and will support both my child and the FSU Summer Music Camps in the administration and compliance to the rules and guidelines as stated in this Camper Conduct Contract and in the Camper Handbook. Failure of my child to abide by these policies and guidelines may result in my child’s dismissal from the FSU Summer Music Camps.

CAMPER’S NAME:

This required form will be used in the event of any necessary medical care for your child and in the event of an emergency. It is imperative that this form be completed in full, with accurate information. If you have any questions about this form, any ongoing medical condition that requires attention, or any other health concern, please call our office at 850-644-9934.

Significant Current Medical, Behavioral, or Physical Conditions:

Activity Restriction or Assistance:Please provide us with detailed information about any activities which the camper may be restricted from or activities which the camper may need assistance with. If none, leave blank. You may attach another sheet if needed.

Continued on next page

Has your child had a tetanus shot within the last 6 years? YES NODoes your child carry a rescue inhaler? YES NODoes your child carry an Epi-Pen? YES NO

PART 1: GENERAL MEDICAL INFORMATION

NoneADD or ADHDAsthma / Breathing ProblemsAutism Spectrum DisordersBleeding Disorder

Cardiac ProblemDepressionDiabetes (requiring management)Diabetes (requiring low/no management)Eating Disorder

EpilepsyHearing ProblemVision ProblemOther (see details below)

Is your child allergic to anything?No Known AllergiesAmoxicillianAspirinIbuprofenPenicillinSulfonamides (Sulfa Drugs)

Other Allergies or Drug Sensativies:

Food AllergiesNut AllergiesInsect Bites / StingsSeasonal / Environmental AllergiesIodine ProductsLatex Allergies

EMERGENCY CONTACT: Mother/Guardian #1 Name: Phone Number:

EMERGENCY CONTACT: Father/Guardian #2 Name: Phone Number:

EMERGENCY CONTACT: Alternate Name: Phone Number:

CAMPER’S PRIMARY PHYSICIAN: Name: Office Phone:

OFFICE: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180 / PHONE: (850) 644-9934 / EMAIL: musiccamps@fsu.edu

Please provide us with detailed information about any other ongoing medical, behavioral, emotional, or physical conditions/treatments or additional information about any of the above conditions. If none, leave blank. You may attach another sheet if needed.

Does your child have any of the following?

Page 1 of 3

fSU SUMMER MUSIC CAMPS medical information and history form

CAMPER’S NAME:

ALL CAMPERS SHOULD BRING A SUPPLY OF MEDICATIONS WITH THEM TO CAMP. This supply should include common medications (ex: Tylenol, Advil, Benadryl, Tums, etc...) that the camper might need in the event that they don’t feel well, and any medications that the camper takes on a regular basis. THE FSU SUMMER MUSIC CAMPS DOES NOT HAVE A SUPPLY OF COMMON MEDICATIONS TO GIVE TO CAMPERS, and we do not have a camp nurse. That means if you don’t pack medication for something like a simple headache, the camper will NOT be able to get any medication. Please visit our web site for complete information about medications.

You will need to provide information about the medications you are packing on a separate sheet. We have provided a sheet you can use on the following pages of this form, or you can provide an instruction sheet of your own.

On the instruction sheet, be sure to include all of the over-the-counter medications you are packing (ex: Tylenol, cough syrup, etc), as well as any daily medications, and/or prescription medications. If you do not have this information yet, or expect it to change by the time camp is here, you always can update the instruction sheet at a later date.

I WANT TO GIVE THE MEDICATIONS WE PACK TO CAMP STAFF AND STAFF WILL ADMINISTER AS I DIRECT ON THE ATTACHED INSTRUCTION FORM

OR OPTION 2:

Acetaminophen (Tylenol)Ibuprofen (Advil, Motrin)Naproxen (Aleve)Antacid (Tums, Milk of Magnesia)Anti-Diarrheal (Immodium AD)Anti-Constipation (Duloclax, Ex-Lax)

Oral Antihistamine (Benadryl)Topical Antihistamine (Benadryl)Cough DropsCough SyrupDaytime Cold Medication (DayQuil)Nighttime Cold Medication (NyQuil)

I request that my child, , be permitted to keep his/her medications on their person or in their room at camp.

Below are the medications that I have packed and that my child will have with them at camp:

Parent/Guardian Signature Date

Other medications not listed above: (Add a separate sheet if needed. We do not need to know the dose; drug names only)

I understand and agree that my child will be solely responsible for these medications and for taking them as directed. I understand and agree that it is not permissible for my child to provide medications to other camper(s) and doing so may result in dismissal from camp. I understand and agree that camp staff will not be involved at all with administration of medications to my child. I understand and agree that any medication that my child needs which they do not bring with them to camp may only be received through treatment at a medical facility by a medical professional.

I WANT MY CAMPER TO KEEP THE MEDICATIONS WE PACK IN HIS/HER ROOM

Do any of the medications you are bringing require refrigeration? YES NO

OPTION 1:

Continued on next pagePage 2 of 3

PART 2: MEDICATIONS

Select one of the two options below for how you would like medications managed for your camper:

Parent/Guardian Signature Date

Authorization: This health history , medication information, and insurance information is correct to the best of my knowledge and the student herein described has permission to engage in activities, unless otherwise noted by me in writing. I give permission to the University Physical and the University Health Center, or other facility, to hospitalize and to secure proper treatment for my child as named above.

Initial in the box to the insurance statement which applies to you:

☐ I am providing the required copy of my insurance card below (or on an attached page).☐ I can not provide a copy of my insurance card because I have TriCare and it is my military ID.☐ I have insurance but I can not provide the required copy of my ID because:

CAMPER’S NAME:

The space below is provided for you to attach the REQUIRED copy of your insurance card (if applicable) or you may attach it on another sheet if needed.

PART 3: INSURANCE

PART 4: FORM AUTHORIZATION

I hereby declare and represent that my Child is NOT covered by an individual or family medical insurance policy and as such, I agree and accept that any and all costs which may be incurred for medical care during the course of the Camp will be solely my responsibility.

ORI hereby declare and represent that my Child IS covered by an individual or family medical insurance policy and this policy will be in effect for the duration of Camp. I have provided the required insurance information below, and I understand that it is my responsibility to provide The FSU Summer Music Camps with any updates and/or changes to this insurance information before or during Camp.

Policy Holder’s Name:Health Insurance Company:Policy Number:Group Number (if applicable):

MEDICATION OPTION 1:DOSE/INSTRUCTION FORM FOR STAFF(Use this form only if you selected Option 1 on the Medication section of the Medical Form)

LAST NAME (print):____________________________________ FIRST NAME:_________________________________

SIGNAURE OF PARENT OR PHYSICIAN

INSTRUCTIONS: Campers who wish to have medications (prescription or non-prescription) administered by camp staff must bring the medications with them to camp. WE DO NOT HAVE A SUPPLY OF MEDICATIONS TO GIVE CAMPERS. Please refer to your Camper Handbook, which explains the camp's policy about medications and how they should be packed

Be sure to include all over-the-counter medications you are packing (ie Tylenol, cough syrup, etc), as well as any daily medications, and/or prescription medications. Please provide us with updates for this form as needed if medications change.

NAME OF MEDICATION: (print) _____________________________________________________

CHECK ALL BOXES THAT APPLY TO THIS MEDICATION. Prescription medication. Over-the-counter medication

Taken on a routine basis. Taken on an as-needed basis.

Complete below as per original container’s label: Dosage:______________________________________________

Frequency:____________________________________________

Expiration Date:________________________________________

Purpose:______________________________________________

_____________________________________________________

Comments: ___________________________________________

NAME OF MEDICATION: (print) _____________________________________________________

CHECK ALL BOXES THAT APPLY TO THIS MEDICATION. Prescription medication. Over-the-counter medication

Taken on a routine basis. Taken on an as-needed basis.

Complete below as per original container’s label: Dosage:______________________________________________

Frequency:____________________________________________

Expiration Date:________________________________________

Purpose:______________________________________________

_____________________________________________________

Comments: ___________________________________________

NAME OF MEDICATION: (print) _____________________________________________________

CHECK ALL BOXES THAT APPLY TO THIS MEDICATION. Prescription medication. Over-the-counter medication

Taken on a routine basis. Taken on an as-needed basis.

Complete below as per original container’s label: Dosage:______________________________________________

Frequency:____________________________________________

Expiration Date:________________________________________

Purpose:______________________________________________

_____________________________________________________

Comments: ___________________________________________

NAME OF MEDICATION: (print) _____________________________________________________

CHECK ALL BOXES THAT APPLY TO THIS MEDICATION. Prescription medication. Over-the-counter medication

Taken on a routine basis. Taken on an as-needed basis.

Complete below as per original container’s label:

Dosage:______________________________________________

Frequency:____________________________________________

Expiration Date:________________________________________

Purpose:______________________________________________

_____________________________________________________

Comments: ___________________________________________

NAME OF MEDICATION: (print) _____________________________________________________

CHECK ALL BOXES THAT APPLY TO THIS MEDICATION. Prescription medication. Over-the-counter medication

Taken on a routine basis. Taken on an as-needed basis.

Complete below as per original container’s label: Dosage:______________________________________________

Frequency:____________________________________________

Expiration Date:________________________________________

Purpose:______________________________________________

_____________________________________________________

Comments: ___________________________________________

NAME OF MEDICATION: (print) _____________________________________________________

CHECK ALL BOXES THAT APPLY TO THIS MEDICATION. Prescription medication. Over-the-counter medication

Taken on a routine basis. Taken on an as-needed basis.

Complete below as per original container’s label: Dosage:______________________________________________

Frequency:____________________________________________

Expiration Date:________________________________________

Purpose:______________________________________________

_____________________________________________________

Comments: ___________________________________________

NAME OF MEDICATION: (print) _____________________________________________________

CHECK ALL BOXES THAT APPLY TO THIS MEDICATION. Prescription medication. Over-the-counter medication

Taken on a routine basis. Taken on an as-needed basis.

Complete below as per original container’s label: Dosage:______________________________________________

Frequency:____________________________________________

Expiration Date:________________________________________

Purpose:______________________________________________

_____________________________________________________

Comments: ___________________________________________

NAME OF MEDICATION: (print) _____________________________________________________

CHECK ALL BOXES THAT APPLY TO THIS MEDICATION. Prescription medication. Over-the-counter medication

Taken on a routine basis. Taken on an as-needed basis.

Complete below as per original container’s label: Dosage:______________________________________________

Frequency:____________________________________________

Expiration Date:________________________________________

Purpose:______________________________________________

_____________________________________________________

Comments: ___________________________________________

NAME OF MEDICATION: (print) _____________________________________________________

CHECK ALL BOXES THAT APPLY TO THIS MEDICATION. Prescription medication. Over-the-counter medication

Taken on a routine basis. Taken on an as-needed basis.

Complete below as per original container’s label:

Dosage:______________________________________________ Frequency:____________________________________________

Expiration Date:________________________________________

Purpose:______________________________________________

_____________________________________________________

Comments: ___________________________________________

NAME OF MEDICATION: (print) _____________________________________________________

CHECK ALL BOXES THAT APPLY TO THIS MEDICATION. Prescription medication. Over-the-counter medication

Taken on a routine basis. Taken on an as-needed basis.

Complete below as per original container’s label: Dosage:______________________________________________

Frequency:____________________________________________

Expiration Date:________________________________________

Purpose:______________________________________________

_____________________________________________________

Comments: ___________________________________________

$11.00

In consideration of my child’s _______________________________________________________participation in Florida State University Summer Music Camps(Print Camper’s Name)

(“Camps”) ____________________________________________________________ and for other good and consideration received by me, receipt of which is (Print Name of Camp Program(s))

hereby acknowledged, I, ___________________________________________________ having actual knowledge and conscious appreciation of the particular(Print Name of Parent /Guardian)

dangers involved in the activities described herein, including, but not limited to sports and recreation activities which may include trips by motor vehicle away from the Florida State University campus, do voluntarily consent to my Child’s participation in the aforementioned activities and release The Florida State University (“FSU”) and The Florida Board of Governors, their employees and agents, from liability therefrom and assume the risks arising therefrom and for my child’s failure to follow the camp’s policies and instructions, such as leaving the camp without permission.

I am fully aware that the employees of The Florida State University Summer Music Camps are not medical health professionals and are not responsible for making medical decisions on behalf of my child. I hereby declare and represent that I am aware that for students aged 12 and under and for students without insurance, the The Florida State University Health Center (“Health Center”) is not available and that any necessary medical treatment for students 12 and under would be administered at a local urgent care facility or hospital. I hereby declare and represent that I am aware that Health Center will be utilized for insured students aged 13 and older, if necessary, for the treatment of certain injuries and illnesses which might arise out of the above described activities and I do fully consent to the Health Center providing such treatment. I understand that the treatment would involve the administering of appropriate medication or drugs. I do understand that generally the administering of proper medication or drugs is preferable to leaving the condition untreated; and that violent reaction to medication or drugs could occur.

Should routine first-aid or emergency medical needs arise such as cuts, scrapes, bruises, or lacerations, I consent to treatment necessary to prevent infection and promote healing. This would involve, as a matter of accepted medical practice in the community, cleansing and use of topical antibiotic cream/ointment, as appropriate under the circumstances.

Regarding major emergencies or medical traumas, I understand that the Health Center professional staff would provide whatever care or treatment they reasonably could and would refer to the appropriate physician/facility the further treatment of such. Should the Health Center be unable to contact me, it is my desire that my child receive such treatment, nonetheless, and I will hold the Health Center harmless for such treatment or referral.

I hereby declare and represent that I am aware that employees of The Florida State University Summer Music Camps dormitory staff will administer medications as directed by me or my child’s physician unless I have signed a Medication Permission form. I am fully aware that it is my responsibility to provide exact medication information and ample medication at the start of Camp, to provide Camp with updates and/or changes to medication usage and/or dosage for my child, and to ensure that all medications have been given to the counselor on the first day of camp. I understand that my child may not keep medications of any kind in the dorm room unless I have signed a Medication Permission Form and I hereby declare and represent that The Florida State University Summer Music Camps reserves the right to have medication administered by the Health Center if necessary.

Being fully aware of the hazards and possible consequences involved in treatment of the above-described routine and major emergency conditions I, being legally competent to give consent, hereby consent to such treatment and agree to hold the Health Center, The Florida State University, and The Florida Board of Governors, their employees and agents, free and harmless from any claims, demands, suits, or damages from any injury or complications whatever which may result from such treatment.

In signing this Voluntary Consent, I recognize that additional costs may be incurred as the result of any accident or medical incident involving my child and I will be responsible for such costs, including medical costs, as a result of such accident or injury in connection with the activities associated with my child’s participation.

I further do hereby consent and agree that the Camp and FSU have the right to utilize photographs or video or audio of Child (and/or property) taken during the Camp program and to use these for educational, promotional or commercial materials, including FSU, Camp web sites and social networking pages. I further con-sent that Child’s name and identity may be revealed therein or by descriptive text or commentary. I do hereby release to FSU all rights to exhibit this work publicly or privately, including posting it on the FSU and Camp web site. I waive any rights, claims or interests I may have to control the use of Child’s identity or likeness in the photographs, video, or audio, in perpetuity and agree that any uses described herein may be made without compensation or additional consideration.

I do hereby declare and represent that in making, executing, and tendering this Voluntary Consent, I understand and acknowledge the circumstances involved in my child’s participation in the described activities, and that I have read this statement, understood its contents, and executed it on my own free will and choice, and do so to benefit the best interests of my child.

I represent that I have read and understand the foregoing statement and am competent to execute this agreement. (Youth under 18 must have parent signature)

I have executed this document this __________ day of _________________, 20 __________,

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF THE FLORIDA STATE UNIVERSITY SUMMER MUSIC CAMPS USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM THE FLORIDA STATE UNIVERSITY SUMMER MUSIC CAMPS IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A LOGICAL PART OF THE CAMP ACTIVITY AND PARTICIPATION. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND THE FLORIDA STATE UNIVERSITY SUMMER MUSIC CAMPS HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

Parent/Guardian Signature

Parent/Guardian Address

Home Phone Alternate PhoneRelationship To Camper

fSU SUMMER MUSIC CAMPS statement of voluntary consentOFFICE: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180 / PHONE: (850) 644-9934 / EMAIL: musiccamps@fsu.edu

Because the registered camper is a minor, the parent or legal guardian is responsible for all charges incurred by the camper. This includes the $100.00 deposit (applied towards tuition charges), appropriate tuition amount, and any housing costs. This may also include any third-party scholarship monies promised by an organization such as from a band booster or youth orchestra. You will receive credit automatically for any discount awarded directly from the Summer Music Camps to your son or daughter.

All monies are due 14 days before the start of a camp and payment can be made in the form of a check, money order, or credit card. By signing this agreement, a parent or legal guardian agrees to comply with all FSU payment time-lines, policies, and procedures. If you change financial institutions, or make other changes that might affect the processing of payments made for the 2020 Summer Music Camps, please notify the Camp Registrar.

To pay online: Go to http://fees.fsu.edu. Select "Guest-Style FSUID". Enter the Customer Number which you received when you registered and proceed as directed. You will be assessed a non-refundable convenience fee to cover the cost of the transaction. The amount will be displayed before you commit to completing your payment.

To pay by check or money order: Make checks payable to Florida State University and mail to: FSU-CAPD, Attn: Cashier, PO Box 3061640, Tallahassee, FL 32306-1640. Be sure to reference the student’s name and the camp they are attending in the memo portion of the check.  PLEASE NOTE THAT CHECKS WILL NOT BE ACCEPTED AFTER THE BALANCE DEADLINE and check payments will NOT BE ACCEPTED at camp check-in under any circumstance.

Scholarships: If you are receiving a scholarship from a third-party (such as from a band booster or youth orchestra), please make certain these funds have been forwarded to FSU in a timely fashion. Please bring contact information for the person or group awarding the scholarship with you when you arrive for check-in the first day of camp in case there are questions about outstanding balances.

Parent/Guardian Name (please print or type)

Parent/Guardian Signature Date

I have read the above Financial Responsibility Agreement and understand that I, as parent/ legal guardian, am responsible for all charges incurred by my student for the 2020 Summer Music Camps.

If the student is unable to attend camp for any reason, the following refund policy will apply:

Written notice received in the camp office 10 or more BUSINESS DAYS (M-F; 8am-5pm) prior to camp check-in:If written notice of cancellation is received 10 or more business days prior to the start of camp you will be refunded tuition and housing payments LESS the $100.00 non-refundable deposit.

Written notice received in the camp office 1-9 BUSINESS DAYS (M-F; 8am-5pm) prior to camp check-in:If written notice of cancellation is received 1-9 business days prior to the start of camp, you will be refunded TUITION LESS the $100.00 non-refundable deposit. No housing refund is available at this point.

As of 5:00pm on the last business day before camp check-in there are no refunds of any kind.

Accepted forms of written notification of cancellation include:• Letters mailed to the camp administration office• Emails sent to the camp administration office at musiccamps@fsu.edu• Letters faxed to the camp administration office at 850-644-5257All of the above methods must be RECEIVED in our office according to the refund policy. Please be sure to get a confirmation from usindicating that your request was received and that the refund is being processed.

THIS FORM MUST BE COMPLETED AND SIGNED EVEN IF YOUR BALANCE HAS BEEN PAID IN FULL

CAMPER’S NAME:

fSU SUMMER MUSIC CAMPS financial responsibility formOFFICE: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180 / PHONE: (850) 644-9934 / EMAIL: musiccamps@fsu.edu

fSU SUMMER MUSIC CAMPS housing, Dining AND TRAVEL formOFFICE: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180 / PHONE: (850) 644-9934 / EMAIL: musiccamps@fsu.edu

CAMPER’S NAME:

Roommates are assigned based on age unless a roommate request has been made. Most campers do not submit roommate requests so please don’t worry if you do not have someone you know to room with. Camp is about making new friends after all!

Yes, I want to request the roommate(s) listed below. PRINT CLEARLY!!! We can’t room you with a person if we can’t read their name!

No, I don’t need to request a roommate.No, I don’t need to request a roommate but I need to let you know that I DON’T want to be roomed with the following person/people:

No, I don’t need to request a roommate but I want to tell you this about my rooming situation:

ROOMMATE REQUESTS

Request #1:

I am attendingname of camp

and I would like to request the following roommate(s):

Name #1:

Name #2:

Request #2:

I am attending

name of camp

and I would like to request the following roommate(s):

Name #1:

Name #2:

: Request #3

I am attendingname of camp

and I would like to request the following roommate(s):

Name #1:

Name #2:

If you are requesting a roommate(s), please keep the following in mind:

• You can request up to 2 other persons to room with.• All campers in your group must submit their own roommate request, and all requests must include the same people. If your group requests don’t match,

then we can not complete the request.• Roommates don’t have to be going to the same camp, but the camps must have the same check-in and check-out dates.• Roommate assignments are NOT confirmed prior to camp. You will find out your room assignment and roommates at check-in.• Every effort will be made to honor your request.

This form is OPTIONAL and can be used to tell us about certain special requests for your camper. You only need to fill out this form if any of these situations apply to you.

EXTRA NIGHTS OF HOUSING IN THE DORM

Extra nights of housing in the dorm are available to campers who need to arrive the night before or leave the day after camp ends due to travel arrangements. An extra night of housing is REQUIRED if you are arriving any time the day before check-in OR anytime between midnight and 8am on the day of check-in..

There are some restrictions to the availability of Extra Nights:

• Extra night stays are limited to one night before and/or one night after your camp starts and ends.

• Campers at Choral Ensemble Camp, Piano Camp, Piano Institute and Guitar Camp can not book an extra night before the start of camp; the

earliest these campers can arrive to the dorm is June 7th at 8:00am.

• Campers at Band Camp for Middle School can not book an extra night at the end of camp; all campers must check-out after the performance on

July 11th.

The cost of an extra night of housing is $50.00. This includes the extra night in the dorm, full counselor supervision and all extra meals.

Checks should be made payable to Florida State University. Payment for extra housing can not be combined with our balance payment of tuition and regular housing - it must be a separate check, but you can use one check to pay for multiple optional items, (for example, you can combine your extra housing payment with a purchase of a CD). It just must be a separate check from the balance of tuition and housing payments.

ATTENDING MULITPLE CAMPS?

If you are attending multiple, consecutive camps, you are able to stay in the dorm for free on the night in-between the two camps.  You also have the option to be checked-out by your parents for the night in between.   Please let us know whether you will be staying with us during the night in-bewteen, or if you will be checked-out.  If you don't know this information yet, you may call us at a later date to update your answer.

I am coming to consecutive camps and want to stay in the dorm during the night in-between.

I am coming to consecutive camps but my parents will be checking me out and then checking me back in so I do not need housing in the dorm on Saturday night.

n/a

INTERNET ACCESSCampers who are enrolled in an academic summer course can be permitted to use wifi for coursework. Internet access will be limited, available only in the dorm office, and only provided on select evenings when the camper’s schedule permits. Campers who need internet access will also need to bring their own computer.

☐ I would like to request internet access for my camper because he/she is enrolled in an academic course and will need to submit assignments.

CAMPER’S NAME:

For Office Use Only: Cashh Amount: Date Received:Check #

I need extra housing in the dorm for the night(s) of: Cost Per Night # Nights Subtotal

$50.00

$50.00

$50.00

x 1

x 1

TOTAL DUE:

Please fill out the section below and mail it back with payment to: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180

June 13, 2020

June 20, 2020

July 4, 2020 x 1x 1

x 1$50.00July 10, 2020

CAMPER’S NAME:

DINING ACCOMODATIONS

FOOD ALLERGIES listed on your medical form will be communicated to the Director of the Southgate Campus Centre, but we ask you to repeat them here and give any specific details that Dining Services should have in relation to the food allergy. We will give you instructions two weeks prior to the start of your camp for communicating directly with the Southgate Dining Director so that a dining plan can be created.

Do you have any of the following:

Tree Nut or Peanut Allergy

Dairy Allergy

Shellfish Allergy

Wheat or Soy Allergy

Other Food Allergy

None - my camper has no known food allergies

The dining hall has limited capability to accommodate non-allergy related food restrictions. Any selection made below will be communicated to the Director of the Southgate Campus Centre but we can not control what options will or won't be provided. We will give you instructions two weeks prior to the start of your camp for communicating directly with the Southgate Dining Director.

Do you need to request any of the following:

Vegan

Vegetarian

Gluten Free (non-celiac)

Kosher

Other

None

LATE ARRIVAL TO CAMPMy camper will be arriving late (after the official camp check-in time or on a day that is after the official camp check-in day):

☐ With a parent/guardian☐ We are scheduling shuttle service on the Shuttle Request Form.☐ Camper is driving him/herself

Date camper will be arriving:Estimated time of arrival:

How will the camper be arriving?

EARLY DEPARTURE FROM CAMPMy camper will be leaving camp early (one or more days prior to the official end date of camp):

☐ With a parent/guardian☐ We are scheduling shuttle service on the Shuttle Request Form.☐ Camper is driving him/herself

Date camper will be leaving:Estimated time of departure:

How will the camper be leaving?

The FSU Summer Music Camps offers pick-up and drop-off service to and from the Tallahassee Regional Airport, Greyhound Bus Station and Red Coach Bus

Stop at Doak Campbell Stadium. If you need Shuttle Service, please fill out the Shuttle Service Order Form.

Parent/Guardian Signature

CAMPER’S NAME:

This form is used to tell us who can sign-out your camper from his/her camp(s). Only persons over the age of 21 may be permitted to sign-out the camper.

Authorized Person #1:

Print Name:

Phone Number:

Relationship To Camper:

Authorized Person #2:

Print Name:

Phone Number:

Relationship To Camper:

Authorized Person #3:

Print Name:

Phone Number:

Relationship To Camper:

I give permission for my child to leave camp with the person(s) listed above. I understand that only designated adults over the age of 21 may check-out my child from camp, and that he/she must present a valid photo ID at the time of check-out. I understand that my camper may only be signed out from the dormitory office located on the second floor of Southgate.

I only want the parent(s)/guardian(s) listed on the campers’ registration to be able to sign out the camper.If there are custody issues we need to be aware of please contact our office. Otherwise, both parents listed on the registration will be able to sign the camper out.

I want the parents/guardians listed on the campers’ registration AS WELL AS the authorized people below, who are over the age of 21, to be able to sign-out the camper.

Please select one of the choices below for Sign-Out:

fSU SUMMER MUSIC CAMPS sign-out permission formOFFICE: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180 / PHONE: (850) 644-9934 / EMAIL: musiccamps@fsu.edu

OR

For Office Use Only: Cash or Check # __________ Amount: Date Received:

Camp Name Description of RecordingCD Audio Recording Group Photo

8x10 of campers ensemble taken at the final concert

Order Subtotal

Price Quantity Price QuantityBand Camp for Middle School Single CD. Final performance. $18.00 $11.00

Band Camp for Senior HighDouble CD. Contains most pieces from the mid-camp concert and most pieces from the final concert.

$24.00 $11.00

Choral Ensemble CampDouble CD. Contains the Small Ensembles concert (Friday PM) and the final concert (Saturday AM).

$24.00 $11.00

Guitar Camp Single CD. Final performance. $18.00

Honors Chamber Winds

Single CD. Chamber Ensemble performance (Thursday concert). Purchase the String Orchestra CD if you want a recording of the Saturday Symphony performance.

$18.00 $11.00

Jazz Ensemble Camp Middle School AND Jazz Ensemble Camp Senior High

Single CD. Saturday Concert. All Big Bands. $18.00 $11.00

Jazz Ensemble Camp for Senior High Single CD. Friday Concert.All Jazz Combos. $18.00 $11.00

Marching Band Leadership and Color Guard Camp No CD Available - only group photo $11.00

Piano Camp Single CD. Final recital. $18.00 $11.00

Piano Institute Single CD. Final recital. $18.00 $11.00

String Orchestra

Double CD. Contains most pieces from the String Orchestras concert (Fri PM) and the Final Performance (Sat AM).

$24.00 $11.00

TOTAL DUE:

• Payment for these items can NOT be combined with your balance payment of tuition and housing.• Checks should be made payable to Florida State University.• If returning by mail, send form and payment to: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180

DEADLINE: This form may be returned in advance, turned in at camp check-in, or mailed back any time BEFORE JULY 11, 2020. Orders received after July 11 will be received but are subject to delayed processing and availability.

Ship To Name:

Address:

City: State: Zip:

SHIPPING ADDRESS:

CAMPER’S NAME:

fSU SUMMER MUSIC CAMPS cd recording and group photo order formOFFICE: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180 / PHONE: (850) 644-9934 / EMAIL: musiccamps@fsu.edu

CD’s are audio recordings - not video. They will be mailed out by the recording company between October and December.

Group Photos are 8x10 images taken during the final performance. They will be mailed out in July.

$11.00

The FSU Summer Music Camps offer pick-up and drop-off service to and from:• The Tallahassee Regional Airport (TLH)• The Greyhound Bus Station: 112 W. Tennessee Street (850.222.4240)• The Red Coach Bus Stop at Doak Campbell Stadium (redcoachusa.com)

Transportation to and from these locations is $35.00 round trip for pickup/drop-off that take place between 8am-10:00pm or $50.00 for a pick-up/drop-off between the hours of 10:00pm-8am. There is no discounted price for one way, though you can request transport in only one direction.

This service is intended for campers traveling by themselves to and from camp. Though we can make arrangements to take parents in the shuttle as well, you may find it more economical to take a taxi.

HOW IT WORKS:Once we have received your shuttle request and payment you will receive a Travel Voucher from us via e-mail. This Travel Voucher will serve as a receipt of payment and verification that we have the correct travel information for your child prior to their arrival. It should be presented to the shuttle driver.

For Pick-Ups: Campers will be met by a uniformed member of our staff. You will be provided with the name of the driver and a contact number for the day of travel the week before camp begins. Our staff will assist in baggage claim and then bring the camper directly to check-in or to the dorm depending on arrival time.

For Drop-Offs: While at camp, campers will work with their counselor to be packed and ready to go at the appropriate time for their return trip. We suggest that airline travel be scheduled no earlier than two hours after the end of the final concert. Please send some kind of identification with your child if possible. The airlines require ID for the camper to check-in for their return flight.

HOW TO ARRANGE FOR SHUTTLE SERVICE:The deadline to schedule shuttle service is two weeks prior to the start of your camp.

Checks in the amount of $35.00 (for pickup/drop-off that take place between 8:00am-10:00pm) or $50.00 (for pick-up/drop-off between the hours of 10:00pm-8:00am) should be made payable to Florida State University.

Please fill out the form, print it and then mail it back with payment to:FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180

Please allow us three weeks to process your request and send you the Travel Voucher.If you have sent in a Shuttle Service Request Form and have not received your Travel Voucher within three weeks, or if it is less then one week prior to the start of the camp, please contact our office.

OTHER THINGS TO KEEP IN MIND:Remember to keep our housing policy in mind when making your travel arrangements. An extra night in the dorm is required if you are arriving the day before check-in, anytime between midnight and 8am on the day of check-in OR departing the day after check-out. You can request an extra night of housing using the Housing and Dining Form. We can help coordinate an early or late check-in for campers taking the shuttle.

Discuss the transport of large instruments with your carrier prior to your trip. Please make sure that your camper has plenty of money for any baggage fees which might occur on the trip home. The camps will not pay for excess baggage fees.

Campers under the age of 14 traveling alone by plane may be considered an “unaccompanied minor” by the airline. This means that he/she is required to be picked up by a designated individual. The airline may require the name, address & contact information of that person at the time you book the flight.

Please make sure that your camper has some kind of identification on them during travel - especially for the return trip home.

fSU SUMMER MUSIC CAMPS shuttle service instructions and order formOFFICE: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180 / PHONE: (850) 644-9934 / EMAIL: musiccamps@fsu.edu

CAMPER’S NAME:

PICK UP DETAILS:

I will be arriving at:

Tallahassee Regional Airport

Airline:

Departure City:

Connecting City (if any)

For Office Use Only: Cash or Check # __________ Amount: Date Received:

PARENT NAME:

What instrument(s) will you have with you during travel?

Please check off the option which applies to you: I only need to be picked-up at the beginning of campI only need to be dropped-off at the end of campI need to be picked-up and dropped-off

Best contact number for PARENT on the DATES OF TRAVEL: ( ) ________ - _______________

If the CAMPER will have a cell phone on them during travel, what is that number: ( ) ________ - _______________

Arrival Date:

Departure Time: Flight Number:

Arriving in Tallahassee. Arrival Time:

Is this camper considered an unaccompanied minor by the airline?

Greyhound Bus Station on Tennessee Street

Departure City: Arrival Time: Bus Number:

Red Coach Bus Stop on Tennessee Street

Departure City: Arrival Time: Bus Number:

DROP-OFF DETAILS:

I will be departing from:

Tallahassee Regional Airport

Airline:

Connecting City (if any)

Departure Date:

Departure Time: Flight Number:

Is this camper considered an unaccompanied minor by the airline?

Greyhound Bus Station on Tennessee Street

Destination City:Departure Time: Bus Number:

Red Coach Bus Stop on Tennessee Street

Destination City:

Destination City:Departure Time: Bus Number:

YES NO

YES NO

fSU SUMMER MUSIC CAMPS shuttle service order formOFFICE: FSU Summer Music Camps, PO Box 3061180, Tallahassee, FL 32306-1180 / PHONE: (850) 644-9934 / EMAIL: musiccamps@fsu.edu

Physical description of camper (or attach photo):