2020 Calibraska Class Registration Form
Thank you so much for joining us for class! We just need to capture a couple things to get you ready to roll.

Please email us at info@calibraska.org if you have any questions at all.
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PLEASE NOTE: IF YOU HAVE ALREADY FILLED THIS FORM OUT FOR THIS STUDENT JUST SEND US AN EMAIL WITH ANY UPDATES YOU NEED TO MAKE AT info@calibrask.org. :D
What Calibraska classes is THIS student registering for? Please check all that apply *
Required
Student's Last Name *
Student's First Name *
Other Name Student prefers to go by (nick name, etc.) *
Student's Preferred Pronouns to be used in class *
Required
Student's Birthdate *
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Student's Current Age *
Student's Grade in School this coming Fall *
Are there any learning sensibilities regarding this student we should know about? *
Does this student need any language interpretation service? *
Primary Contact First and Last Name *
Street Address *
City *
State *
Zip Code *
Primary Contact Phone (enter as  000-000-0000 ) *
Primary Contact Phone Type *
Alt. Phone 1
Alt. Phone 2
Primary Contact Email *
Who referred you to Calibraska or how did you find out about us? *
Required
FINANCIAL AID INQUIRIES
If you are interested in receiving financial aid in the form of 25%, 50%, or 100% off AND/OR a class material kit please email us at info@calibraska.org before paying for your class(es).

PLEASE NOTE: Class Material kits need to be requested 2 weeks from the class start date.
Questions for our Inclusivity Mission
The Calibraska Arts Initiative strives to be an inclusive program for all individuals. The following questions help us understand the populations we are currently serving and to monitor the diversity of our program whether online or in-person.

Because we offer educational opportunities to both youth and adults, some questions may not directly apply to this particular participant.

Please help us serve you better by selecting the best answers to these questions.
Student's Preferred Spoken/Written Language *
Required
Which categories describe the Student? (Check all that apply) *
Required
Which Identity best describes this student at this time? *
Required
Student's Current Orientation (if applicable) *
Required
Is this Student a Veteran? *
Is this Student a Migrant Worker or in a Migrant/refugee family? *
ACKNOWLEDGEMENTS AND AGREEMENTS
I acknowledge that I am either the student participating or the guardian of the participant and Therefore able to register this student. I verify that the information put forward is correct and valid for further communication.

I acknowledge registration is ONLY complete when both PAYMENT and COMPLETION OF REGISTRATION FOR EACH INDIVIDUAL STUDENT have been submitted

I agree to either myself or the student I am registering to adhere to the online educational standards put forward by the Calibraska Arts Initiative, 4-H, and any affiliates or partners to the summer 2020 Calibraska Arts Initiative.

I or the student I am registering agree to participate with respect for the teaching artists, fellow students, and any affiliates with the program.

I acknowledge that I have the technical ability to participate in the classes including access to the internet, zoom platform, and technical equipment which can run zoom.
RELEASE
Calibraska Arts Initiative Release Form
Parent/Guardian or Participant 18yrs or older, hereafter known as Releasor, wishes the Participant to participate in the Calibraska Arts Initiative Event named on this document and participate in all activities except as noted on this form.

1. In consideration for the participation in the Calibraska Arts Initiative and its affiliates (including but not limited to Nebraska 4-H, eekart and Comedy Playground, LLC.) activities, Releasor hereby RELEASES and covenants not-to-sue UNL or 4-H, Calibraska Arts Initiative and its affiliates for any and all present and future claims resulting from ordinary negligence on the part of UNL or 4-H, Calibraska Arts Initiative and its affiliates for property damage, personal injury, or wrongful death arising as a result of engaging in or receiving instruction for Calibraska Arts Initiative, 4-H camp and its affiliates activities or activities thereto, wherever, whenever, or however the same may occur.

2. Releasor hereby voluntarily waives any and all claims or actions resulting from ordinary negligence, both present and future, that may be made by Releasor’s family, estate, personal representative, heirs, or assigns. Further, Releasor realizes that participation in 4-H camp and Calibraska Arts Initiative and its affiliate’s activities involves certain risks and danger and may be a vigorous activity involving severe respiratory and cardiovascular stress.

3. Releasor accepts and understands that supervision of the participant is not the responsibility of the Calibraska Arts Initiative, 4-H Camp and any affiliates. Thereby participant remains under the supervision of releasor and releasor waives any and all claims of responsibility of ordinary negligence or toward Calibraska Arts Initiative, 4-H Camp and any affiliates.

4. In addition, I understand and accept the incidental risks of online education including any that may exist in the environment which participatory activities are taking place and release Calibraska Arts Initiative, 4-H Camp and its affiliates from any legal action on this basis including any injuries which may occur due to the location of the participant, and environmental and or other spatial factors.

5. In the event of a medical emergency, the 4-H camp or University of Nebraska or its representatives have my permission to take whatever measures they deem reasonable to render assistance and that I and/ or my family will be financially responsible for any expense involved.

6. I have read and understand that this WAIVER is intended to be as broad and inclusive as permitted by the laws of the State of Nebraska and agree that if any part is held invalid, the remaining parts of this WAIVER AND RELEASE will continue in full force and effect as intended. I further agree that the venue for any legal proceeding shall be in the State of Nebraska.

Photo and Creative Release
I hereby grant to the University of Nebraska and Calibraska Arts Initiative and it's partners and or affiliates the irrevocable and unrestricted right to use, reproduce, publish and copyright artwork and other creative productions from the event, photos and video recordings of myself and or child/ward taken in the course of the 4-H or Calibraska Arts Initiative activity; and to use such photos for any lawful purpose, in any manner or medium, and to alter the same without restriction including promotional purposes.


I Agree to these Terms *
Today's Date *
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DIGITAL SIGNATURE
By my eSignature verification below, I verify that I understand that electronic signatures are legally binding and have the same meaning as handwritten signatures. Pursuant to section 11.100 of Title 21 of the Code of Federal Regulations, this is to certify that I confirm that this electronic signature is to be the legally binding equivalent of my handwritten signature and that the data on this form is accurate to the best of my knowledge.

This Signature confirms and binds you and the student to the terms set forth in this document.
Signature *
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