SHSU School of Music Summer Camps Medical Release and Media Consent Form

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All participants must complete the SHSU School of Music Medical Release form in order to attend camp.

By completing the below, you the parent/guardian, hereby authorize such diagnostic, medical and/or surgical treatment considered necessary or appropriate under the circumstances for the treatment of any illness or injury of the minor. The undersigned understands that a reasonable attempt will be made to contact the parent/guardian before any action is taken and agrees to be financially responsible for all medical attention so authorized or ordered. To the fullest extent permitted by law, the undersigned hereby releases SHSU, its employees, counselors, and agents from all liability, and waive and release all claims, related to or arising from such decisions or actions as may be taken under the authority of this document.

Parent/Guardian and Camper Information:

1. By clicking this box, I have read and agree to the above terms and conditions of this medical release waiver.

Yes, I have read and agree to the above terms and conditions.

Required

2. Campers Last Name
*

3. Campers First Name
*

4. Which camp are you attending?

Junior High Band Camp

Single Reed Institute Summer Camp

All State Choir Camp

5. Parent/Guardian First and Last Name
*

6. Parent/Guardian Phone Number (Please list the main number where you can be reached.)

*

8. Alternate Emergency Contact, Phone Number
*

9. What is the relationship of the emergency contact to the camper?
*

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