Summer Camp 2026 Registration

Parent/Guardian Medical Consent Form - 2026

Parental/Guardian Consent: I (Mr., Mrs., Ms.,) ___________________________________________, the parent or legal guardian, as appropriate, of ________________________________, give my consent for him/her to participate in all activities associated with the above stated Yellow Springs Summer Music Camp (hereafter known as YSSMC). I understand that this consent will include participation in all rehearsals, concerts, and activities related to YSSMC and will include travel to and from these events. I also understand the camper above is responsible to behave in a respectful manner and follow the rules set up at the above location(s) or locations of events related to the camp.

2.Covid-19 Release: As parent/guardian of the above said camper, I am aware of the potential risks due to the current pandemic as well as other similar factors such as influenza, SARS, or MRSA. I understand that by agreeing to send my child to this/these class(es), I am agreeing to the following: I am waiving my right to any liabilities, claims, lawsuits, collection of expenses, damages, or actions against representatives of YSSMC or facilities where classes, rehearsals, and performances take place due to injury, loss, or death related to the above illnesses. I am agreeing to safety procedures which align with YSSMC, Mills Lawn, State, Local, and Federal law and mandates. I realize that if my child or immediate family show symptoms of or have come in contact with someone diagnosed with the above mentioned illnesses, including Covid-19, I will notify YSSMC representatives and will not attend camp until safe.

STUDENT CONFIDENTIAL MEDICAL INFORMATION AND EMERGENCY NOTIFICATION

Medical Treatment Authorization: I hereby authorize and consent to the administration of all medical and/or surgical treatment(s) to my child by a licensed physician, nurse, or hospital in the event that I am not available to consult with the attending physician(s), attempts to contact me have been unsuccessful, and the attending physician(s) deem it advisable to proceed with such treatment(s). (Parental consent is required before a hospital's emergency department can give medical treatment to a minor. Every effort will be made to contact parents/guardians, but a completed consent form will expedite treatment. Any exclusion from particular treatments must be legal and stated explicitly on this form with attachments if details are necessary.)

NOTE: class attendees 18 or older who are their own legal guardian may sign this form.

Parent/Guardian Media Release Form - 2026

YSYOA Yellow Springs Summer Music Camp

Media release: At times, families and representatives of YSSMC will want to take pictures or video of concerts and activities. These may be posted on the YSYOA website or social media of YSYOA or families of campers (including, but not limited to concert programs, brochures, booklets, videotapes, reports, press releases, websites, and exhibits.) I understand that names of campers shall never be distributed or posted without the express written consent for each image used of the below legal guardian(s).