filmcamp-2013-registration

SASK FILM CAMP 2013 Participant’s Name: Age: Cell: Hospitalization number: Allergies: Mailing Address (for mailing out the DVDs) Street: City: Postal:

Parent / Guardian name(s): Home: Cell: Work: ** For Office Use Only: full payment is required to register ** Staff: Please complete & date & initial when received.

Method of Payment: Cash: Cheque: # Payment Received *please check / circle* SASKFILMCAMP w/ no DVD - $275.00 SASKFILMCAMP w/ 1 DVD - $285.00 w/ 2 DVDs - $295.00 ANY OTHER NOTES:

*Cheques payable to: Saskatchewan Filmpool Cooperative or The Filmpool.

Please list specific areas of film or video making that interests you.

Where did you find out about this Summer Film Camp?

Please indicate: radio, posters, website, word of mouth, facebook, twitter, ect.

For the Parent’s and Guardians: It is our preference that participants arrive with a bagged lunch every day, with exception of Friday - when the participants are provided with a free pizza lunch! This helps to facilitate a smooth lunch break, with participants remaining on the premises and under the instructor’s supervision. * However, if you prefer - there is an option to participants to leave unaccompanied for lunch AND/OR at the day’s end. Please read below for details.

Optional - Permission to leave unaccompanied: (Please read thoroughly.)

If you do sign below, you have given permission for the registrant to leave. The participant will be able to leave the supervision of the Filmpool staff without accompaniment. The Filmpool and/or SaskFilm or their affiliates will not be held accountable for the safety or any actions of the participant once they are dismissed. This also applies to permission given for unaccompanied lunches.

If you do not sign below, the participant will be kept on Filmpool premises / under instructor’s supervision until said parent or guardian arrives to pick up the registrant at the end of each camp day.

Indicate here LUNCHES or DAYS you agree to allowing the participant leave UNACCOMPANIED.

Circle the day(s) when participant is allowed to LEAVE FOR LUNCH Circle the day(s) when participant is allowed to LEAVE AT DAY’S END

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Signing here is required if you are giving permission for registrant to leave UNACCOMPANIED.

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Signature: X

Printed Name:

MAIL, FAX or DROP OFF this form & MAIL or DROP OFF PAYMENT to: The Saskatchewan Filmpool Cooperative a.k.a. The Filmpool at - #301-1822 Scarth Street, Regina, Sask. S4P 2G3 Phone 306.757.8818 Fax 306.757.3622

Would you give the Filmpool permission to use images from the camp for future promotional use?

This really helps us showcase what the participants do and shows the hands on elements of this camp.

Signing below indicates that you will give The Filmpool only, permission to use sounds and images recorded during this camp for future promotion of SASKFILMCAMP. Thank you so much!

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