REGISTRATION

Camper's Name

First

Last

Camper's Email Address

Email

Confirm Email

Address

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City

State

Zip Code

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Parent's Email Address

Parent's Home Phone

School Name

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Age

Gender Identity

Male
Female
Non-Binary
Prefer to self describe

Instrument

Drumline (you will need to bring your instrument)
Mallets (no need to bring your instrument)

MEDICAL RELEASE FORM & LIABILITY WAIVER

Please complete the fields below. Each camper must have this form on file with the camp director.

MEDICAL RELEASE STATEMENT:

I hereby authorize the camp officials to have my son or daughter or myself treated by local medical personnel for any medical problems which may arise white attending any Alan Keown, Scott Reese or Scott Reese Leadership Summer Camp. I also authorize the appropriate medical personnel to admit my son or daughter or myself to the local hospital.

PARENT OR GUARDIAN SIGNATURE or CAMPER SIGNATURE (IF OVER 18)

Clear Signature

Date

Name of person attending camp:

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

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Home Phone

Insurance Carrier

Work Phone

Group Number:

Medical conditions or allergies:

LIABILITY WAIVER

I agree to hold Alan Keown, Yamaha Drum Company, Sabian Cymbal Company, Vic Firth Drumstick Co., Remo Corporation and Camp Serene free from any liability for any injury, accident, or property loss of any kind while my son or daughter or I am in attendance at Alan Keown Drum Camp. I give permission to have my son/daughter treated medically.

PARENT OR GUARDIAN SIGNATURE or CAMPER SIGNATURE (IF OVER 18)

Clear Signature

Date

Alan Keown Drum Camp Photo Release

I hereby grant Alan Keown Drum Camp permission to use my likeness in a photograph, video, or other media in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of the Alan Keown Drum Camp.

I hereby authorize the Alan Keown Drum Camp to edit, alter, copy, exhibit, publish or distribute any photos, video, or other media obtained during the week of camp for purposes of publicizing the Alan Keown Drum Camp’s programs.

I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

Signature

Clear Signature

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Printed Name

Date

If the person signing is under age 18, there must be consent by a parent or guardian, as follows: I hereby certify that I am the parent or legal guardian of the camper above, and do hereby give my consent without reservation to the foregoing on behalf of this person.

Parent/Guardian’s Signature

Clear Signature

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Parent/Guardian’s Printed Name (copy)

Date (copy)

Camp Rules & Regulations

Below are the general rules and policies of the camp. Violation of these may result in expulsion from camp and forfeiture of all tuition and fees. Please read carefully and sign to signify your acceptance of these rules. The parent/guardian and camper should sign if the camper is under 18, just the camper is required to sign if over 18.

Observe nightly curfew (11:00 pm).
Respect the sleep, study, and privacy of others.
Campers must attend all rehearsals, performances, and scheduled events unless cleared by a counselor.
Maintain a good, cooperative, and constructive attitude at all times.
Do not tamper with firefighting equipment or engage in behavior that constitutes a fire hazard.
Observe the noise curfew. (10 pm-8 am).
No disorderly conduct. This includes pranks
No possession or consumption of alcoholic beverages, illegal drugs, tobacco, vapes, or weapons.
No damaging or theft of other’s belongings or camp property
No indecent or unacceptable conduct.
Campers are expected to demonstrate modesty and respect, especially in cabins, tents, and shower rooms, as well as the entirety of the camp.
No abuse or improper conduct toward others. This includes bullying and hazing.
No unauthorized use of personal vehicles.
No unauthorized swimming.

The Alan Keown Drum Camp will not tolerate discrimination on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, disability, age, or genetic information (including family medical history). Any incidents should be reported to a counselor immediately.

We have read these rules, fully understand them, and agree not to violate any of them while at any camp administered by Alan Keown.

Parent or Guardian Signature if the camper is under 18.

Signature

Clear Signature

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Camper or Parent/Guardian’s Printed Name

Camp Registration Fees

Price: $650.00

Date

Scholarship or Discount Code

Pay by Credit Card

Camp Registration and Tuition Payment

MEDICAL RELEASE FORM & LIABILITY WAIVER

MEDICAL RELEASE STATEMENT:

LIABILITY WAIVER

Alan Keown Drum Camp Photo Release

If the person signing is under age 18, there must be consent by a parent or guardian, as follows: I hereby certify that I am the parent or legal guardian of the camper above, and do hereby give my consent without reservation to the foregoing on behalf of this person.

Camp Rules & Regulations