(Must be signed by parent/guardian if participate is under 18 years of age)
I hereby give permission for student listed above to participate in the Phantom Regiment Educational Camp. I/We understand that Phantom Regiment and their respective officers, directors, agents (including Drum Corps International, Rockford University, University of Akron, McKendree University, University of Central Arkansas, Frostburg State University and their respective directors, officers, employees and agents) and employees shall not be nor later become, liable or responsible in any way in conjunction with services, for any death, injury, damage, delay or irregularity which may occur while participating in this Phantom Regiment sponsored event (the “Sponsored Event”).
Also, in case of emergency, I/we hereby give my consent for a qualified physician to perform any medical or surgical procedures s/he deems necessary to the welfare of this applicant while participating in the Sponsored Event. I/we hereby give permission to the Phantom Regiment nursing staff to observe students self-administering prescription medication and non-prescription medication during the sponsored event. It is understood that Phantom Regiment and medical personnel will make every attempt to contact parents, guardians or relatives listed above prior to taking any such actions, but in the event that they cannot be reached for an emergency, I/we hereby give permission to the physician selected by Phantom Regiment to secure and administer such treatment(s) as may be necessary, including hospitalization, for participant as named above and while attending the Sponsored Event. I/we also authorize Phantom Regiment and its agents to release copies of participant’s medical record to hospitals and other physicians to which they are referred and to insurance companies for payment of a medical claim. A photocopy is as valid as the original.
Further, this authorization permits said physician and medical professionals to hospitalize, secure appropriate consultation, order injections, anesthesia (local, general or both) or surgery for this applicant if such emergency conditions warrant. The undersigned does hereby assume and agree to pay any indebtedness or physician’s or surgeon’s fees and hospital charges for such service, and for any ambulance or any other emergency transportation that may be needed.
I/We hereby irrevocably grant to Phantom Regiment and their respective agents, licensees and assigns, the right to use in any and all media and in any and all forms this participant's name, likeness, photographic prints and any reproduction of his or her sounds, performance or appearance while attending the Sponsored Event, for any purpose including promotion, advertising or otherwise. I/We understand I/we will not be paid any royalty or other compensation. With the use of the rights, we hereby waive and release Phantom Regiment and their respective agents, licensees and assigns from all claims, liabilities and/or damages which now or in the future may arise from such use.
I/We acknowledge that the participant is responsible for the safety and security of their musical instruments, equipment and personal belongings and for loss or damage arising from mischievous acts, vandalism, theft or other causes. I/We the undersigned understand that the Sponsored Events are a smoke free and drug-free environment and that consumption of alcohol or unlawful drugs or the smoking of any substance is prohibited and will be grounds for immediate dismissal from the program without refund. If a serious problem of misbehavior of the participant should arise and in the judgment of the Phantom Regiment officials the participant should be sent home before the end of the Sponsored Events, I/we authorize Phantom Regiment to take such action. I/We, the undersigned, have read, understand and accept the “Late Fees and Cancellation Policy” on the front of this registration form and the foregoing statements and policies.
