Teen Patriots

Name
First Last
Address*
Street Address City ZIP Code
State*
Phone*
Email*
Grade entering in the Fall*
Age during camp week*
Gender*
- Male
- Female
T-shirt size*
- Adult S
- Adult M
- Adult L
- Adult XL
- Youth S
- Youth M
- Youth L
- Youth XL
- Size not listed; will email
Hobbies, Interests, Skills*
List all that may apply
Previous Volunteer Experience*
Extra Curricular Activities*
Camp Assignments*
What types of role for camp interests you?
- Supervising younger children
- Assisting Group Leaders
- Role playing/acting as a colonist in plays
- Any of the above
Emergency Contact*
List name, relationship and phone number. (This may be changed at a later date if need be.)
Photo and Video Release*
PARENT AUTHORIZATION REQUIRED: I hereby authorize the Liberty Camp For Kids to take pictures and videos, reproduce, and/or publish all written and/or visual materials that are made during Liberty Camp For Kids events, including photographs and video that may pertain to me or my child/ren. This material may be used in publications, public affairs releases, social media, or recruitment materials. This authorization is continuous and may only be withdrawn by my specific rescission of the authorization. Liberty Camp For Kids may publish materials, use my name or my child's name, photograph, video, and/or make reference to me or my child in any manner that the Liberty Camp For Kids deems appropriate in order to promote/publicize the event.
- I approve
- I disapprove
Liability Authorization*
PARENT AUTHORIZATION REQUIRED FOR ATTENDANCE AT CAMP: The undersigned (parent) hereby request and approve entrant's application and participation in the Liberty Camp For Kids. In consideration of this application, the undersigned hereby agrees: that entrant's participation will be at the sole risk of entrant and the undersigned without liability to the Liberty Camp For Kids and their officers, members, and agents, all of whom the undersigned hereby agrees to release, indemnify and hold harmless from any and all claims and expenses resulting from or relating to entrant's said participation.
- I approve
- I disapprove
Parent Signature*
- I have reviewed the application (parent)

Where Kids Experience the Founding of America