We Rock Charlotte

2026 Camper Form

Part I: Emergency Contact Information

Camper Information

Camper First Name

Camper Last Name

What camp will your camper be attending?

Kids Camp (rising 4th-7th graders)

Teen Camp (rising 8th-11th graders)

Any health conditions we should be aware of?

Any dietary restrictions?

Describe any allergies, what the severity of reaction is and how to handle in case of accidental exposure.

Emergency Contact 1

Emergency Contact #1 First Name

Emergency Contact #1 Last Name

Emergency Contact #1 Phone Number

Emergency Contact #1 Relationship to Camper

Emergency Contact 2

Emergency Contact #2 First Name

Emergency Contact #2 Last Name

Emergency Contact #2 Phone Number

Emergency Contact #2 Relationship to Camper

Part II: Media Release

I, being 18 years or older, or with the consent of my Mother/Father/Legal Guardian, hereby grant permission to We Rock Charlotte and its collaborators to use any video, audio, or photo content capturing my participation in their activities. This includes the right to reproduce, edit, and publish these materials for promotional and business purposes without compensation to me.

I understand that I may or may not be identified in these reproductions and agree that my name will not be associated with endorsing specific commercial products or services. I acknowledge the following:

We Rock Charlotte and collaborators have full rights to these materials.
The materials are not confidential and can be shared and used without liability.
We Rock Charlotte and collaborators exclusively own all rights to the materials for any purpose.

I also grant We Rock Charlotte and its Sponsors and assign the unrestricted right to use photographs, videos, and audio recordings of me for various purposes, including copyrighting, publishing, and republishing, with the understanding that my name may be used in connection with these materials.

I release We Rock Charlotte and associated entities from any liability related to using or modifying these materials unless it can be proven that such actions were maliciously intended for ridicule or harm. I waive any claims based on the use of these materials, including invasion of privacy or libel, and confirm that I will not disaffirm this release due to being a minor at the time of execution or any similar grounds.

What happens with the photos and videos we take?

We take pics at camp and send them to families in the camp newsletter
We'll snap some action shots of what's happening and post them on our Instagram and FB stories
Photos get used to market future events or just celebrate what we've accomplished year to year!
Photos and videos of participants and volunteers help us fulfill our mission to empower allies and advocates through music and arts; by getting the right people out to our events, fundraisers, and workshops and helping us get grant funding!
If you feel uncomfortable with our media release form or have children in foster care, please let us know so we can discuss further!

I agree to terms and conditions.

Signature of Parent/Guardian

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