Summer Arts for Youth Programs 2024

* denotes required field

Student Information

First Name*

Preferred Name

Last Name*

Birthdate*

Email Address*

Mailing Address*

Country

Street

City

Region

Postal Code

School Currently Attending*

Grade Completed in 2023

Preferred Pronouns

Please indicate your preferred pronouns*

Summer Programs

Program descriptions listed at ohio.edu/fine-arts/summer-arts-programs/summer-arts-youth

Select programs of interest

June 3-7, Tantrum Theater Kids Drama Camp: Ages 7-9

June 3-7, Tantrum Theater Youth Drama Camp: Ages 10-14

June 10-14, Intro to Painting: Unconventional Portraits: Ages 10-14

June 10-14, Sculpture: Contemporary Art Machines: Ages 10-14

July 1-3, Athens Community Music School Summer Music Week 1: Ages 4-6

July 8-12, Athens Community Music School Summer Music, Week 2: Ages 6-12 (rising 1st-6th graders)

July 15-19, Athens Community Music School Summer Music, Week 3: Ages 11-14 (rising 6th-8th graders)

Instrument

Years of experience playing your instrument

Parent/Guardian Information

I give consent for my minor child/dependent ("child" or "Participant") to participate in the Ohio University Summer Arts for Youth Program at Ohio University, Athens, Ohio ("OHIO" or "University"), and I will complete the following information and forms completely and accurately*

I agree

Electronic signature of parent/guardian of minor participant.*

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email*

Parent/Guardian Phone*

Would you like to add contact information for a second parent/guardian?*

Yes

No

Parent/Guardian 2 First Name*

Parent/Guardian 2 Last Name*

Parent/Guardian 2 Email*

Parent/Guardian 2 Phone*

Please list two additional emergency contacts and telephone numbers.

Emergency Contact 1 Name (different from parent/guardian)*

Emergency Contact 1 Relationship to Participant*

Emergency Contact 1 Phone*

Emergency Contact 2 Name (different from parent/guardian)*

Emergency Contact 2 Relationship to Participant*

Emergency Contact 2 Phone*

The above information is complete and accurate.*

Yes

Electronic signature of parent/guardian of minor participant.*

Student Dismissal and Pick-up

Only children aged 10 and older are eligible for unescorted dismissal

My child has permission to be dismissed on their own at the end of camp each day.*

Yes

No

Please list all individuals who may pick up your child. You may update this list with us at any time.

Participant's Medical Information and Emergency Medical Consent

Ohio University requests this information so that our program staff can properly plan to meet the needs of Participant and if there is an emergency, to have accurate information to provide and/or seek treatment for Participant. Participant refers to: (1) if the Participant is 18 years of age or older, it refers only to Participant; or (ii) if the Participant is under the age of 18, Participant refers to the Participant’s parent/guardian that signs below.

Physician Name*

Physician Address*

Physician Phone*

Dentist Name*

Dentist Address*

Dentist Phone*

Does the Participant have any illness, special conditions, activity limitations, asthma, allergies (including food), etc. that the program staff should be aware of?*

Yes

No

Please identify and explain:*

Is the Participant currently taking any medications that we should be aware of including side effects?*

Yes

No

Please identify and explain*

Is the Participant taking any medications that must be administered during the program?*

Yes

No

Please also complete the required Authorization for Medication Administration and return it to program staff prior to start of program. The bottom half must be completed and signed by a physician. No medications (including rescue inhalers, EpiPens and insulin) will be permitted on campus without this form fully completed.

Does the Participant have any relevant medical history that we should be aware of?*

Yes

No

Please identify and explain:*

Does the Participant need any accommodations to safely participate in the program?*

Yes

No

Please identify and explain:*

If the Participant has any other medical conditions or special needs that you think are important for program staff to be aware of, please identify and explain here:

To the best of my knowledge the Participant is capable of participating safely in the program and that any activity restrictions, allergies, and medications are listed on this form. I give permission to program staff to provide routine first aid care and in the event of serious illness or injury, I give program staff permission to seek and authorize emergency medical treatment. I hold harmless and agree to indemnify the program and Ohio University from any claims, causes of action, damages and/or liabilities arising out of or resulting from said medical treatment. I further agree to accept full responsibility for any and all expenses, including medical and transportation expenses that may derive from any injuries that Participant may incur during participation in this program.

I understand and acknowledge that failure to disclose relevant information may result in harm to Participant and/or others during this program. By signing my name, I represent that I have provided all materials and important information to the program pertaining to Participant’s medical, mental and physical condition and that it is accurate and complete. I agree to notify the program of any changes in the mental, physical or medical condition of Participant before the program begins.*

I agree

Electronic signature of parent/guardian of minor participant.*

Agreement and Release of Liability Form

This release executed by the Undersigned on behalf of “Participant” to Ohio University, Athens, Ohio (the “University”). The term, “Undersigned,” is used in this Agreement as pertaining to: (i) if Participant is of majority age, it refers only to Participant; (ii) if Participant is not of majority age, Undersigned refers to Participant and Participant’s Parent or Guardian. In consideration of Ohio University through its College of Fine Arts organizing and operating Summer Programs in the Fine Arts and making them available from June 1, 2024 through July 31, 2024 ("Program") for participation by Participant and others, the Undersigned agrees as follows:

The Undersigned acknowledges that the Participant will participate in activities both on and off of University's Athens campus including, but not limited to: painting; drawing; printmaking; observing and operating equipment such as laser cutters, 3D printers, letterpress equipment, soldering irons, and welders; walking; playing an instrument(s); marching; running; strenuous and rigorous dance; sewing by hand and machine; acting; jumping; stage combat choreography; singing; theater improvisations and physical games; mask work; all activities associated with creating theater; attending education sessions; traversing the University campus; etc. The Undersigned understands that if the Program they are attending is for dance or theater that because of the physical nature of the art, there may be required and necessary physical contact between participants, employees, instructors, etc. Activities involve strenuous exertions of strength using various muscle groups, some involve quick movements using speed and change of direction, some involve other participants or instructors, and others involve sustained physical activity that places stress on the cardiovascular system. The specific risks vary from one activity to another, but the risks may include: minor injuries such as scratches, bruises, and sprains; major injuries such as a broken/fractured bone, eye injury or loss of sight, joint or back injuries, heart attacks, and concussions; or catastrophic injuries including paralysis and death.
The Undersigned understands and agrees that the state of Ohio, University, its governing board, employees, agents, and volunteers: (i) are not responsible or liable for any injury, damage, loss, accident, delay or other irregularity which may be caused by the defect of any vehicle or building or the negligence or default of any company or person engaged in providing or performing any of the services involved in this Program; (ii) are not responsible for losses or expenses due to sickness, weather, strikes, hostilities, wars, natural disasters, or other such causes; (iii) are not providing liability insurance for vehicles and will not be responsible for any accidents, injuries, damages, etc. in the transportation to and from the Program; (iv) are not responsible for any disruption of travel arrangements, or any consequent additional expenses that may be incurred therein; (v) assume no liability whatsoever for any loss, damages, destruction or theft or the like to Participant’s luggage or personal belongings and that Undersigned has retained adequate insurance or has sufficient funds to replace such belongings and the Undersigned will hold the University harmless therefrom.
Knowing the dangers, hazards, and risks of such activities, and in consideration of being permitted to participate in the Program, the Undersigned, on behalf of Participant, Participant's family, heirs, and personal representative(s), agrees to assume all the risks and responsibilities surrounding Participant's participation in the Program, the transportation, and in any activities undertaken as an adjunct thereto, and in advance releases, forever discharges, waives, and covenants not to sue the University, its Board of Trustees, officers, agents, employees, invitees, volunteers, and students (“the University and its Agents”), from and against any and all liability for any harm, injury, damage, claims, demands, actions, causes of action, costs, and expenses of any nature whatsoever which Participant may have or which may hereafter accrue to the Participant, arising out of or related to any loss, damage, or injury, including but not limited to suffering and death, that may be sustained by Participant or by any property belonging to Participant, whether caused by the negligence or carelessness of the University and its Agents, or otherwise, while in, on, upon, or in transit to or from the Program or any activity adjunct to the Program. The Undersigned hereby releases the University for any liability for any medical decisions or actions and from all medical and transportation expenses incurred on behalf of or for the benefit of Participant.
The Undersigned assures the University of Participant having consulted with a medical doctor with regard to Participant's personal medical needs such that the Undersigned can and does further state that there are no health related reasons or problems which preclude or restrict Participant's participation in this Program. The Undersigned is aware of all applicable personal medical needs of Participant and will meet any and all needs for payment of hospital costs while Participant is undertaking this Program and that the Undersigned hereby grants the University and its agents full authority to take whatever actions they may consider to be warranted under the circumstances regarding Participant’s (or Participant’s baby if born during the Program) health and safety if the Participant is unconscious or otherwise unable to do so them/her/himself, and fully releases the University and its Agents for any liability for such decisions or actions or expenses as may be taken in connection therewith. The Undersigned authorizes the University and its Agents, at their discretion, to place Participant at the Undersigned’s expense, and without further consent by Participant or the Undersigned, in a hospital for medical services and treatment. The Undersigned hereby releases the University and its Agents from all medical and transportation expenses incurred on behalf of or for the benefit of Participant.
The Participant agrees to participate fully in the schedule of the Program. Participant hereby recognizes that the Program and attendant activities are group endeavors and agrees to accept and abide by the University and its agents, or the will of the majority whenever a matter of choice is presented to the group. Participant acknowledges that the University reserves the right to cancel, without penalty, the offering and conduct of the Program and the right to make any alterations, deletions or modifications in the schedule or academic program as deemed necessary by the University or its representative. Participant is not permitted to separate from the group. If Participant breaks the schedule and leaves group, they does so at their own risk and University will bear no responsibility to Participant or the Undersigned.
The Participant agrees to respect and abide by the laws of the location(s) of the Program and any other location traveled. Participant agrees to review in advance of the Program, respect and abide by University’s Student Code of Conduct which is incorporated herein in addition to any other rules provided to the participants at the Program, written or oral. The Participant further agrees to accept corrective actions up to and including termination of participation in the Program if Participant’s conduct is determined to be detrimental to the best interest of the Participant, the Program, or University. Participant acknowledges and agrees that they may be required to leave the Program at the sole discretion of the University. The Participant also may be required to leave the Program for medical reasons. If asked to leave for any reason, the Participant agrees to immediately leave campus or if Participant is a minor, the Undersigned will take immediate action to travel to the University and to take Participant from campus or to make arrangements for the Participant to immediately and safely leave campus.
The Undersigned further agrees that this Agreement shall be construed in accordance with the laws of the State of Ohio, which shall be the forum for any lawsuits fled under or incident to this Agreement or the Program. The term and provisions of this Agreement shall be severable, such that if a court of competent jurisdiction holds any term to be illegal, unenforceable, or in conflict with any law governing this Agreement the validity of the remaining portions shall not be affected thereby.

THIS IS A RELEASE OF LEGAL RIGHTS. READ BEFORE SIGNING. IF PARTICIPANT IS A MINOR UNDER THE AGE OF 18 YEARS OLD, A PARENT OR LEGAL GUARDIAN MUST SIGN BELOW

As a parent/guardian on behalf of the above-named minor, I have read the above Agreement and Release of Liability Form and I understand and agree to the terms and conditions stated herein. I further indemnify the state of Ohio, Ohio University, its trustees, employees, and agents for any action brought against the state of Ohio, Ohio University, its Board of Trustees, employees, agents, and volunteers by the above-named Participant, including but not limited to an action brought by him or her upon reaching the age of majority. I warrant that I am authorized to execute this document on behalf of the above-named minor.*

I agree

Electronic signature of parent/guardian of minor participant.*

Photo and Film Waiver

Choose one of the two options below*

Yes - Media, Photo and Video Authorization. I understand that during the course of the Participant’s participation in the Program, that the Program, and those acting with the Program’s permission or authority, may capture the Participant’s name, likeness, image, or voice in photographic, audio, video, digital or other recording forms (“Recordings”). I give my permission for the Program to: use those recordings or “Works” produced by the Participant (i.e., art work) for promotional, commercial, informational, or educational purposes in any and all media for any purpose consistent with the Program’s or University’s mission; and to distort, alter, or use in composite form, either intentionally or otherwise, that may occur or be produced during the production of the finished product(s). I understand that I will not have an opportunity to review or approve uses of the Recordings or Works. I understand that neither the Participant nor I will receive payment or any other compensation for the taking or use of any Recordings or Works created as a result of the Participant’s participation in the Program.

No - Media, Photo or Video Authorization. I do not grant permission to Program to take or use the Participant’s name, likeness, image, or voice in any form or to use work produced by Participant for any reason unless necessary for the administration of the Program while the Participant is participating in the Program.

Electronic signature of parent/guardian of minor participant.*

Program Discounts and Financial Aid

Alumni, Faculty and Staff Discount

Alumni, faculty, and staff of Ohio University qualify for a 10% discount on program fees for their children or dependents. If applicable, please select your status and enter your information below to receive your discount code via email. Only one 10% discount will apply to any registration.

What was your program of study and year of graduation?*

What is your department?*

Financial Aid

Select below if you wish to apply for need-based financial aid

Yes, I wish to apply for need-based financial aid

No, I do not wish to apply

Please submit a letter or statement detailing your individual situation and your request for aid.

How did you hear about summer programs?

How did you hear about summer programs at Ohio University?