Filmsters Academy - Summer Film Camp for Young Filmmakers Registration



	REGISTRATION FORM FILMSTERS ACADEMY CLASSES, Summer 2008 Please complete the following information in its entirety. If you have any questions, call us at 410-263-3023 or e-mail us at filmsters@aol.com. Thanks! Printable PDF Registration Form, please print, fill out the form, sign and mail or fax back to Filmsters Academy. STUDENT INFORMATION: STUDENTS LAST NAME ________________________________________________ STUDENTS FIRST NAME ______________________________________________ STUDENTS AGE: ________ STUDENTS GRADE: ________ DOB:____________ MOTHERS NAME _____________________________________________________ MOTHERS HOME PHONE ____________________________ WORK ____________________ CELL ___________________ FATHERS HOME PHONE _____________________________ WORK ____________________ CELL ___________________ CONTACT E-MAIL ADDRESS __________________________ MAILING ADDRESS: ___________________________________________________ _____________________________________ ZIP _______________ IT IS CRITICALLY IMPORTANT TO LET US KNOW IF YOUR CHILD HAS ANY HEALTH CONCERNS OR IS ON ANY MEDICATION WHIILE IN OUR PROGRAM. IF THIS INFORMATION IS NOT FULLY DISCLOSED TO US, FILMSTERS ASSUMES NO RESPONSIBILITY FOR ANY HEALTH-RELATED INCIDENTS OR ISSUES. EMERGENCY CONTACT INFORMATION: If we cannot reach you, whom else should we contact in the event of an emergency? NAME: ______________________ RELATIONSHIP:________________________ HOME PHONE: ___________________ CELLPHONE:_________________ IS THERE ANYTHING THAT WE NEED TO KNOW ABOUT YOUR CHILD WHILE THEY ARE PARTICIPATING IN OUR FILM CAMP? (Medications? Allergies? Bee stings? Etc. HOW DID YOU FIND OUT ABOUT FILMSTERS ACADEMY? (Please check one) FRIEND ___ NEWSPAPER ARTICLE ____ CAPITAL STORY ___ POSTCARDS ____ FIRST NIGHT____ CAMP FAIR _____ OTHER ____________________________ WHAT EXPERIENCES, IF ANY, HAS YOUR CHILD HAD IN THE VIDEO/FILM OR MULTI-MEDIA ARTS PRIOR TO THIS CLASS? ______________________________________ DOES YOUR CHILD HAVE ANY SPECIAL TALENTS? IF SO, WHAT?________________________________________________________ LOCATION: Location of the camp is: THE KEY SCHOOL, Lower School Building a.k.a. “the barn” on HILLSMERE DRIVE, ANNAPOLIS, MD. Please be sure that your child arrives on time 9 am for Beginners and 10 am for Intermediate and Advanced students. Pick up for Beginner’s is 3 p.m. for Intermediates it is 4 p.m. PLEASE, PLEASE, PLEASE do not come early and leave late. We are not staffed for this. IN THE EVENT OF EMERGENCIES: THE EMERGENCY FILMSTERS CELLPHONE # IS 410-353-8808 TO REACH US CLASS LOCATION: All students should report to the Upper School Building. They can park in the first parking lot if they drive themselves. There will be signs. CHILDREN GOING OFFSITE FOR LUNCH: Please make sure that your child brings his or her own lunch. There is no open facility on the campus to serve food all day. If kids drive, they can go to McDonald’s, Subway or Jerry’s. If you approve that they can leave the campus during lunch break please sign below, however, we will not be responsible for their welfare when off of the property. Signed Print Name Relationship to child IMPORTANT! ON THE LAST FRIDAY OF THE CAMP, IT RUNS ALL DAY FROM THE START TIME UNTIL THE 7 PM SCREENING PARTY. There will be food and movies provided for all students and their guests! Children will be asked to bring an ‘audience' who will screen their work. This can be parents, neighbors, aunts/uncles, grandparents, mentors or friends. However, we ask that each child bring no more than 4 guests. Please let us know by Thursday how many guests each child will bring. If you’d like to request more, talk to us. We love to see the kids supported. TO REGISTER, PLEASE FILL OUT WITH YOUR CHOICES AND SUBMIT ALONG WITH PAYMENT TO FILMSTERS VIA CHECK OR CREDIT CARD TO: NOTE* PARTIAL PAYMENT AFTER MAY 1, 2008 DOES NOT HOLD OR GUARANTEE A SPOT FOR YOUR CHILD FILMSTERS P.O. BOX 4876 ANNAPOLIS, MD. 21403 410-263-3023 PH. 410-626-1513 FAX (YOU CAN FAX CREDIT CARD order as well) LIMITED ENROLLMENT!!!!!! WE WERE FULL LAST YEAR CLASS SELECTION Please print clearly, and match up your days and dates CLASS NAME _____________________ SECTION ________ SECTION 1 – Beginning Filmmakers JULY 28 – AUG. 1, 2008 $645.00 Plus materials fee of $50 due at first class SECTION 2 – Beginning Filmmakers AUGUST 4 -8, 2008 $645.00 Plus materials fee of $50 due at first class SECTION 3 – Intermediate Filmmakers JULY 28 - AUG. 8, 2008** $1,095.00 Plus materials fee of $60 due at first class SECTION 4 – Advanced Filmmakers JULY 26 - AUGUST 8, 2008* $1275.00 Plus materials fee of $75 due at first class * THESE ARE CONSECUTIVE DAYS TOTALING 14 DAYS, including weekends CLASS FEE DUE $ ______ PLUS MATERIALS FEE $ ______ TOTAL AMOUNT DUE $ ______ VISA ____ MC ____ DISCOVER ____ AMEX ____ NAME AS IT APPEARS ON CARD: __________________________________________ CREDIT CARD # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ EXP. _______________________ PLEASE NOTE: FILMSTERS Academy is not a Key School sponsored program. TERMS & CONDITIONS: To reserve space, registration must be received by May 1, 2008. Final payments MUST be received by July 15, 2008. Any registrations taken after July 20, 2008 must be paid in full. I hereby authorize FILMSTERS to charge my credit card or cash my enclosed check for the total amount that I have written above. If a deposit is paid by credit card and additional payment instructions are not received within three weeks of the scheduled camp start date, FILMSTERS Academy will assume balance is to be charged to the credit card on record. I understand, that these fees are not tax-deductible and are non-refundable after the close of the first day (July 28, 2008). If there are medical issues or family emergencies that arise during the camp requiring your child’s absence, we will handle those refund requests on a case-by-case basis. I understand that FILMSTERS will keep my financial information private and confidential. Any bounced check fees or declined credit card fees will be passed on to the financially negligent party. No refunds will be issued for early withdrawal, absences, behavioral dismissals, power failures or other acts of nature. Fees for campers leaving early are NOT prorated. If a child is disruptive, threatening to himself or others or unable to obey the wishes of the staff, they may be asked to leave. If this occurs, tuition is non-refundable. Tuition for camp may only be transferred to another student at the discretion of FILMSTERS Academy. On occasion, the cameras, equipment, software and hardware we use at camp may change due to ever-changing and evolving technology. I have read and understand all of the above. I understand that the camp does not provide meals or transportation for the students. I hereby release and hold harmless FILMSTERS ACADEMY from any and all claims, legal actions and liabilities, even those resulting from third parties that may arise from my child’s participation in this program. I promise to let FILMSTERS Academy know how many guests my child wishes to bring to the Friday night screening party. _______________________________ ___________________ Signature Date Printed name RELEASE FORM I hereby consent to the recording, use and reuse by DIZENFELD MILLER WHITE PRODUCTIONS, INC., FILMSTERS, LLC and any of its licensees and assigns and each of their respective employees, agents, parents, subsidiaries, and related companies (collectively, “Producer”) in any and all media, whether now known or hereafter devised, worldwide, in perpetuity, of my voice, actions, likeness (actual or simulated), name, sobriquet, picture, photograph, silhouette, appearance, and other reproductions of my physical likeness (as the same may appear in any still camera photograph and/or motion picture film or tape) and biographical information (i.e., collectively “likeness”) in and in connection with the production and exhibition (on television, theatrically, feature, festival or otherwise) of a program and/or series of television programs currently entitled “FILM CAMP” (the “Program”). I agree that Producer may use all or any part of my likeness or originally created materials, including, but not limited to my writings, artwork, original music, ideas or scripts and that they may alter or modify it, regardless of whether or not I or the original materials remains recognizable. I further agree, that Producer may use my likeness and/or name in connection with any marketing, promotion, publicity, advertisement, merchandising for the Program and all other commercial and non-commercial purposes. I release Producer (and its employees, officers and directors) from liability arising out of its use of my likeness and/or name. I agree not to make any claim against Producer (or its employees, officers and directors) as a result of the recording or use of my likeness (including, without limitation, any claim that such use invades any right of privacy and/or publicity). I and my representatives, heirs, successors and assigns hereby absolutely, unconditionally and forever release and discharge Producer, Producer’s affiliates, licensees, successors and assigns, and the employees, shareholders, directors, officers, agents and representatives of each of the foregoing (collectively, “Released Parties”), from any and all claims, demands, controversies, causes of action, damages, rights, liabilities and obligations whatsoever (including, without limitation, any defamation claim and/or claim that such use invades any right of privacy and/or publicity) (“Claims”), arising directly or indirectly out of or in connection with the Program and/or the use of my likeness. I acknowledge and agree that by reason of my releases, discharges and covenants not to sue contained herein, I expressly assume the risks of unknown and unanticipated claims concerning the matters so released, and agree that such releases apply to such unknown and unanticipated claims. In connection therewith, I expressly waive the benefits of Section 1542 of the California Civil Code, and similar statutes of other jurisdictions with respect to unknown and unanticipated claims, concerning the matters released herein, which section reads as follows: FILMSTERS Academy RELEASE FORM, P. 2 “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM MUST HAVE MATERIALLY AFFECTED HIS SETTLEMENT WITH THE DEBTOR.” I understand and acknowledge that my appearance on the Program does not fall under the jurisdiction of any SAG or AFTRA agreements (whether or not I may be a member of either such guild). My appearance and participation in any aspect of the Program is not a performance, and I am not portraying any role or part or taking direction as a performer, but am appearing as myself. My appearance on the Program is as a non-performer only, and is not employment, and does not entitle me to wages, salary or other compensation under any collective bargaining agreement or otherwise. I understand that Producer is recording my likeness in reliance upon this consent. I acknowledge that Producer has no obligation to use my likeness. I further understand that all original films, concepts, music and ideas are held under the copyright of FILMSTERS Academy and are owned by FILMSTERS Academy. This release shall be deemed to be entered into in Los Angeles County, California, and shall be governed by and interpreted in accordance with the laws of the State of California applicable to agreements entered into and carried out entirely within California. I agree that any and all disputes or controversies arising under this release or any of its terms shall be resolved exclusively by binding arbitration before a single, neutral arbitrator, to be conducted under the auspices of the American Arbitration Association, under its Commercial Arbitration Rules, through its Los Angeles, California office; provided, however, that I agree that my remedies for any breach of this release by Producer or others will be limited to damages and in no event will I be entitled to rescind this agreement or to seek injunctive or any other equitable relief. Any waiver of any term of this release in a particular instance shall not be a waiver of such term for the future. I agree that the invalidity or enforceability of any part of this release shall in no way affect the validity or enforceability of any of the remainder of this release. I understand that this Release is not intended to, and does not, negate, undermine or denigrate in any way any written representations or warranties or releases that I may have previously or otherwise made to Producer, and this Release shall survive the termination or expiration of the agreement to which this Release is attached. I have signed this release and consent on the day of , 2008. Signature Address _______ Name (Please Print or Type) City/State/Zip Telephone No. Consent of Parent or Guardian [To be signed if the person signing the attached Release is under the age of 18] I acknowledge that I have read the foregoing Release and am familiar with each and all of the terms, covenants an conditions contained therein, I am satisfied that said Release is fair and equitable, and I hereby give my express consent to the execution thereof and will not revoke my consent thereto at any time hereafter. Parent or Guardian