Madam President Camp · June 24th - 28th MPC @ Truman Library Registration 2024

June 24th - 28th MPC Registration 2024

We are excited to have your camper join us June 24th - 28th (9AM-4PM) at the Truman Library!

How did you learn about Madam President Camp?

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Other (please specify)

Where did you hear about us?

Camper Information

*If you would like to register multiple campers, please complete a separate application for each camper.

Camper Name

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First Name

Last Name

Camper's Nickname (if applicable)

Date of Birth

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(mm/dd/yyyy)

Age at time of camp:

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Camp is intended for girls ages 11-13.

Grade completed at time of camp:

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School camper will attend in Fall 2024

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Has this camper previously attended Madam President Camp?

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Yes

No

If so, what year(s)?

Race

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Help us learn more about our campers by selecting one of the fields below:

Ethnicity

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Help us learn more about our campers by selecting one of the fields below:

Allergies

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Does your camper have any allergies?

Medications

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Does your camper take any medication? Please provide details (time taken, with/without food, refrigeration required, etc).

Additional Considerations

Are there any additional considerations camp staff should be aware (medical concerns or diagnosis)?

Consent Forms

MADAM PRESIDENT CAMP Release, Authorization and Consent

Consent. As parent or legal guardian of Camper, I authorize and consent to Camper’s participation in the Madam President Camp, all associated activities, and collaborating organizations (“Camp”).

RELEASE. ON BEHALF OF CAMPER AND MYSELF, I WAIVE, RELEASE, HOLD HARMLESS AND ASSUME THE RISK OF ALL CLAIMS, ACTIONS, DAMAGES, LOSSES OR LIABILITIES OF ANY KIND ARISING OUT OF OR RELATED TO CAMPER’S PARTICIPATION IN CAMP (“CLAIMS”) AGAINST CAMP AND ITS DIRECTORS, STAFF, AGENTS AND REPRESENTATIVES, TO THE FULLEST EXTENT ALLOWED UNDER LAW.

Indemnity. I agree to indemnify, defend, and hold Camp harmless with respect to any Claims by third parties (including other Campers) arising out of Campers’ participation in the Camp, including payment of reasonable defense costs incurred by the Camp.

Medical Authority. I authorize Camp staff to provide or procure medical attention for Camper for any injuries or illnesses that arise during in-person Camper’s participation in Camp, as Camp in its discretion deems necessary, and to pay for any such medical attention.

Prescription Medicines. Camp is not authorized to accept, store, or distribute prescription medication. All campers must be responsible for their own prescription medications.

Severability and Governing Law/Forum. If any aspect of this waiver is deemed to be invalid, I acknowledge that the remainder of the agreement will continue to have full force and effect. I agree that Missouri law shall govern any Claim, and any action regarding such claim shall be brought in the state or federal courts in Missouri.

I CERTIFY THAT I HAVE READ THIS, FULLY UNDERSTAND ITS CONTENT, AND AGREE TO ITS TERMS.

Release, Authorization and Consent

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By certifying this, I agree to the terms above.

I certify

MADAM PRESIDENT CAMP Video, Audio, and Photograph Consent Form

Video, Audio, and Photograph Consent. I grant Camp permission to record and publish audio files, quotes, photographs, and videos in which Camper appears, and use them for educational purposes or in the promotion of Camp. I waive any right of compensation and ownership with respect to such recorded content.

I CERTIFY THAT I HAVE READ THIS, FULLY UNDERSTAND ITS CONTENT, AND AGREE TO ITS TERMS.

Video, Audio, and Photograph Consent

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By certifying this, I agree to the terms above.

I consent

I do not consent

MADAM PRESIDENT CAMP Text Communication Consent Form

Consent. As parent or legal guardian of Camper, I authorize and consent for Camper to receive the following forms of communication from Madam President Camp and associated entities (“Camp”).

Text Message Communication: I grant Madam President Camp permission to contact Camper via text message to receive information about future camps and events, leadership and community opportunities, and other programs or activities directly related to the mission of Camp. Camper maintains the ability to opt out of receiving text messages at any time. Standard text message rates may apply.

I CERTIFY THAT I HAVE READ THIS, FULLY UNDERSTAND ITS CONTENT, AND AGREE TO ITS TERMS.

Text Consent

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By certifying this, I agree to the terms above.

I consent

I do not consent

Preferred Contact Number

MADAM PRESIDENT CAMP Email Communication Consent Form

Consent. As parent or legal guardian of Camper, I authorize and consent for Camper to receive the following forms of communication from Madam President Camp and associated entities (“Camp”).

Email Communication: I grant Camp permission to contact Camper via email to receive information about future camps and events, leadership and community opportunities, and other programs or activities directly related to the mission of Camp. Camper maintains the ability to unsubscribe from emails at any time.

I CERTIFY THAT I HAVE READ THIS, FULLY UNDERSTAND ITS CONTENT, AND AGREE TO ITS TERMS.

Email Consent

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By certifying this, I agree to the terms above.

I consent

I do not consent

Preferred Email Address

Verify Email

Parent/Guardian Information

Name

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First Name

Last Name

Email

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Verify Email

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Cell Phone Number

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Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Additional Parent/Guardian Information

Additional Parent/Guardian Name

First Name

Last Name

Additional Parent/Guardian Email

Verify Email

Additional Parent/Guardian Cell Phone Number

Emergency Contact Information

Emergency Contact Name

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First Name

Last Name

Emergency Contact Email

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Verify Email

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Emergency Contact Cell Phone Number

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Emergency Contact Relationship to Camper

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Additional Individuals Permitted to Drop Off/Pick Up Camper

Please list the names, cell phone numbers, and the relationship to the camper of additional individuals besides those listed above who are allowed to drop off or pick up my camper.

Individual 1 Name

First Name

Last Name

Individual 1 Cell Phone Number

Individual 1 Relationship to Camper

Individual 2 Name

First Name

Last Name

Individual 2 Cell Phone Number

Individual 2 Relationship to Camper

Proceed to Payment

Dropdown

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