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2018 Animation Gets Real Registration and Payment

2018 Animation Gets Real Registration/Payment

1. Student Name and Contact Information
2. Would you like to share your student's diability?
3. Does your student have any allergies that we should know about?
4. Has the student used a computer animation program before?
5. Can your student navigate a computer independently?
6. Does your student need any accommodations/modifications to successfully participate?
7. Will your student be participating with a personal assistant?
8. Will your student be participating in the lunch programs?  A second survey will be sent to students purchasing the lunch option.
9. Each student will receive a T-shirt for their participation in Animation Camp.  What size shirt would your student wear?  Sizes listed are adult sizes.
10. Where did you hear about Animation Gets Real Summer Camp?  Please select all that apply.
11. In the case of a physical or any injury to registrant associated with an activity involving VSA and/or VSA Florida or CARD, Center for Autism and Related Disabilities, the registrant and contractor shall indemnify and hold harmless, and hereby releases, discharges, and acquits VSA and VSA Florida, Inc. and CARD (and their respective directors, officers, members, employees, agents and independent contractors) from and against any and all claims, damages and liabilities resulting from or associated with said injury or the treatment of said injury.

I/(my son/daughter has permission) will/to participate in Animation Gets Real.  I hereby give my consent to have a doctor of medicine or dentistry provide me (my son/daughter) with emergency medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of each assistance and/or treatment. *This question is required.
Signature of
12. My signature on this document gives my consent to VSA Florida to photograph or videotape me/my child and to use such photos, voice or other likeness for future public awareness including print media, online news distribution, VSA Florida website, television and radio opportunities, video, promotional materials and other educational or exhibition purposes.  I also acknowledge that my/my child's work that is created through VSA Florida programs may be selected, displayed, used, or reproduced to benefit the ongoing statewide art programming of VSA Florida. *This question is required.
Signature of