Teen Patriot Application Form

XS (4-6)
S(6-8)
M(10-12)
L(14-16)
Adult S
Adult M
Adult L
Adult XL
Yes
No
except M
except T
except W
except H
except F
Supervising young children
Assisting group leaders
acting out historical events
See below
Previous volunteer
Friend/Neighbor/Relative
Phone Call
Email
Website
Facebook
Newspaper
Flyer
Radio
Fair
Parade
Other
I hereby authorize the Liberty Camp For Kids to use, reproduce, and/or publish all written and/or visual materials, including photographs and video that may pertain to me or my children. I understand that this material may be used in various publications, public affairs releases, recruitment materials, or for other related endeavors. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, the Liberty Camp For Kids may publish materials, use my name, my child's first name, photograph, video, and/or make reference to me or my child in any manner that the Liberty Camp For Kids deems appropriate in order to promote/publicize the event.
I approve
I disapprove
The undersigned hereby request and approve entrant's registration and participation in the Liberty Camp For Kids. In consideration of such registration, the undersigned hereby agree: that entrant's participation will be at the sole risk of entrant and the undersigned without liability to the Liberty Camp For KIds and their officers, members, and agents, all of whom the undersigned hereby agree to release, indemnify and hold harmless from any and all claims and expenses resulting from or relating to entrant's said participation.
I approve
I disapprove
If you do not have a sibling who is attending as a camper, but you wish to make a reservation for Friday's picnic, please do so below. Include one reservation per family and be sure to include yourself. If you are not able to attend or if your reservation is included in a camper's reservation, please list as a zero.