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Fortnite Camp Registration

Summer Camp

Camper Information

Parent/Guardian Contact Information

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TERMS AND AGREEMENT PERMISSIONS I understand that by submitting this Summer Camp registration for the above-named camper, I am hereby granting permission for the above-named camper to participate in all Susquehanna Esports Academy's Summer Camp activities, including Academy-sponsored trips off-campus. I understand Susquehanna Esports may deny enrollment or dismiss any student whom it considers not to be participating properly in the program. I also understand that any of the programs receiving an insufficient registration may be cancelled. In the event of an emergency requiring immediate medical treatment, I understand that the staff of Susquehanna Esports Academy will try to reach me by using the telephone numbers listed on this form. In the event that I cannot be reached, I authorize treatment by appropriate personnel as approved by Susquehanna Esports Academy staff. We understand and accept the need for Susquehanna Esports Academy to be fully informed as to the physical and mental health of the enrollee. Failure to disclose such essential information at the time of enrollment or upon the request of Susquehanna Esports can be cause for disenrollment. Susquehanna Esports pledges to respect the confidentiality of such information and to use it only for professional purposes. Doses of prescribed or over-the-counter medicine must be administered by a parent or guardian.

I agree to terms and agreement permissions listed above. *

MEDIA PERMISSIONS I understand that unless I give Susquehanna Esports written notice to the contrary, by signing this form I am granting permission: (a) for the Academy to use information, photos, and video of and/or prepared by the above-named student online and in Academy publications and to share that material with newspapers, magazines, and radio/television media as appropriate; and (b) for Susquehanna Esports to use information, photos, and video of and/or prepared by the above-named student in social media applications (including but not limited to Facebook, Twitter, Instagram, YouTube, and other web-based communication tools). I am aware that I have the right to add the above-named camper to the Academy’s media exclusion list for the summer of the current year by providing written notice to Susquehanna Esports. I understand that the media exclusion list is all-inclusive, and if the above-named camper is listed, all information, photos, and video of and/or prepared by the above-named camper will be excluded from all internal and external media, including but not limited to: Academy print publications, external newspapers and magazines, radio/television media, the school website, and social media platforms. The permissions noted above extend in perpetuity beyond the camper’s enrollment and/or termination of this agreement. By signing this Agreement, I irrevocably release Susquehanna Esports, its successors and assigns, and those acting with its permission and upon its authority, from any liability, responsibility, or claim that may arise by reason of exercise of the authority granted above.

I agree to media permissions listed above. *
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