2016 YOUNG WRITERS WORKSHOP
Information Packet
CONTENTS
Letter from the Coordinators .............................................................................................................. 1
Procedures, Regulations, Emergency, Cancellation, Cell Phone, and General Information ................ 3
What to Bring ..................................................................................................................................................... 7
Frequently Asked Questions ............................................................................................................................ 9
Transportation Release Form......................................................................................................................... 11
Medical Release Form ..................................................................................................................................... 12
Code of Conduct.............................................................................................................................................. 15
Release / Waiver .............................................................................................................................................. 16
1
Dear UNCW Young Writers Workshop Participant:
We’re happy to have you as a participant of the 2016 UNCW Young Writers Workshop! We
hope this will be a unique and exciting learning experience for you. The camp will take place
from Tuesday, July 12th to Saturday, July 16th, 2016.
The registration deadline is Tuesday, June 28, 2016.
The Young Writers Workshop staff looks forward to meeting you at your check-in on Tuesday,
July 12th, 2016, from 2 p.m. to 3 p.m. in the lobby of the Honors House, on Community Drive,
just off Cahill Drive (near Wagoner Dining Hall). Payment is due before the start of the camp. In
addition, please be prepared upon arrival to pay a refundable $50 deposit (exact cash or check
accepted) for your room key. Please note that you cannot check in at the residence hall before 2
p.m. or after 3 p.m. on July 12th.
Check-out will be Saturday, July 16th, between 11am and noon. During this time you will return
your room key, have your linens counted, and account for any deliberately damaged or lost linens.
There will be a $50 charge for lost keys (lost or misplaced keys cannot be accepted after check-out)
and a $5 charge for each piece of missing linen. Parents will be asked to pay by check during the
residence hall check-out for charges exceeding their $50 deposit. Students will be required to wear
keys on lanyards to prevent loss.
Attached, you will find the following helpful materials to prepare you for the UNCW Young
Writers Workshop and assist you in becoming familiar with the University of North Carolina
Wilmington:
ƒ
ƒ
ƒ
ƒ
YWW procedures, regulations, emergency, cell phone, and general information
A list of items to bring
Frequently Asked Questions about YWW
A map of the UNCW Campus
Also attached are 4 forms that you are required to sign and return by Tuesday, June 28.
1. Participant Information and Medical Release Long Form
2. Assumption of Risk, Release of Liability, Waiver of Claims, Photo & Media Release
and Indemnity Agreement for UNCW Program
3. Camper/Student Code of Conduct
4. Transportation Release Form
Please complete and mail all forms (by Tuesday, June 28) to the below address:
2
Young Writers Workshop Department of
Creative Writing University of North
Carolina Wilmington
601 South College Road
Wilmington, NC 28403-5938
In addition to the signed forms, students are required to send us a copy of one original piece
of creative writing for workshop during the camp. The manuscript may be a short story, three
poems, or a creative nonfiction piece. The total length of the piece should be no more than 10
typed pages, double-spaced. This will be read and discussed by peers in the camp in a
workshop setting. In order to give our workshop leaders time to read and prepare relevant
materials for your workshop, we need to have your manuscript as soon as possible.
MANUSCRIPTS MUST BE RECEIVED BY TUESDAY, JUNE 28. Send your manuscript
as a single Microsoft Word or PDF attachment to youngwriterscamp@uncw.edu. Make sure
that the student’s name appears in the file name, as well as in the document itself. Or, you
may mail a printed copy to:
Young Writers Workshop Department of
Creative Writing University of North
Carolina Wilmington
601 South College Road
Wilmington, NC 28403-5938
If you have questions after reading the materials, feel free to e-mail us at
youngwriterscamp@uncw.edu.
We’ll present you a final daily itinerary during check-in on Tuesday, July 12th. Remember, your
manuscript for workshop and all signed forms are due as soon as possible, but no later
than June 28th.
On behalf of the entire Young Writers Workshop staff and UNCW—welcome. We look forward
to seeing you on campus!
Sincerely,
Isabelle Shephard, Elizabeth Davis, and Carolyn Desalu
Coordinators, UNCW Young Writers Workshop
UNCW Young Writers Workshop – Summer 2016
3
UNCW Young Writers Workshop, Summer 2016
PROCEDURES, REGULATIONS, EMERGENCY, CANCELLATION, CELL PHONE,
AND GENERAL INFORMATION
I.
PROCEDURES
a)
Check-In Procedures:
Check-in will be Tuesday, July 12th, 2016, from 2 p.m. to 3 p.m. in the lobby of the Honors
House residence hall. During check-in, you will have the opportunity to become acquainted
with the staff and familiar with the rules and procedures of the Young Writers Workshop. A daily
itinerary will be presented to you and your parent(s) at this time. If you need directions to the
UNCW campus, please visit www.uncw.edu/admissions/Directions.html
b)
Residence Hall Procedures:
At check-in, you will receive your room key and linens. Please count your linens to be sure you
have two sheets, pillow and case, two bath, two hand, and two face towels. If any item is missing,
notify a staff person immediately so you will not be charged for that item at check-out. There will
be a $5 charge per piece of missing linen (to be paid during check-out).
After you check in, any changes you feel are absolutely necessary (concerning your room
location or roommate) can be discussed with the Young Writers Workshop coordinators on
Tuesday, July 12th. You may not change your room or exchange keys with anyone without the
express approval of a coordinator (who must keep a written record of each room occupant).
The camp’s lights-out time is 10 p.m. You will need to rise each day at 7:30 a.m. and be ready to go
to the cafeteria for breakfast by 8:15 a.m.
Parents should meet students between 11a.m. and noon on Saturday, July 16th, for check-out
(load luggage, return room keys, and pay for lost room keys, linen and/or deliberately damaged
equipment). Students who have driven themselves will need to check out with a counselor before
leaving campus.
c)
Workshop Procedures:
All participants in the Young Writers Workshop will need to send a printed copy of at least one
original piece of writing for workshop no later than Tuesday, June 28. The manuscript may be
one short story, one essay, or one to three poems. The entire manuscript should be 10 pages or
less, typed and double-spaced in a standard font (we prefer Times New Roman, 12 point). The
Young Writers Workshop staff will make copies for all participants in the workshops. Please be
4
sure your manuscript includes the participant’s full name. Also include the participant’s name in the
Word document or PDF file name. E-mail manuscripts to youngwriterscamp@uncw.edu, or
mail a hard copy to:
Young Writers Workshop
Department of Creative Writing
University of North Carolina Wilmington
601 South College Road
Wilmington, NC 28403-5938
Students will be responsible for reading and critiquing each other’s work in a structured and supportive
setting overseen by Young Writers Workshop staff. Students should come prepared to discuss the
manuscripts assigned each day. Students will be encouraged to revise their work based on the feedback
received in the workshop. For more information about workshop procedure and etiquette, please see
“Workshop FAQ,” also enclosed in this packet.
II.
REGULATIONS
a)
All UNCW Young Writers Workshop students will be under the supervision of the UNCW
Young Writers Workshop coordinators and staff from check-in on Tuesday until check-out on
Saturday, and the coordinators and staff will be responsible for each student’s well-being.
b)
Students are expected to adhere to their itinerary without exception (except during cases of
injury or illness). Students who do not adhere to the itinerary will receive a verbal warning. A second
violation will result in a phone call to the student’s parents.
c)
Any student who drives him/herself to the Young Writers Workshop will be issued a parking
pass at check-in. Students will park their cars in a designated lot and will surrender their keys to the
workshop coordinators at this time. For the duration of the camp period, no student will be allowed to
leave campus without the supervision of the Young Writers Workshop staff.
d)
Residence Hall Regulations:
While in their residence hall, students must adhere to an open-door policy when socializing, meaning
that doors will have to be completely open during visiting hours. No room visitation with closed doors is
allowed. Students may not invite anyone not connected with the Young Writers Workshop onto their
floor or into their room at any time for any reason. At 10 p.m., staff will check each room to be sure
students are ready for lights-out and will have students lock their residence hall rooms. University police
will lock all outside residence hall doors at 11 nightly. No students are allowed outside the residence hall
after 11 p.m.
5
Once students have returned to the residence hall for the evening, they may not leave their floor
or the residence hall itself. There can never be more than two students (designated roommates)
sleeping in a room. Any problems or concerns at any time must be addressed to the staff.
Students will become acquainted with the staff’s room location and nighttime emergency
procedures on the first day of camp.
Travel arrangements to and from campus must be made by the student and/or parent. UNCW
does not have residence hall space or adult supervision available prior to check-in or following
check-out. Early arrivals or late stay-overs may make arrangements in advance with one of the
many nearby hotel/motel options in Wilmington.
e) If a Young Writers Workshop student does not adhere to the Workshop procedures and
regulations, his or her parent will be called and appropriate actions taken. If it is deemed necessary
to expel a student from the Young Writers Workshop, no refund or partial refund will be granted.
If a student is expelled, his or her participation in all activities will cease immediately, and parents
will be required to make arrangements for their child to leave the Young Writers Workshop and
UNCW as quickly as possible.
III.
CELL PHONE AND LAPTOP POLICY
Young Writers Workshop participants are permitted to bring cell phones and laptops, but their use
will be restricted in order to minimize distractions and promote a sense of community among our
young writers. Students will be expected to exercise good judgment regarding appropriate cell
phone use. Camp administrators may confiscate the cell phones of students who fail to demonstrate
a mature attitude regarding cell phone use. Students who have lost their cell phone privileges will be
allowed to make calls during certain hours daily. Cell phone numbers will be collected by camp
coordinators at check-in.
IV.
CANCELLATION POLICY
In the event of cancellation, a $50 fee will be withheld from your refund. No refunds will be
granted after June 28.
V.
EMERGENCY INFORMATION
a) Students may be contacted during business hours (8 a.m.-5 p.m.) by calling the UNCW Creative
Writing Department at 910-962-7063, or the Office of Public Service and Continuing Studies at
910-962-3546. Callers should state the student’s name and provide a phone number and time at
which the student can return the call. We will be able to tell you where the student is
6
at the time of your call and what time he or she will be able to return your call. We will then get
your message to the student and staff.
If you need to reach a student between 5 p.m. and 8 a.m., call the UNCW University Police at
910-962-2222. State the student’s name, the name of the camp (Young Writers Workshop), the
residence hall (Honors House), and the phone number where you can be reached.
b) In case of an injury or illness that requires treatment other than application of basic first aid, the
student will be treated appropriately and taken to the nearest medical facility for attention. Parent(s)
will be contacted via the phone numbers listed on the student’s emergency form. Actions will be
taken according to parental wishes. A formal accident/illness report will be filed with the UNCW
Safety Office. UNCW does not carry accident insurance for Young Writers Workshop
students.
VI.
GENERAL INFORMATION
a)
If a student must leave the camp for any reason, no refund of any type may be issued.
b)
It is advisable to leave valuable items such as jewelry at home. Items such as watches,
cameras, and digital recorders are your responsibility at all times. Students must lock room doors
everyday upon leaving dorm.
7
UNCW Young Writers Workshop – Summer 2016
Items to Bring
$50 cash or check for key deposit, which will be returned upon receipt of the key. There will
be no change available. If you bring three $20 bills, then $60 will be put in the envelope to
return to you upon receipt of the key.
Pencils, pens, notebooks, and journals.
Pocket change for snack and refreshment machines, as well as some spending money for
students interested in visiting the UNCW bookstore.
Cell phones are acceptable. The student rooms are not equipped with phones; please see Cell
Phone Policy above for guidelines.
Students are encouraged, but not required, to bring books by authors they admire to help
facilitate discussion about good writing. We also hope to have an evening program where
students read from their favorite texts, so we encourage you to bring writing you might like
to share with your peers.
A comfortable pair of walking shoes—UNCW is a large campus and we will walk
everywhere.
Appropriate attire—Wilmington gets hot in July!
Residence Hall Item Checklist
Extra towels.
A blanket. Air conditioning in residence hall may get cool at night. You might also want to
bring your own pillow for a more comfortable rest.
Toiletries: soap, shampoo, toothpaste, toothbrush, comb, brush, hair dryer, deodorant,
shower shoes (flip flops), etc.
Any medications you normally use. Special administration of medications should be
brought to the attention of the coordinators upon arrival.
8
An alarm clock (this is important—you will be responsible for getting yourself up on
time every day).
UNCW cannot be responsible for personal items that may be stolen, damaged, lost, or left on
campus.
9
UNCW Young Writers Workshop
Frequently Asked Questions
What happens in the writing workshop?
In a creative writing workshop, you will share a piece of your original writing (poem, short story or
personal essay) with a group of your peers and a workshop leader, all of whom will read your piece
and give you written and oral feedback. The workshop process is a great learning experience from
both sides: you will gain insight not only from the comments you receive about your own work, but
also from reading and commenting on other students’ work.
What is proper workshop etiquette?
The workshop has some simple rules that need to be followed. When your piece is up for
workshop, come prepared to listen with an open mind. Otherwise, come prepared to talk. You
don’t need to wait to be called on, but please talk one at a time. Be honest, but remember: Give
your positive comments before the “negative” (constructive) ones. Remember, the purpose of
workshop is to help the author make his or her piece stronger, not to make anyone feel bad about
his or her writing.
How do I participate?
There are two ways you’ll participate in the workshop: as a writer and a reader. As a writer, you’ll
listen to a discussion of your work and take notes on what is said. During this discussion, you
aren’t allowed to talk, but at the end you may ask questions of your readers (such as asking them to
clarify points of discussion that you found confusing).
Each workshop is about giving and getting helpful comments and contributing to a supportive
environment in which all writers learn more about their craft. As a reader, you’ll need to read the
manuscripts assigned for workshop each day—you can’t give useful feedback if you are unfamiliar
with the pieces to be discussed. Have positive comments and suggestions for improvement ready
before you go into the workshop, so you’ll provide the author a helpful critique of his/her
manuscript. Treat each other respectfully, and remember that the discussion is always about the
writing, not the writer. If you follow this rule as reader and writer, the workshop will run smoothly.
What do I say?
Tell the workshop group what you liked. Offer suggestions for improvement. Be specific, and
cite examples from the work. Generic comments such as “I like it” or “I don’t think it works”
aren’t helpful.
These comments, though, are appropriate and useful:
10
ƒ “I like your main character. The details about her on page 5 are clear and
realistic.”
ƒ “In your poem, I have trouble seeing the image in the first line. More visual
details there would draw me into the poem right away.”
What are some kinds of comments I can make?
Below are a few aspects of writing that often receive comments in workshops:
ƒ Word choice
ƒ Characters (Are they realistic? Are they consistent? Do you like them as people?)
ƒ Metaphor/Imagery
ƒ Theme (Does the story/poem have a larger meaning?)
ƒ Setting (Can you “see” the setting?)
ƒ Description (of character, setting, action)
ƒ Line breaks (in poetry)
ƒ Dialogue (Is it realistic, or does it sound contrived—written, not spoken?)
Is the workshop scary?
Workshops should be exciting and inspiring, not scary. The UNCW Young Writers Workshop
leaders have been trained in facilitating workshops and will cover the rules and expectations with
everyone on the first day. The workshop should be an environment in which writers feel free to
share their stories and poems without fear, and our leaders will work to make this possible. If you
have questions or anxieties about the workshops, feel free to talk to your workshop leader or any of
the other camp counselors. We want the workshops to be a positive experience for everyone—
writers and readers alike.
11
Transportation Release Form
Please mail this completed form to:
Young Writers Workshop Department of
Creative Writing University of North
Carolina Wilmington
601 South College Road
Wilmington, NC 28403-5938
On Thursday evening, July 14th, 2016, the campers and staff will travel to Wrightsville Beach, then
will return to campus well before time for lights out.
By signing below, I hereby give permission for my child,
,
to ride in a vehicle (trolley or van) chosen by the staff of the Young Writers Workshop at the
University of North Carolina Wilmington, to Wrightsville Beach on the evening of Thursday,
July 14th, 2016.
Signature (parent or guardian):
Date:
12
UNIVERSITY OF NORTH CAROLINA
WILMINGTON
PARTICIPANT INFORMATION AND MEDICAL RELEASE LONG FORM
Program registering for
Date
Name of Participant/Camper
0
Male
0 Female
Date of Birth
/
/
Parent/Guardian Name (if applicable)
Home Address
City
State
Day Phone (
)
Cell Phone (
)
Zip
Evening Phone (
)
Parent/Guardian Email (print clearly)
Alternate Emergency Contacts:
Primary Contact
Day Phone (
Relationship
Cell Phone
Secondary Contact
)
(
)
Day Phone (
Relationship
Cell Phone
)
(
)
If the student must leave the program for any reason and you cannot be reached, there must be another adult
available who will take responsibility for removing the student from the campus.
Name(s) of adult(s) other than parent/guardian authorized to act on your behalf in this situation:
Name
Name
Physician or clinic you usually consult for medical care:
Name
Medical Information:
)
Cell Phone (
)
Day Phone (
)
Cell Phone (
)
Phone (
)
Date of last tetanus immunization
Allergies
Drug Sensitivities
Current medical/psychological/behavioral problems being treated
Participant Information and Medical Release Long Form rev. 11/08
Day Phone (
/
/
13
Current restrictions/recommendations due to medical condition(s)
Current medications, reason for taking
What accommodations should be made to insure proper administration and storing of the medication?
Past medical/psychological problems staff should be aware of
Is an identification band or card carried to alert others to the allergy(ies), medical conditions or medication use?
0 Yes 0 No
Please note that if your child refuses to take their prescribed medicine as directed, they may be sent home.
If your child is dealing with any type of learning disability or on a behavioral management plan that you think we
should be aware of, please consider sharing this information with us so their camp experience will be successful.
The Program’s activities may inhibit or prevent participation. If any of these conditions pertain to you,
you may VOLUNTARILY indicate by circling the information below. (Information will be shared ONLY with
pertinent
Program staff or medical professionals).
1. Motion sickness
2. Hospitalized
3. Serious Injury
4. Back problems
5. Physical handicap
6. Regular medication
7.Allergies, including drugs
8. Dizziness or fainting
9. Epilepsy
10. Heart trouble
11. Sinus trouble
12. Diabetes
13. Tuberculosis
14. Bronchitis
15. Claustrophobia
16. High blood pressure
17. Respiratory problems
18. Persistent cough
19. Pregnant
20. Chest pains
21. Contact lenses
22. Dental plates
23. Hay fever
24. Asthma
25. Trouble equalizing pressure in sinuses/ears
26. Frequent colds or sore throat
27. Severe or frequent headache
28. Ear or hearing problems
29. Alcohol or drug problems
30. Mental or emotional problems
31.Current communicable disease
32. Rejected from an activity for medical reasons
33. Any medical problem not listed
Knowing these health risks, is your child capable of participating in this activity? Please answer if you will/she/he
may participate. 0 Yes 0 No
If yes, print or type remarks:
I agree to notify the camp director by the registration deadline of any change that may occur in his/her physical
or mental health prior to arrival at the Program or in the course of his/her attendance there.
Participant Information and Medical Release Long Form rev. 11/08
2 of 3
14
Swimming Level (check one)
0 Unable to Swim
0 Weak
0 Average
0 Strong
Do you have health insurance?
0 Yes
0 No
(At the sole discretion of the Program, proof of insurance may be required before participation.)
Insurance Company’s Name _____________________________
Medical/ Hospitalization Insurace Policy Number _____________________________________
Phone Number of Office Holding Policy (_______)__________________________________
• I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE.
•
I AUTHORIZE THE ABOVE LISTED ADULT(S) TO TAKE CHARGE OF THE
STUDENT IF HE OR SHE MUST LEAVE THE PROGRAM AND I CANNOT BE
REACHED.
CAMPER/STUDENT’S SIGNATURE
DATE
CUSTODIAL PARENT’S OR GUARDIAN’S SIGNATURE (Signature of one parent binds both
parents)
DATE
PRINTED NAME OF PARENT
PRINTED NAME OF CHILD
Name of camp your child is attending
Participant Information and Medical Release Long Form rev. 11/08
3 of 3
15
UNIVERSITY OF NORTH CAROLINA
WILMINGTON
CAMPER/STUDENT CODE OF CONDUCT
To ensure that everyone has a positive experience while participating in a camp or program located at facilities of the
University of North Carolina Wilmington (“UNCW”), campers attending the Program are expected to behave in a
disciplined, responsible, and respectful manner when on or off the UNCW campus. Failure to follow these rules and
regulations will subject the campers to immediate disciplinary action as described more fully below.
As a condition of the Student’s participation, both Parents and Students must agree that neither UNCW (nor the
instructors, staff members, resident assistants and desk staff) are guarantors of the safety of the Students,
particularly for the Students’ unsupervised time, and instances where the Students fail to follow applicable rules
and regulations.
Students will:
- respect Program staff requests and follow all of their directions;
- respect all safety guidelines required by Program staff and UNCW;
- respect all curfew, wake-up and lights-out policies (residential campers);
- wear appropriate clothing and shoes during all activities;
- respect the differences in other people, make an effort to include everyone, and not behave in a manner that
may hurt another camper or staff member’s feelings;
- pick-up after myself (at all locations) and throw all trash away;
- respect other people’s personal property;
- respect all UNCW property including equipment, boats, buildings and the campus;
- be respectful of UNCW students and staff when in university buildings;
- let my Program counselor know if I am not having a good time;
- immediately bring disagreements to the attention of Program staff;
- behave in an age-appropriate manner and have fun while remaining safe to others and myself;
Students will not:
- fight with other campers using any part of their body, gestures or words;
- go anywhere without the permission and accompaniment of counselors;
- go into water above knee-level unless given permission while in a lifeguard’s presence
- use derogatory terms or offensive language at any time;
- tease or bully other campers;
- bring inappropriate items to camp (weapons, drugs, cigarettes, R-rated materials, etc)
- enter the sleeping quarters or shower areas of the opposite sex (residential campers)
- bring electronic equipment, except cell phones (campers may not use cell phones during the camp day or
other organized activities; residential campers should leave cell phones in their dorm room; they can be used after the camp day is over
but they may not be used after lights-out).
Parents will not:
- interact with Program staff in a threatening/abusive manner at any time (in person or on the phone) or they
will risk their child’s dismissal from the Program without tuition/fee refund.
If I chose not to follow the Camper Code of Conduct, I acknowledge (with my signature below) that on my:
First offense: I will be given a verbal warning explaining the expected behavior. (Unless the offense involves
physical or substance abuse for which we have a zero tolerance policy and you will be
immediately dismissed.)
Second offense: I will be removed from the activity and my parent(s) will be called to discuss my behavior.
Third offense: My parent(s) will be called notifying them of my dismissal from camp requiring immediate pick up.
Parent’s Signature _____________________________________
Camper’s Signature _____________________________________
Camper Code of Conduct (rev. 04/08)
Date ____________________
Date ____________________
16
UNIVERSITY OF NORTH CAROLINA
WILMINGTON
ASSUMPTION OF RISK, RELEASE OF LIABILITY, WAIVER OF CLAIMS, PHOTO &
MEDIA RELEASE AND INDEMNITY AGREEMENT FOR UNCW PROGRAM
PLEASE READ CAREFULLY BEFORE SIGNING
In consideration of
being allowed to participate in
the
(hereinafter referred to as the ‘Program’) as well
as the use of any of the facilities and the use of the equipment of the below listed releases, as his/her
custodial parent/guardian, I hereby agree as follows:
I,
, do hereby affirm and acknowledge that I have
been fully informed of the inherent hazards and risks to my child associated with hiking, game playing, wall
climbing, swimming, boating/canoeing/kayaking, and other water activities associated with the Program
and the physical exertion required therein. Despite potential hazards associated with the Program, including
falls, contact with other participants, sprains, ligament and tendon damage, broken bones, other personal
injury, drowning and other hazards (being caught in rip currents, shark bites, capsizing, rough water
conditions, man-made objects in the water including but not limited to: ropes, bridge pilings, and metal
junk, the forces of nature including lightning, weather changes, and ocean level changes) from participation
in water activities, injuries inflicted by animals, insects, reptiles or plants, accidents or illness in remote
places without medical facilities, illness, paralysis, permanent disability, and death, I voluntarily authorize my
child’s participation in reliance upon my own judgment and knowledge of my child’s experience and
capabilities.
Additionally, I understand that there are also risks to my child associated with travel, including, but
not limited to the possible injury or loss of life or property. Despite the potential hazards and dangers, I
voluntarily agree to allow my child to participate in the Program and hereby accept and assume all such risks,
known and unknown, and assume all responsibility for the losses, costs and/or damages following such
injury, disability, paralysis or death of my child and damage or destruction to my child’s property, even if
caused, in whole or part, by the negligence of the staff member and volunteers of the Program or the
University of North Carolina at Wilmington (hereinafter “UNCW”) with the exception of willful or gross
negligence.
I understand that I may inspect the premises, facilities and equipment to be used or with which
my child may come in contact. If I believe anything is unsafe, I will immediately refuse to allow my child
to participate further in the Program activity. By entering into this agreement, I am not relying on any oral
or written representation or statements made by UNCW, other than what is set forth in this agreement.
I give permission to any doctor, hospital, or other medical agency to release confidentially to the
treating physician(s) for my child any information they may have concerning his/her medical condition and
their professional contact with him/her. I hereby grant my permission for such diagnostic, therapeutic, and
operative procedures as may be deemed necessary for my child. (Where practical, you
Camp Release Long Form – rev. 11/08
1 of 2
17
will be notified by telephone before any procedures are done.) A photocopy of this permission is to be
considered as valid as the original. I further understand that treatment for any medical problems my child
may suffer is my responsibility and will be paid by me and/or covered by my insurance.
I shall indemnify, defend and save harmless UNCW, its officers, directors, employees,
representatives, agents and volunteers from all liabilities, losses, costs, damages, claims or causes of action of
any kind or nature whatsoever, and expenses, including attorneys fees, arising or claimed to have arisen out
of personal injuries or death, or property damage or loss, sustained by my child or me as a result of
negligence on the part of any of the entities or individuals identified above as a result of my child’s own
negligence or intentional acts, during my child’s participation in this Program, including travel to and from
the activity sites.
I have read the Camper/Student Conduct Rules & Regulations and hereby accept the regulations of
the program described therein. I understand that the Program has the authority to establish and enforce
other regulations in addition to these.
I have agreed that my child may be photographed, audio or videotaped by the Program or UNCW.
With my signature, I agree that photographic image(s) and information that correspond with the photographic
image(s) may be disseminated for any public release usage by the Program or UNCW.
□ Check only if: I do not agree to photo/media dissemination for any public release from UNCW.
I further agree that this agreement shall be governed by and interpreted in accordance with the laws
of the State of North Carolina, United States of America. If any provision of this release is found to be
unenforceable or invalid, that provision shall be severed from this contract. The remainder of this contract
will then be construed as though the unenforceable provision had never been contained in this document.
With the Program and activities having been fully explained to me and all of my questions answered
to my satisfaction, I agree to participate in the Program, fully aware of the activities and risks that may be
involved. I also understand that this is a legal document which is binding on me, my heirs and assigns and
on those who may claim by or through me. I am eighteen years of age or older, have full capacity to enter
into this Agreement, and do so voluntarily.
I HAVE READ THIS AGREEMENT, I UNDERSTAND IT AND
I AGREE TO BE BOUND BY IT.
CUSTODIAL PARENT’S OR GUARDIAN’S SIGNATURE
(Signature of one parent binds both parents)
PRINTED NAME OF PARENT
DATE
PRINTED NAME OF CHILD
Name of camp your child is attending
Camp Release Long Form – rev. 11/08
2 of 2