BEYOND YOUR BLOCK FILM CAMP - SIGN-UP FORM

Youth Ages 12–17

Week 1 (Virtual): July 8–10 | 10 AM–1 PM

Week 2 (In Person): July 15–18 | 9 AM–3 PM

In-person Location: The Chesapeake House, 178 Chesapeake St. SW, Washington, DC 20032

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Full Name
T-shirt Size (circle one)
Full Name
I give permission for my child to be photographed or filmed during the Beyond Your Block Film Camp and for those images/videos to be used for promotional or educational purposes.
1. Health & Safety: I affirm that my child is in good health and physically able to participate in all camp activities. I understand that I must inform camp staff of any medical conditions or special needs.

2. Liability Waiver: I release Beyond Your Block, Rodney “Red” Grant, Noell Grant, Beyond Your Block staff, volunteers, and affiliates from liability for any injuries, accidents, or losses sustained during the program, both virtual and in person.

3. Virtual Participation: I understand my child must have access to a device and internet connection for the virtual portion and that I am responsible for their online conduct and participation.

4. Transportation: I understand that transportation to/from the in-person location is my responsibility.

5. Behavior Agreement: I understand that disruptive or inappropriate behavior may result in dismissal from the camp.