Visual Storytelling Summer Camp

Participant Name:*
First Last
DOB:*
Age:*
School:*
Mailing Address:*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian Emergency Contact Information
Name*
First Last
Cell Phone:*
Email
Relationship:*
Alternative Number:*
Alternate Emergency Contact Information
Name*
First Last
Cell Phone:*
Relationship:*
Alternative Number:*
Health Insurance Coverage Information
Insurance Provider:*
Policy / ID Number:*
Subscriber Name:*
Providers Address:*
Street Address Address Line 2 City State ZIP Code
Health Information
Please list any medical conditions your child has, including any requiring maintenance medication (e.g., Diabetes, Asthma, Seizures).
Medical problem we should be aware of:
Is your child presently being treated for any injury or sickness, or taking any form of medication for any reason?*
If yes, please explain:
Is your child allergic to any type of food or medication?*
If yes, please explain:
Does your child require a special diet?*
If yes, please explain:
The purpose of this information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.
The participant's legal guardian authorizes the VSTS camp staff to apply first aid to my kid if needed.
I certify that the above information is complete and accurate:
Parent/Guardian Electronic Signature:*
Date:*
Photograph/Recordings Release & Transportation Release
Photograph/Recordings Release:
I understand that photographs and/or video/audio recordings may be made of my child during the Visual Storytelling Summer Camp (VSTS) 2023. I grant full permission for VSTS camp to use any photographs, recordings, or any other record of my child’s activities during the Camp. I understand that all photographs and recordings are the property of SUNY Oswego.
Transportation Release:
I understand that, as part of the VSTS Camp program, my child might be transported to different locations in the Syracuse area. I hereby give permission for the transportation of my child for VSTS Camp activities by modes of transportation determined by VSTS Camp staff. I also understand that transportation to the camp for drop off and pick up won’t be provided and it is of my responsibility to drop my child off at 8:30am and pick up at 3:00pm.
Emergency or Alternative Pick Up:
This is a person over the age of 16 who is authorized to pick up your child and can be contacted by VSTS camp staff when the parent/guardian can’t be reached or when the parent/guardian let the VSTS camp staff via text or phone call know that this authorized person will be the one picking up your child. Please be sure to text VSTS camp staff at least an hour before picking up time to let them know.
Name of the Alternative Driver:*
First Last
Phone Number:*
Relationship:*
By my signature below, I affirm that I have read, understood, and voluntarily accept the terms of this agreement.
Parent/Guardian Electronic Signature:*
Date:*
Participant Acknowledgement of Responsibilities:
I understand that if I choose not to follow activity rules or regulations, I can be removed from participation in VSTS Camp by VSTS camp staff and returned immediately to my parent’s or guardian’s care. I understand the care and security of my personal belongings are my responsibility. I understand that my participation in VSTS Camp activities is voluntary.
By my signature below, I affirm that I have read, understood, and voluntarily accept the terms of this agreement.
Participant Electronic Signature:*
Date:*
Image(s)
This step isn't a requirement, but we would like to know the participant a little better before the camp starts. So please upload two pictures of your kid, family, pets, etc., with the form. That would be very much appreciated.
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WCNY and SUNY Oswego are Proud to Present Visual Storytelling Summer Camp 2023!

We are proud to announce that we’ve selected ten 7th, 8th, and 9th graders to join us this summer to learn about visual storytelling and audiovisual production at the WCNY-TV Studios in Syracuse, NY! This hands-on program takes place June 27 through July 26 on Mondays-Fridays from 8:30 a.m.-3 p.m. During each program, participants will learn the principles of storytelling, character development, storyline, plot and resolution, and visual storytelling techniques like video recording, audio recording, and video editing.

SUNY Oswego

Syracuse City School District

Central New York Community Foundation

For General Questions, please email marketing@wcny.org or call (315) 385-7401.

Press contact: Please email Professor Francisco Suarez at francisco.suarez@oswego.edu for any press coverage.

TV

Local Programs

Local Documentaries

National Programs

PBS KIDS

Visual Storytelling Summer Camp

Parent/Guardian Emergency Contact Information

Alternate Emergency Contact Information

Health Insurance Coverage Information

Health Information

The participant's legal guardian authorizes the VSTS camp staff to apply first aid to my kid if needed.

I certify that the above information is complete and accurate:

Photograph/Recordings Release & Transportation Release

Photograph/Recordings Release:

Transportation Release:

Emergency or Alternative Pick Up:

By my signature below, I affirm that I have read, understood, and voluntarily accept the terms of this agreement.

Participant Acknowledgement of Responsibilities:

By my signature below, I affirm that I have read, understood, and voluntarily accept the terms of this agreement.

WCNY and SUNY Oswego are Proud to Present Visual Storytelling Summer Camp 2023!