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Summer High School Film Camp Application
Summer High School Film Camp Application
Kait Fore
2025-03-17T20:37:38+00:00
SUMMER HIGH SCHOOL FILMMAKING CAMP
APPLICATION
Camp dates from July 14th – 18th
"
*
" indicates required fields
Student's Legal Name:
*
First
Last
Nickname (if applicable):
Sex:
*
Male
Female
Other
Home Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
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District of Columbia
Florida
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Guam
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Maryland
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New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
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Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cell Phone Number:
*
Permission
By providing my cell phone number I agree to receive calls and texts to this number from Motion Picture Institute. Msg & Data Rates May Apply.
Alternative Phone Number:
Email Address:
*
High School Grade Fall 2025 (outgoing seniors accepted):
*
T-Shirt Size:
PARENT/GUARDIAN CONTACT INFORMATION
State law requires that the following information indicate physical address of the parents/guardians in case of emergency.
Parent or Guardian's Name:
*
First
Last
Home Address:
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cell Phone Number:
*
Alternative Phone Number:
Email Address:
*
Business Address:
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Business Phone Number:
*
Business Email Address:
AUTHORIZED PERSONS FOR PICK-UP OF STUDENT:
Required for registration - unless student is 16 years of age and has a valid driver's license.
Please list all persons, including parents, who are authorized to pick up this student. The student WILL NOT be released to any person not listed here, regardless of relationship to the student.
Person 1:
*
First
Last
Person 2:
First
Last
Person 3:
First
Last
MEDICAL INFORMATION:
Medical treatment information for students is required for registration.
Person to call in case of emergency:
*
First
Last
Relationship to the student:
*
ICE Contact Phone Number:
*
Conditions or restrictions which Motion Picture Institute should be aware of to best serve your child:
(restricted to vision or hearing, listed allergies, sun sensitivity, attention deficit disorder, etc.)
MEDICAL TREATMENT AGREEMENT:
"In case of a medical emergency, I understand that every effort will be made to contact parents or guardians of students. In the event that I cannot be reached, I the parent or this applicant, delegate to Motion Picture Institute the authority to authorize and consent to any and all medical, surgical, dental, or hospital care or treatment while he/she is a Filmmaking Camp student at MPI. Such treatment is to be rendered, or under the jurisdiction of a duly licensed physician, nurse, or dentist.
Motion Picture Institute is fully authorized to act in accordance with their best judgement in such emergency and is absolved from any liability or financial responsibility in connection therewith".
NOTE: For any medical condition that requires administration of medication and/or if medications will be brought onto Motion Picture Institute campus: provide a copy of actual prescription, conditions under which medication shall be administered, and by whom. (ie: administrated nurse, by camper, etc.) Please inform us if student has medication for self-administration and if refrigeration is required. Attach copies of originals to page 3 of this form. Motion Picture Institute does not retain a nurse during the program. The program staff dispenses no medication (i.e. aspirin).
READ REGISTRATION TERMS:
PAYMENT: All programs require full payment in order to reserve a seat in the camp. If the camp is unavailable at the time of your registration we will return your check.
We accept checks, money orders (made out to Motion Picture Institute), credit cards (subject to a 2.5% processing fee) and paypal (made to payments@motionpicture.edu). If you have questions you may call us at (248) 528-1760.
CANCELLATION: In the unlikely event the Motion Picture Institute needs to cancel registrations for the camp your entire payment will be refunded. Returned checks will be mailed to the student's home address.
PARTICIPATION CANCELLATION REFUNDS: In the event a student elects to cancel enrollment, full refunds (less a $25.00 processing fee) will be given if written cancellation notice is received before May 1st. Any cancellation after this date student will receive a 50% refund (less a $25.00 processing fee). No refunds are given after June 1st.
SUMMER WAITING LISTS: If the camp fills, the registrar will provide registrants with the opportunity to be placed on a waiting list. Throughout the registration season, the registrar will communicate with wait list families when and if an opening occurs. Participation on any waiting list will be organized according to the date the registration was received.
DECLINING APPLICATION: Motion Picture Institute reserves the right to decline any application for programmatic reasons.
MOTION PICTURE INSTITUTE is not responsible for lost or stolen articles.
PAYMENT:
SUBMIT PAYMENT IN FULL. COST IS $699.00 (includes MPI T-Shirt)
a. Mail to 2040 Crooks Rd. Ste. B. Troy, MI 48084.
b. Have questions regarding registration? Call (248) 528-1760 or Email: info@motionpicture.edu
c. Registrations cannot be processed and space cannot be reserved without payment in full.
AGREEMENT
*
By checking this box, I (the parent or guardian) agree that all information I have provided is true, and I agree to all above terms and conditions.
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