Summer Youth Program Registration

You are signing up for Waiting List Only.

Student Information

Student Name
Student Shirt Size

Parent/Guardian Information

Parents Name
Parents Address

Emergency Contact 1

Emergency First Contact Name

Emergency Contact 2

Emergency Second Contact Name

Medical Information

Camp Locations

Week Camp Location
Week 1 and Week 2 Gulf Middle School 1809 SW 36th Terrace Cape Coral 33914
Week 3 Lehigh Middle School 651 Sunrise Blvd Lehigh Acres 33936
Week 4 Three Oaks Middle School  18500 Three oaks Parkway Ft Myers 33967

Your child can only register once. Please choose a week for your child to attend. All lines with red asterisk (*) must be filled out.

Important Information Prior to Submitting this Application

Sheriff Carmine Marceno’s Summer Youth Program is FREE of charge. The program will be held Week #1 and Week #2 at Gulf Middle School at 1809 SW 36th Terrace, Week #3 at Lehigh Middle School at 651 Sunrise Blvd, and Week #4 at Three oaks Middle School at 18500 Three Oaks Parkway. Parents must drop off/pick up children at program location. Students currently between 3rd grade and 9th grade who may be interested in participating in the program, are encouraged to apply. Unfortunately, space is limited and the program is based on availability.


Week #1, Week #2 and Week #3 is a five-day summer program, Monday through Friday. Week #4 is a four-day summer program due to the holiday.   A parent/guardian will be responsible for dropping off and picking up their child on time at the program site. Children will be transported by bus from the program site to various field trip locations. Children are required to wear appropriate, comfortable clothing and closed-toed athletic shoes each day. Lunch and a snack will be provided each day, however, your child may bring their own.


This Summer Youth Program offers a creative and interactive approach geared towards today’s youth. Each child will participate in various law enforcement demonstrations, off site field trips and physical activities.

Authorization
Clear Signature
“The school is neither endorsing nor sponsoring this event, product or service, nor endorsing the views of the sponsoring organization.”

PARTICIPANT WAIVER

Clear Signature

PHOTO, VIDEO, AND SOUND RECORDING RELEASE AND CONSENT

By digitally signing below, I irrevocably give permission to Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League, including all of their officers, agents, employees, successors, licensees, and assigns (including any entity Sheriff Marceno, the Lee County Sheriff's Office, or the Sheriff’s Youth Activities League so designates) to take and use photographs, video or sound recordings of myself and/or my minor child for the following project/event:

This is completely voluntary and up to me.

My consent to the use of the photographs, video and sound recordings and my child's and/ or my image, likeness, appearance, and voice is for forever. I will not receive compensation for the use of my and/ or my child's image, likeness, appearance, and voice now or in the future. Sheriff Carmine Marceno, the Lee County Sheriff's Office, the Sheriff’s Youth Activities League may use the photographs, video and sound recordings containing my child's and/or my image, likeness, appearance and voice in any manner or media, including but not limited to use on web pages and social media page. The photographs, video and sound recordings may be used in whole or in part, alone or with other recordings. The photographs, video and sound recordings may be used for any purpose including but not limited to educational, institutional, and informational purposes. Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League have the right and may allow others outside the Lee County Sheriff’s Office and the Sheriff’s Youth ctivities League to copy, edit, alter, retouch, revise and otherwise change the photographs, video and sound recordings at Sheriff Carmine Marceno, the Lee County Sheriff’s Office’s, and/or the Sheriff’s Youth Activities League’s discretion. All rights, title, and interest whatsoever in the photographs, video and sound recordings belong solely to Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League.

I further give permission to Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League to use my child's and/or my name, biography, and any other personal data, events, or other material in or in connection with any such uses of the photographs, video and sound recordings.

By digitally signing this form I also understand and agree to the conditions outlined in this photograph, video and sound recording release and consent form. As the parent or legal guardian of the child named below and on behalf of myself and/ or my child, I irrevocably give consent to Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League and their respective officers, agents, employees, successors, licensees, and assigns (including any entity Sheriff Marceno, the Lee County Sheriff's Office, or the Sheriff’s Youth Activities League so designates) forever to make use of my child's and my image, likeness, appearance, and voice in photographs, video and sound recordings as described above.

I acknowledge that I am fully aware of the contents of this release and am under no disability, duress, or undue influence at the time of my signing of this instrument.

I waive any right or claim for compensation of any kind or type whatsoever from Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League for the use, maintenance, release, display, distribution, and publication and promulgated of my child's and my image(s)/photograph(s)/likenesses(s)/depiction(s).

I waive and release Sheriff Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League from any and all claims, demands, damages and/or liability resulting from, or related to the use, release, display, publication, distribution, publication/promulgation of any image(s)/photograph(s)/likenesses(s)/depiction(s), including, without limitation, any such claims and/ or demands made by individuals or entities other me.
My consent to the use of the photographs, video and sound recordings and my child's and/ or my image, likeness, appearance, and voice is for forever. I will not receive compensation for the use of my and/ or my child's image, likeness, appearance, and voice now or in the future. Sheriff Carmine Marceno, the Lee County Sheriff's Office, the Sheriff’s Youth Activities League may use the photographs, video and sound recordings containing my child's and/or my image, likeness, appearance and voice in any manner or media, including but not limited to use on web pages and social media page. The photographs, video and sound recordings may be used in whole or in part, alone or with other recordings. The photographs, video and sound recordings may be used for any purpose including but not limited to educational, institutional, and informational purposes. Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League have the right and may allow others outside the Lee County Sheriff’s Office and the Sheriff’s Youth Activities League to copy, edit, alter, retouch, revise and otherwise change the photographs, video and sound recordings at Sheriff Carmine Marceno, the Lee County Sheriff’s Office’s, and/or the Sheriff’s Youth Activities League’s discretion. All rights, title, and interest whatsoever in the photographs, video and sound recordings belong solely to Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League. I further give permission to Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League to use my child's and/or my name, biography, and any other personal data, events, or other material in or in connection with any such uses of the photographs, video and sound recordings. By digitally signing this form I also understand and agree to the conditions outlined in this photograph, video and sound recording release and consent form. As the parent or legal guardian of the child named below and on behalf of myself and/ or my child, I irrevocably give consent to Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League and their respective officers, agents, employees, successors, licensees, and assigns (including any entity Sheriff Marceno, the Lee County Sheriff's Office, or the Sheriff’s Youth Activities League so designates) forever to make use of my child's and my image, likeness, appearance, and voice in photographs, video and sound recordings as described above. I acknowledge that I am fully aware of the contents of this release and am under no disability, duress, or undue influence at the time of my signing of this instrument. I waive any right or claim for compensation of any kind or type whatsoever from Sheriff Carmine Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League for the use, maintenance, release, display, distribution, and publication and promulgated of my child's and my image(s) / photograph(s) / likenesses(s) / depiction(s). I waive and release Sheriff Marceno, the Lee County Sheriff's Office, and the Sheriff’s Youth Activities League from any and all claims, demands, damages and/or liability resulting from, or related to the use, release, display, publication, distribution, publication/promulgation of any image(s)/photograph(s)/likenesses(s)/depiction(s), including, without limitation, any such claims and/ or demands made by individuals or entities other me.
Clear Signature
Photo Address