Summer Youth Program 2024

Student Information

Parent/Guardian Information

Emergency Contact 1

Emergency Contact 2

Medical Information

Week #1 & #2 Camp Location: Lehigh Middle School, 651 Sunrise Blvd

Week #3 & #4 Camp Location: North Fort Myers Academy of the Arts, 1856 Arts Way

BUS Schedule and Locations

Buses will be provided at the following locations with 8am Pickup and 4pm Drop off

Week Bus School Bus Address Dates Pick Up Drop Off
One Oak Hammock Middle School 5321 Tice St June 10- June 13, 2024 8am 4pm
Two Bonita Middle School 10141 W Terry St, Bonita Springs June 17 - June 20, 2024 8am 4pm
Three Lehigh High School 901 Gunnery Rd June 24 - June 27, 2024 8am 4pm
Four Cypress Lake Middle School 8901 Cypress Lake Dr July 8 - July 11, 2024 8am 4pm

You can only select one week. 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 #2 at Lehigh Middle School at 651 Sunrise Blvd, and week #3 and #4 will be held at North Fort Myers Academy of the Arts at 1856 Arts Way. Buses will be provided to students if needed, at the locations listed above. Parents may 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.

This is a four-day summer program, Monday through Thursday. A parent/guardian will be responsible for dropping off and picking up their child on time at the program site or bus stop location. In addition to the optional bus drop off and pick up, children may be transported by bus from the program site to Nan's Ranch, the Sheriff's Animal Farm located outside the Lee County Jail to interact with and learn about various wild and domestic animals. Children are required to wear appropriate, comfortable clothing and closed-toed athletic shoes each day. Lunch and snacks 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, team building exercises and physical activities. They will learn about the dangers of drugs, bullying, cyber safety, peer pressure, and many other issues encountered by today’s youth on and off campus.

PARTICIPANT WAIVER


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.