Medical Condition Disclosure

My student has the following medical condition(s)

(Write "N/A" if none)

My student requires these accommodations

(Write "N/A" if none)

Camp Locations

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 and Week #4 at Lehigh Middle School at 651 Sunrise Blvd.   Parents must drop off/pick up students at program location.    Students currently between age range (9-13) 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 are 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 student on time at the program site.   Students will be transported by bus from the program site to various field trip locations. Students 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 student may bring their own.

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

By signing below, I agree to the following:

1. I understand and agree, for myself and on behalf of the Student, that participation in the Summer Youth Program ("Program"), sponsored by Sheriff Carmine Marceno and the Lee County Sheriff’s Office (collectively, with their officers, agents, employees, successors, licensees, and assigns, "LCSO") and the Sheriff’s Youth Activities League (collectively, with its officers, agents, employees, successors, licensees, and assigns, "SYAL"), where LCSO and SYAL (together, the "Released Parties") provide facilities, instruction and/or supervision, could result in injury to the Student, to me, or to personal property owned by the Student or me.   In consideration for the Student's participation in the Program, I release, waive and discharge the Released Parties from, and covenant not to sue the Released Parties for, any and all liability, claims, demands, actions, or causes of action for loss, damage, injury, or illness (including those related to disclosed or undisclosed medical conditions), whether caused by negligence of any of the Released Parties or otherwise.
2. I agree, for myself and on behalf of the Student, not to make any type of legal or equitable claim on the Released Parties with respect to any injury I or the Student may suffer that is in any way related to the Program, whether or not it arises through the negligence, omission, default or other action of anyone affiliated with the Program, including other students.   I further agree that if any such claim is made, I will indemnify and defend the Released Parties with respect to any such claim, injury or damage.
3. I authorize the Released Parties to provide or obtain emergency medical treatment for the Student in my absence and shall be responsible for any resulting expenses.
4. I understand that there may not be licensed medical professionals available to attend to the Student in the event of an emergency and I shall hold the Released Parties harmless for any resulting injury or illness.   Further, I shall hold the Released Parties harmless for any injury or illness arising from any assistance that the Released Parties render in good faith.
5. I certify that the Student is physically and mentally fit to participate in the Program. I shall provide necessary instructions for the Student and I understand that my failure to do so may result in limitation of the Student's participation in, or the Student's removal from, the Program for safety reasons.
6. I authorize the Released Parties to photograph, film, and audio-record the Student or me, and to use our image, likeness, appearance, voice, name, and biographical information in any media, in whole or in part, for any purpose including educational, institutional, and informational purposes, without compensation, in perpetuity.
7. I understand and agree that these photos and other media may be edited, altered, copied, revised, or combined with other media at the discretion of the Released Parties, and that all rights, title, and interest in such media belong solely to Lee County Sheriff's Office and the Sheriff’s Youth Activities League.
8. I waive any right or claim to compensation arising from the use, display, publication, or distribution of any images, videos, depictions, or recordings of the Student or me, and I release the Released Parties from any and all claims, demands, damages, or liabilities related to such use or publication.
9. I agree, for myself and on behalf of the Student, to comply with all Program rules and regulations, including any rules and regulations governing any activities or programs for which the Student has registered, and understand and agree that noncompliance with any such rules and regulations by the Student or me may result in termination of the Student's privilege to participate in the Program.