Experience Camp Registration Week 1 - PM Session - Louisville Leopard Percussionists

2023 LLP Experience Camp Week 1 ( July 10-14 ) - AFTERNOON SESSION

Who: Children entering 4th & 5th grade in the fall of 2023

When: July 10-14 1:00pm to 4:00pm

Where: Leopard Rehearsal Space ~ 969 South 2nd Street, 40203 ~ Corner of 2nd & Kentucky

Cost: $140 (includes camp T-shirt)

What: The Louisville Leopard Percussionists (LLP), Louisville's own nationally-recognized children's percussion ensemble, is offering a week-long percussion camp for children who are entering 4th-5th grade in fall 2023. Camp participants will experience first hand the high-energy, uniquely hands-on teaching style of the award-winning Leopard camp staff. Children will take daily classes in drum set, hand drumming, percussion rudiments, and mallet percussion ensemble. No prior musical experience is required, expected, or even desired!

How: To register, please complete the following form and make your payment by credit card. $25 of the fee is non-refundable. If making this payment is an issue, please contact our Business Manager, Caroline Taylor, at caroline.h.taylor@gmail.com. We do have camp scholarships available. Once you have submitted your registration, you will receive an email confirmation with further details. If you do not receive a confirmation email, your child was not registered. Contact Caroline Taylor with questions.

Student Name*
First Last
Preferred Name (if different than above)
Gender*
- Female
- Male
- Non-Binary
- Other
- I prefer not to say
Preferred Pronouns (optional)
- She/Her
- He/Him
- Them/They
- Other
Grade entering in fall 2023*
- 4th Grade
- 5th Grade
School in which this student will be attending 4th or 5th grade in fall 2023*
Is your student qualified for JCPS Free/Reduced-Price Meals?*
- Yes
- No
- I don't know
Has this student attended our summer camp before?*
- Yes
- No
Race Demographic*
This is anonymous data used for grant reporting.
- American Indian or Alasakan Native
- Asian
- Black or African American
- Native Hawaiian or other Pacific Islander
- White
- Some other race, ethnicity or origin
- I prefer not to say
Ethnicity Demographic - Is your child of Hispanic, Latino/a/x or Spanish origin?*
This is anonymous data used for grant reporting.
- Yes
- No
- I prefer not to say
Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian Name*
This name must match the name on the credit card.
First Last
Parent/Guardian Email*
This is where your registration confirmation will be sent.
ParentGuardian Cell Phone*
2nd Parent/Guardian Name
First Last
2nd Parent/Guardian Email
2nd Parent/Guardian Cell Phone
Emergency Contact (Other than Parent/Guardian listed above)*
First Last Relationship Cell Phone
T-Shirt Size*
- YOUTH Small (6-8)
- YOUTH Medium (10-12)
- YOUTH Large (14-16)
- YOUTH XL (18-20)
- ADULT Small
- ADULT Medium
- ADULT Large
Comments, Questions or Special Requests:
Please let us know here if your child has a friend also attending camp that they would like to be grouped with or carpool with.
Photo & Liability Release*
I hereby give permission for the above-named student to attend The Louisville Leopard Percussionists (LLP) camps or classes. In consideration of the advantages of LLP, I agree that the Board of Directors of LLP, its agents, and employees shall be exempt from liability for damages, for bodily injury or property damage that might occur while participating in LLP, except to the extent of insurance liability as provided by law. I understand that photos and videos are taken for publicity and distribution purposes. I hereby give my consent for any pictures in which my child appears to be used for purposes related to the promotion of LLP. I release LLP and all its members from any obligation or liability arising from use of such pictures.
I agree to this LLP photo and liability release.
COVID-19 Consent*
IN CONSIDERATION for being permitted to use the services and programs of The Louisville Leopard Percussionists, Inc. (LLP) and/or for my child/children listed above (Participating Children) to participate for any purpose, including but not limited to, observation or use of facilities or equipment affiliated with LLP,
Parent/Guardian listed above (I or Me), on behalf of myself and such Participating Children and any personal
representatives, heirs, and next of kin, hereby acknowledge, agree, and represent that I have carefully considered. My and Participating Children’s participation in LLP’s camp, understanding that there will be some shared equipment and facilities, and that I find and accept same as being safe and reasonably suited for the use or
participation by Me and Participating Children. On my own behalf and on behalf of Participating Children, I agree as
follows:

I acknowledge that novel coronavirus (COVID-19) infections have been confirmed throughout the United States, including in Louisville, KY. In accordance with the most recent guidance and protocols issued by the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the Kentucky Department of Health (KDH) for slowing the transmission of COVID-19, I hereby agree, represent, and warrant that neither I nor Participating Children shall visit or use the facilities, services, and programs of LLP within 14 days after (i) returning from highly impacted areas subject to a CDC Level 3 Travel Health Notice, (ii) being exposed to any persons returning from areas subject to a CDC Level 3 Travel Health Notice, or (iii) being exposed to any person who has a suspected or confirmed case of COVID-19. I understand that the CDC Travel Health Network is continuously updating the Travel Health Notices list and I acknowledge that I am aware of that list and the countries listed. I agree to check that list ( https://www.cdc.gov/coronaviurs/2019-ncov/travelers/index.html ) before using the facilities, services, and programs of LLP, on a daily basis if necessary. I agree, represent, and warrant that neither I nor Participating Children will visit or use the facilities, services, and programs of LLP if I or they (i) experience symptoms of COVID-19, including, without limitation, fever, cough or shortness of breath, or (ii) have a suspected or diagnosed/confirmed case of COVID-19. I will notify LLP immediately if I believe that any of the foregoing access/use restrictions may apply.

LLP has taken certain steps to implement recommended guidance and protocols issued by public health agencies
for slowing the transmission of COVID-19, including, without limitation the access/use restrictions set forth above. I acknowledge and agree that LLP may change its procedures at any time based on updated guidance and protocols issued by public health agencies and I agree to comply with LLP’s revised procedures before using LLP’s facilities, services, and programs. I acknowledge and agree that, due to the nature of the facilities, services, and programs offered by LLP, social distancing of 6 feet among children and the instructors in this setting is not possible. I understand and appreciate both the known and potential dangers of using the facilities, services, and programs of LLP and I acknowledge that use thereof by Me and/or Participating Children may, despite LLP’s reasonable efforts to mitigate such dangers, result in exposure to COVID-19, which could result in quarantine requirements, serious illness, disability, and/or death.

IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER LLP’S PREMISES FOR ANY PURPOSE, INCLUDING, BUT NOT LIMITED TO, OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH LLP, I AGREE TO THE FOLLOWING ON MY OWN BEHALF AND ON BEHALF OF PARTICIPATING CHILDREN (COLLECTIVELY, WE OR US):

WE RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE LLP, its directors, officers, employees, volunteers, and agents with respect to all liability to Me or Participating Children, and all personal representatives,
assigns, heirs, and next of kin of Me or Participating Children, for any loss or damage, and any claim or demands on account of any property damage or any injury to, or an illness or the death of, Me or Participating Children (or any person who may contract COVID-19, directly or indirectly, from Me or Participating Children) whether caused by the negligence, active or passive, of LLP or otherwise, while I or Participating Children are in, upon, or about the LLP premises or facilities, or LLP’s equipment, or participating in any program affiliated with LLP.

WE WILL INDEMNIFY AND SAVE AND HOLD HARMLESS LLP, its directors, officers, employees, volunteers, and
agents, and each of them, from and against any loss, liability, damages or costs they may incur, whether caused by the negligence, active or passive, or otherwise, while I or any Participating Child is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with LLP. We understand and agree that LLP is not required to provide insurance to cover Me or Participating Children in the event I or they suffer illness, injury, death, property loss, or damage of any sort upon or about the premises or any facilities or equipment therein or as a result of participating in any program affiliated with LLP.

We acknowledge that use of LLP facilities and services, and participation in LLP programs, may involve inherent
danger and risk, including, without limitation, the risk of physical illness or injury, death, or property damage. WE
ASSUME FULL RESPONSIBILITY FOR, AND RISK OF, ILLNESS, BODILY INJURY, DEATH, OR PROPERTY DAMAGE to Me or Participating Children due to negligence, active or passive, or otherwise, while in, about, or upon the premises of LLP, and/or while using the premises or any facilities or equipment thereon or participating in any
program affiliated with LLP. We acknowledge that any illness or injuries that I or Participating Children contract or
sustain may be compounded by negligent first aid or emergency response of those released by this agreement and waive any claim in respect thereof.

This Agreement is intended to be as broad and inclusive a waiver and release as permitted by Kentucky law and if
any portion of it is held invalid, the balance shall continue in full legal force and effect.

I HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND WAIVER
OF LIABILITY, AND INDEMNITY AGREEMENT AND AGREE THAT NO ORAL REPRESENTATIONS,
STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE.
I AM AWARE THAT BY AGREEING TO THIS AGREEMENT I AM GIVING UP VALUABLE LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES FROM LLP IN CASE OF ILLNESS, INJURY, DEATH, OR PROPERTY LOSS OR DAMAGE, INCLUDING, FOR THE AVOIDANCE OF DOUBT AND WITHOUT LIMITATION, EXPOSURE TO COVID-19 AT ANY LLP FACILITY OR PROGRAM AND ANY ILLNESS, INJURY, OR DEATH RESULTING THEREFROM. I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDEMNIFICATION FOR ALL CLAIMS. I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON BEHALF OF THE MINOR CHILD(REN) AND/OR LEGAL WARDS LISTED ABOVE, AND I REPRESENT AND WARRANT TO LLP THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT, AND TO WAIVE AND RELEASE SUCH CLAIMS, ON BEHALF OF SUCH MINOR(S).

I have read and understand the terms of this Assumption of Risk, Release and Waiver of Liability, and Indemnity Agreement and agree to its terms.
I agree to this Assumption of Risk, Release and Waiver of Liability and Indemnity Agreement.
Pediatrician & Medical Insurance Information
Pediatrician's Name Pediatrician's Phone Insurance Co. Policy Number Member Number

Should a medical emergency arise, we will contact you immediately. If a hospital is required, we will send all kids to Norton Children's Hospital on Chestnut Street.
Allergies

(Please let us know if your child will be bringing an EpiPen)
Is there anything else LLP should know about your child? (medications, behavioral issues, special needs, etc.)
Pick Up Authorization
Please list below the names and relationship of anyone who is authorized to pick up and sign your child out at the end of our camp day:
Product Name*
Price:
$25 of this fee is non-refundable should you withdraw your child from camp by June 30th. Should you withdraw your child from camp after July 1st, the full amount is non-refundable.
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address*
Same as student address above

Street Address Address Line 2 City State ZIP Code
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Pediatrician's Name	Pediatrician's Phone	Insurance Co.	Policy Number	Member Number

Experience Camp Registration Week 1 – PM Session

2023 LLP Experience Camp Week 1 ( July 10-14 ) - AFTERNOON SESSION