Teen Registration - Manhattan Film Institute

Manhattan Film Institute - Two Week Gold Program 2021

ADMISSIONS PACKET

Which Program are you enrolling in?*

Actor's Gold Program
Director's Gold Program

Are you writing an original screenplay for the program?

Yes
No

Are you a returning student?*

Yes
No

Student Name*

First Last

Date of Birth*

Phone*

Email*

Behavior Policy

MFI was created to provide quality arts training and positive personal experiences that will allow each participant to learn and grow within a fun and nurturing environment. We strive to create an atmosphere that ensures the safety, wellbeing, happiness and productivity of each member of our community. It is essential to each student’s success that they have chosen to come to MFI and are committed to getting the most out of this opportunity. We ask that ALL students review the following behavior expectations to insure an understanding and willingness to abide by this agreement.

Enrollment Agreement & Behavior Contract (Please Read Carefully)*

Students must agree to follow these behavior guidelines:

1. To participate in classes and events with energy, focus and a positive attitude.

2. To take all prescribed medications.

3. To eat a full and balanced diet. Special dietary needs are the responsibility of the student.

4. To participate in all activities with safety and moderation in mind. In the event of illness or injury, I will be responsible for medical expenses that are necessary for my care.

5. To act with respect, courtesy and consideration toward all members of the community. I understand that acts of violence, real or threatened, bullying, harassment or intimidation of any member of the school community will not be tolerated and may result in expulsion with no refund of fees.

6. Not to use drugs or alcohol, or possess any drug paraphernalia. I understand that students using or in possession of these items, will be expelled with no refund of fees.

7. To be respectful of MFI property and the property of others. I understand that vandalism against and theft of property and possessions of the school or other students will not be tolerated and will result in immediate expulsion with no refund of fees.

8. Not to bring pets on campus.

9. To have no outside visitors to my room or cabin without the consent of an MFI director or faculty member. Non-adherence is subject to expulsion with no refund of fees.
While I am aware that MFI provides all necessary film equipment, I am allowed to bring my personal equipment, but must take responsibility for its storage and care.

10. Agree to give permission to MFI to use photographs, video, or other representations of me or my work for promotional, documentation or educational purposes.

11. Agree to seek the assistance of counselors, teachers or program directors if I have a problem or concerns.

12. Agree to be on time for film shoots and classes.

I agree to the behavior policy.

Student Signature*

I attest I have read and agreed to all 12 items in the Behavioral Policy.

Emergency Contact Information

In case of Emergency, please contact:

Emergency Contact 1*

First Last

Phone*

Relationship to Student*

Email*

Emergency Contact 2

First Last

Phone

Relationship to Student

Email

Payment & Refund Policy

Consent*

NOTE: We are closely monitoring CDC, STATE and LOCAL guidelines for Covid 19. On or before May 1, we will make a final determination and if we need to cancel, you will receive a FULL refund.

Prior to May 1, 2021, all tuition, except the $500 deposit, is fully refundable.

For cancellations between May 1, 2021 and June 1, 2021, we will refund 50% of the tuition and fees.

For cancellations after June 1, 2021 there are no refunds.

The seasonal nature of the program precludes any refund, credit, or reduction for late or non-arrival, early withdrawal or student cancellation after June 1 for any cause.

Students sent home in violation of our rules, for medical reasons, or at the discretion of the student or family member will receive no refund.

I agree to the payment and refund policy.

Responsible Party Signature*

Will student be under 18 on the first day of the program?*

Yes
No

Medical Information & Authorization

Primary Care Physician Name

Physician Phone Number

Health Insurance Company

Health Insurance Policy Number

Does the student have any known allergies or reaction to foods, plants, insect toxin, immunizations and/or medications?

Yes
No

Please tell us about the student's allergies:

Does the student have any other condition that may require emergency or special care or medication?

Yes
No

Please tell us about the student's conditions or medications we should be aware of:

Certification

To the best of my knowledge, this history is correct and complete. I know of no reason to restrict the applicant’s activity, and give permission for participation in all activities except as specifically noted herein. In the event that I cannot be reached in an emergency, I hereby give permission to the camp director to secure proper treatment for my child as named above.

I agree to the above statement

Responsible Party Signature

All students should plan to arrive vaccinated for COVID-19. If for some reason this is not possible, please let us know.

Student is already vaccinated
Student will be vaccinated by program date
Will call to explain vaccination situation

Indemnity

RELEASE: I have enrolled my child in the summer program of Manhattan Film Institute. I understand the activities will include filmmaking including classroom time, location shoots, screenings and evening programs.

I, the parent/guardian of the above named minor do hereby give my approval for his/her participation in any and all activities during the current program session. I assume all risks and hazards whether occurring at the campus location, during transportation to and from activities, or off site at activities.

I hereby waive, release, absolve, indemnify and hold harmless Manhattan Film Group, LLC, and its officers, directors, agents, employees, and volunteers, in case of any injury or damage to my child/ward resulting from any and all acts of commission or omission, including acts of negligence arising out of or in the course of the above activities.

The waiver of legal liability should not be deemed to grant immunity to any person causing damage by his willful, wanton or grossly negligent act of commission or omission. By signing this document, I authorize that I am the parent or guardian of the above-named camper and am authorized to sign this document.

I agree to the indemnity of Manhattan Film Group LLC and its officers, directors, agents, employees, and volunteers.

Responsible Party Signature

Authorization

MEDICAL AUTHORIZATION: I understand that Manhattan Film Group, LLC, shall attempt to contact me in the event of any injury to my child/ward.

I authorize Manhattan Film Group, LLC, to seek medical attention for my child/ward in the event of any injury and authorize any transportation necessary to take my child/ward to a physician or a hospital. I agree to be responsible for any expenses so incurred. Set forth below is the name of the insurance company and a policy number of the primary health insurance policy covering my child/ward.

I authorize Manhattan Film Group LLC to seek medical attention as outlined above.

Responsible Party Signature

We require immunization records for students under 18

The immunization record may be obtained from your school nurse or doctor. This section must be completed.

I have immunization records handy
I will email immunization records to info@manhattanfilminstitute.com ASAP

Please specify dates of vaccination for the following:

Tetanus / Diphtheria / Whooping Cough (Tdap)

Measles/Mumps/Rubella (MMR)

Chicken Pox (Varicella)

Polio (IPV)

Registration

Manhattan Film Institute - Two Week Gold Program 2021

Behavior Policy

Emergency Contact Information

Payment & Refund Policy

Medical Information & Authorization

Please specify dates of vaccination for the following:

Success!

Contact Us
646-363-6446
info@manhattanfilminstitute.com

Follow US