Robotics Camp 2020 Registration

It's all About Robotics one-week summer camp
Nathan Hale Middle School
July 6-July 10, 2020
Time: 9:00-3:00
Investment $210

Girls 6th-8th grade

Child's Name

First NameLast Name

Birth Date

MonthDayYear

Parent/Guardian

First NameLast Name

Child's Age

Grade

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number

Area CodePhone Number

Work Phone Number

Area CodePhone Number

Email

example@example.com

Cell Phone Number

Area CodePhone Number

Emergency Contact

First NameLast Name

Emergency Phone Number

Area CodePhone Number

Please list any of your child’s allergies, medications or medical conditions we should be aware of:

Please pack a healthy snack & lunch for your child. PLEASE NO PEANUTS OR PEANUT PRODUCTS

Voice, Likeness, Comments Release: I give my permission to Saturday Academy Inc to use photographic images taken or likeness taken of my child in college publications, displays, marketing materials and website pages. I understand my child’s image may also be used in press releases and sent to news publications and other forms of print and digital media. I fully understand the intent of using my child’s likeness and /or comments, and in doing so do hereby relinquish any responsibility on the part of Saturday Academy Inc.

Parent Signature

Today's Date

Date

If paying by check or money order check here: Make checks payable to Saturday Academy, P.O. Box 702, Norwalk, CT. 06854

QUESTIONS? Call Dr. Cynthia Barnett 203-855-9714

IDENTIFYING AND COLLECTING ITEMS TO UPCYCLE
Help our program participants’ with their prototypes by collecting upcyclable materials to use and share. These items are an important component to the prototype design process. Please refer to the listed items below when determining whether an item is acceptable or unacceptable.

ACCEPABLE ITEMS for upcycling:
Beads, Buttons and Craft Supplies, Boxes (shoe, cereal, etc.), Bubble Wrap, Building Blocks, CDs, Fabric, Film Canisters, Foam Trays, Game Parts, Miscellaneous Paper (magazines, newspaper, kraft etc.), Milk /OJ Cartons /Jugs (rinsed), Oatmeal Canisters, Paper Towel Tubes, Pinwheels, Plastic Bottle Caps, Containers/Lids, Pulleys, Rubber Bands, Springs, Sporting Goods and Balls (No golf clubs or bats), Strainers, String, Washers

UNACCEPTABLE ITEMS for upcycling:
Batteries, Cords, Glitter, Liquids, Medicine Containers, Paint, Prescription Bottles, Soda Pop Cans, Packing Peanuts, Wire Hanger

IMPORTANT: Please thoroughly wash out all bottles, containers, foam trays and/or any other items, as needed.

Acceptable Behavior

It is important to Saturday Academy that all campers receive a positive and rewarding experience while attending our program. In order to ensure a safe and fun environment for all, children are expected to behave in an acceptable manner and use appropriate language. ANY behavior deemed to be detrimental to or in violation of Camp Invention standards will be dealt with by the staff and/or Director. Unacceptable behavioral instances include, but are not limited to: any form of intended harm to another camper or staff member, bullying or any form of aggression.

Any situation that involves distracting other participants or disrupting camp activities will not be tolerated. It is important to remember that there are NO REFUNDS if a child is asked to leave Camp Invention due to unacceptable behavior. By paying your registration fee in full, you signify that you understand and agree to, the Acceptable Behavior Policy.

I have read and will abide by the Camp Invention rules. I understand that Camp Invention staff have the right to remove any person from the program that does not abide by these rules. If I am asked to leave, I understand that my tuition is nonrefundable.

Alternative contacts/transportation arrangements

In the event of an emergency, I authorize the following individual(s) to pick up my child from the program:

Name/Relationship

First NameLast Name

Name/Relationship

First NameLast Name

Phone Number

Area CodePhone Number

LIABILITY WAIVER

MUST be signed in order for your child to participate.

I am the parent/legal guardian of (“child”). On my own behalf and as parent and guardian, I acknowledge and agree that there is the possibility of physical injury or loss associated with my Child’s participation in the Camp Invention program (the “Camp Invention Program”). I hereby release, discharge Saturday Academy its affiliated organizations, employees and associated personnel including the owners of the camp facility against any and all claims, liabilities and/or damages as a result of my Child’s participation in the program, including but not limited to, any claim that the program was negligent. I further agree to defend and indemnify Saturday Academy its affiliated organizations and employees and associated personnel if any claim is made against them by or on behalf of my Child. I understand that my Child will not be permitted to participate in the Program without my signing this Agreement.

Camp Invention at Nathan Hale Middle School operated by Saturday Academy, an independent licensee of Camp Invention programs.

Emergency Medical Consent

In the event that reasonable attempts to contact me and the two alternate individuals that I have designated at the phone numbers that I have provided on this form have been unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary by the physician, dentist and/ or hospital, as applicable, listed below:

Preferred Physician

First NameLast Name

Phone Number

Area CodePhone Number

Preferred Dentist

First NameLast Name

Phone Number

Area CodePhone Number

Preferred Hospital

First NameLast Name

Phone Number

Area CodePhone Number

In the event that the designated preferred physician, dentist and/or hospital, as applicable, is not available, I hereby give my consent for the administration of any treatment deemed necessary by another licensed physician or dentist at any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists (as applicable), concurring in the necessity for such surgery, are obtained before surgery is performed.

Today's Date

Date

Parent/Guardian Signature

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It's All About Robotics$210.00

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It's All About Robotics Registration Form