GirlTech Summer Camp
July 14 - 18, 2014, 7:45 am - Noon
Cost: $45
Please fill in this information as a
parent
or
legal guardian
.
Fields with '*' are required.
* First Name:
Middle Initial:
* Last Name:
* Preferred Email:
Confirm Preferred Email
Send confirmation to preferred email
* Preferred Phone:
(e.g. 555-555-5555)
Home Phone:
(e.g. 555-555-5555)
Cell Phone:
(e.g. 555-555-5555)
We will use this information to contact you with registration information.
Please fill in the following questions for the
child
you are signing up for this event.
*
Consent and Waiver
The following release is required so that the GirlTech Summer Camp program may take pictures and/or video tape during our event:
I hereby grant full permission to Fox Valley Technical College to prepare, use, reproduce, publish, distribute and exhibit my student's name, picture, portrait, likeness or voice, or any or all of them in or in connection with the production of web sites, still photography, motion picture film, television tape, film or sound track recording, scientific publication for informational or any other professional purpose deemed necessary in the interest of the mission of Fox Valley Technical College.
I hereby waive all rights of privacy or compensation for me my student, which she/he may have in connection with the use of her/his name, picture, portrait, likeness or voice, or any or all of them, in or in connection with said web sites, still photography, motion picture film, television tape, film or sound track recording and any use to which the same or any material therein may be put, applied or adapted by Fox Valley Technical College.
This consent and waiver will not be made the basis of a future claim of any kind against Fox Valley Technical College and any of its agencies.
A release is required for every FVTC Activity so that our staff and local news media may take pictures during our events. I have read and agree to the terms set forth in the Consent and Waiver form.
...
Yes, I consent
No, I do not consent
*
Waiver of Liability and Disclaimer
I acknowledge that by participating in the GirlTech Summer Camp program and the different activities and duties of a student and volunteer that the risk of physical injury is present. I further acknowledge that the programs of GirlTech Summer Camp are primarily administered by staff and individuals who volunteer their time rather than paid professionals. In consideration for GirlTech Summer Camp accepting the above named individual & permitting the voluntary participation of said individual in its GirlTech Summer Camp program, I hereby release, discharge, & hold harmless Fox Valley Technical College, its employees, volunteers, & any other representatives from any claims arising out of or relating to any physical injury that may result to said individual while participating in the GirlTech Summer Camp sponsored events, including any physical injury caused by the negligence of any supervisors while performing his or her duties during any functions.
By selecting the "Yes, I have read and agree with this Waiver," I am acknowledging that I have read and fully understand the above information and that I have provided true and correct information. I am also agreeing to the terms set forth in the above sections for both Consent and Waiver and Waiver of Liability and Disclaimer.
...
Yes, I have read and agree with this Waiver
Student Ethnicity (for statistical purposes only):
...
Asian
African American
Caucasian
Hispanic/Latino
Native American
*
Behavioral/Discipline Policy
Much work goes into planning GirlTech each year.
Our goal is to provide an enjoyable learning environment for each participant.
To ensure a safe and successful camp experience, participants are expected to act and conduct themselves appropriately while engaging in camp activities.
Fox Valley Technical College has high behavioral standards for each student to foster the core ability of personal integrity through ethical and responsible behavior.
Camp participant behavior expectations include respect for:
• Property, equipment and facilities
• Instructor authority
• Camp participants
Attending GirlTech is a privilege, and those not following the behavior expectations, may be asked to leave.
...
I acknowledge that I have read the Behavioral/Discipline Policy
*
Would you like a Photo DVD of the week's events?
If you would like a Photo DVD of the week's events, please add $5.00 to the $45.00 registration fee.
...
Yes
No
* Participant's first name
* Participant's last name
* Participant's address
* Participant's city
* Participant's state
* Participant's zip code
* Participant's birthdate (MM/DD/YY)
* Participant's T-shirt size (Adult) (S, M, L, XL)
* Participant's school name
* Participant's grade for Fall 2014
Any accessibility or special needs?
Any health issues or allergies that we should be aware of?
Please send check payable to FVTC, Attn: Barb Wilkinson, PO Box 2277, Appleton, WI 54912.
An email confirmation will be sent when payment is received.
Please hit SUBMIT once.
Thank You!
Event Forms