VEX Robotics Camp
August 4-8, 2014, 8:00 am - Noon
Registration open to students ages 12-15
Please fill in the contact information and waiver as a
Participant information is collected at the bottom of this form.
Fields with '*' are required.
* First Name:
* Last Name:
* Preferred Email:
Confirm Preferred Email
Send confirmation to preferred email
* Preferred Phone:
We will use the above email to contact you with registration and further camp information.
Consent and Waiver
The following release is required so that FVTC's 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 child'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 child, which she may have in connection with the use of her 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 FVTC VEX Summer Camp program and the different activities and duties of a student that the risk of physical injury is present. I further acknowledge that the programs of FVTC's VEX Summer Camp are primarily administered by staff and individuals who volunteer their time rather than paid professionals. In consideration for FVTC accepting the above named individual & permitting the voluntary participation of said individual in its VEX 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 VEX 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
No, I will not sign this waiver
Student Ethnicity (for statistical purposes only):
* 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 gender (M/F)
* 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?
You will receive an email confirmation when this form is submitted.
To complete your registration, please send a $50 check payable to FVTC, Attn: Laura Waurio, PO Box 2277, Appleton, WI 54912.
The non-refundable $50 enrollment fee must be received by July 21 to hold your spot.
An email confirmation will be sent when payment is received.
Please hit SUBMIT once.