K I D S C A M P

K I D S C A M P 2 0 1 4

June 9 - 12

8 a.m. — 4 p.m.

Grades 3-12

Fee: $50

Join us for a fun-filled

learning experience!

For an application packet

Please stop by the

Ben Hill-Irwin Campus at

667 Perry House Road

Or

Contact: Bryan McRee at

(229) 468-2021 or

bryan.mcree@wiregrass.edu

CSI Summer Camp

June 9-12, 2014

Student’s Name: Student’s School: Mailing Address:

Home Phone: Parent Cell: Student’s Cell: Email Address: Date of Birth: Grade Level:

Please check T-Shirt Size: Child Small___ Child Medium ___

Adult Small___ Adult Medium ___ Adult Large__

Adult X-Large__ Adult XX-Large__ Adult XXX-Large ___

Will participant be driving a vehicle to campus? YES___ NO___

If you checked YES to the previous question please give make, model and tag number below.

Make & Model: _____________________________Tag No. ________________________________

*STUDENTS WILL NOT BE ALLOWED TO DRIVE DURING CAMP HOURS*

FEE & Payment: $50

Make check payable to Wiregrass Georgia Technical College Foundation-North.

Payment can be made by Cash/Check/Visa/Mastercard/Discover or call Mona Paulk at (229) 468-2102 to make a payment by phone.

Parent/Guardian Information (Emergency Primary Contact)

Name: ___________________________________ Workplace: _____________________________ Phone: ___________________________________ Work Phone: ____________________________ Cell Phone: _______________________________

Parent/Guardian Information (Emergency Secondary Contact)

Authorized Pick-up

If applicable, names of individual(s) who will be picking student up from camp:

Medical Information/Allergies

Please list any type of medical/health issues in which we should be aware.

Grades 3-12 $50 per student All materials provided

Lunch provided daily

(Applications received after May 23 cannot be guaranteed t-shirts) Clothing:

Tennis shoes, t-shirt, shorts (no skirts or flip flops)

Camp Information

CSI Kid’s Camp has been created in an effort to give area students a chance to experience a new kind of summer camp! With new equipment and state-of-the-art techniques the Criminal Justice Department at Wiregrass Georgia Technical College is hosting CSI Kid’s Camp. Students will learn how to gather evidence for scientific analysis in a crime laboratory. All supplies and materials needed are included in the registration fee.

DATES:

June 9-12, 2014 (Mon – Thur)

TIME: 8:00 a.m. – 4:00 p.m.

Where to drop off & pick up?

Camp participants may be dropped off at the main entrance of the Charles Harris Learning Center located behind the flagpole. Camp volunteers will be waiting for students as early as 7:50 am.

Do you have an emergency?

Wiregrass Georgia Technical College

RELEASE OF LIABILITY

I,__________________________________, the undersigned, in consideration of being allowed to participate in the Wiregrass Georgia Technical College Criminal Justice’s CSI Kids Camp, its related training events and/or activities do acknowledge, appreciate, agree, and accept that my participation is completely of my own choosing.

And I fully understand that:

1. There is a potential risk of injury from the activities involved in this program from the use of printing equipment and travel for field trips. While particular skills, equipment, and personal discipline may reduce this risk, the risk of injury does not exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my participation and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately and,

4. I, for myself, and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE INDEMNIFY, AND HOLD HARMLESS Wiregrass Georgia Technical College officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers and, if applicable, owners and lessors of premises used for the activity (“Released”), WITH RESPECT TO ANY AND ALL, INJURY, DISABILITY, DEATH, or loss or damage to person or property, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND its TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREE LY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

__________________________________ ____________ _____________ Participant’s Signature Age Date

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above to the fullest extent permitted by law.

Photo/Video Release

Office of Public Relations

4089 Val Tech Road – Lowndes Hall Valdosta, GA 31602

Phone

·

·

I, ___________________________________________, hereby grant to the Technical

PRINT NAME – FIRST, MIDDLE INITIAL, LAST

College System of Georgia on behalf of Wiregrass Georgia Technical College (the “College”) the right to

reproduce, use, exhibit, display, broadcast, distribute and create derivative works of College-related photographs or videotaped images of the undersigned person for use in connection with the activities of the College or for promoting, publicizing or explaining the College or its activities.

This grant includes, without limitation, the right to publish such images in PR/promotional materials, such as marketing and admissions publications, advertisements, fundraising materials, and any other College-related publication. These images may appear in any of the wide variety of formats and media now available to the College and that may be available in the future, including but not limited to print, broadcast, videotape, CD-ROM, and electronic/online media. Signature: Date of photo: Student ID#: Telephone #: Email address: