Dear Academy Participant:

Transcription

1 Dear Academy Participant: We have received your registration for the Georgia Journalism Academy on June 9-15 and look forward to meeting you. We have designed an interactive program that will be an intense, fun learning experience! Enclosed are conduct, liability, health, roommate and participant forms to be filled out and signed by you and your parent(s)/ guardian(s). These forms need to be filled out (you can type directly on the.pdf) and signed where appropriate. Please return them by the postmark date of Friday, May 24 to Joe Dennis, Grady College of Journalism and Mass Communication, 120 Hooper Street, Athens, GA Please note that we need the original forms -- we cannot accept faxed copies or scans. You will not be allowed to check-in until we have all completed forms. Here s some important information you need to know: CHECK-IN: 4-6 p.m., Sunday, June 9, Church Hall lobby CHECK-OUT: 9 a.m.-noon., Saturday, June 15, Church Hall lobby Housing: You will be housed in Boggs Hall, an air-conditioned dormitory on campus. The phone number for the UGA Campus Housing Hill Community front desk (staffed 24 hours a day) is Please give this number to your parent/guardian. You need to bring linens, a pillow, blanket(s), towels, washcloth, etc. See the enclosed checklist. Dorm counselors will supervise students at all times and men and women will be housed on separate floors. Upon arrival, you will be issued a room key that you should keep with you at all times. There is a $50 replacement fee for lost keys. Church Hall has wireless Internet. Visit for more information about Church Hall. Parking: Students are strongly encouraged to be dropped off at the Academy by their parent or guardian. If you must drive yourself, you will be required to park in the the Hull Street Parking Deck, located about four blocks from Church Hall. You will be responsible for paying for parking on your own $10 per night. Any students who drive themselves to the Academy will be required to turn in their keys at registration. They will be returned at checkout. Meals: Most meals will take place in Bolton Dining Hall and the food court at the Tate Center. Students will be given a dining hall wrist band at check-in. It is the student s responsibility to wear the wrist band throughout the week. For lunches, students will be given a food ticket for the Tate Center. Students are responsible for the cost of lost ticket. The registration fee covers all meals -- with the exception of one lunch on your own in downtown Athens. Bring roughly $8-$10 for this meal. Recreation: Group recreation plans include -- among other things -- a cookout and movie night on the Grady College quad, a bowling night and an end-of-week banquet. Everyone who attends Academy is required to attend group recreation activities. Clothing: Bring casual clothes and comfortable shoes as you ll do a lot of walking. You ll also need a dressy outfit for the closing awards banquet. Athens is typically hot and humid in mid-june; however, you may need a sweater or jacket for air-conditioned buildings and the possibility of a cool spell. Don t forget rain gear! Students will have an opportunity during free time to swim in a nearby campus pool if desired. Please bring appropriate attire. Classes: Classes will be in the Grady College (Journalism Building) as well as in Miller Learning Center. In addition, some assignments may take you to other points on campus and to nearby off-campus sites, in walking distance or with transportation provided. Communication: Get in touch with other campers, get to know your counselors and get up-to-date information about the Academy. Like Grady Games 2013 on Facebook. Also, the list you registered with has been added to an Academy listserv. If you are not getting s for us, and/or would like to register a different address, let us know. We re looking forward to our week together! Remember to please return all forms on white paper by Friday, May 24. Feel free to jodennis@uga.edu if you have any questions. Joe Dennis & Karen Andrews, Academy Directors June 9-15, 2013 Grady College of Journalism and Mass Communication The University of Georgia

2 Georgia Journalism Academy 2013 Participant Information Sheet Name: School: City, State: Birthday: Class status next fall: rising sophomore rising junior rising senior rising college freshman Check all that apply: Member of school newspaper staff Member of school broadcast news staff Member of school yearbook staff Member of school literary magazine staff How many years?: How many years?: How many years?: How many years?: List leadership positions you have held on any of the above staffs and/or in journalistic organizations: Computer Experience Check each program with which you have had at least one year of experience: WordPress PhotoShop Final Cut Pro InDesign Explain experience with each program checked above (i.e., use InDesign to layout school newspaper, etc.): Work Experience Please list any work experience you have had (i.e. working at McDonalds, etc.)

3 The University of Georgia Grady College of Journalism and Mass Communication Release, Waiver of Liability and Covenant Not to Sue To Be Signed by Parents of Participants Who Are Under 18 Years of Age READ CAREFULLY BEFORE SIGNING I certify that I am the parent or legal guardian of (name of child) who will be a participant in the Georgia Journalism Academy at The University of Georgia's Henry W. Grady College of Journalism and Mass Communication from June 9, 2013, through June 15, I understand that during this time my child will participate in formal study in classrooms and labs, will attend discussions by working news personnel and will participate in hands-on practice and field trips in the Athens, Georgia, area for study and recreation. I hereby acknowledge my awareness that my child s participation in the Georgia Journalism Academy may expose my child to risk of property damage and bodily or personal injury, including injury that may prove fatal. I understand that the risks my child may be exposed to include: car accidents; sickness; and criminal acts, as well as other risks that may not be foreseeable. I agree that I will discuss with my child the importance of following the instructions of University of Georgia personnel who are present during the Georgia Journalism Academy. For the sole consideration of The University of Georgia s arranging for my child to participate in the Georgia Journalism Academy, I hereby release and forever discharge The University of Georgia, the Board of Regents of The University System of Georgia, their members individually and their officers, agents and employees from any and all claims, demands, rights and causes of action of whatever kind that I may have, either in my own behalf or in my capacity as legal representative of my child, arising from or in any way connected with my child s participation in the program. I certify that my child is participating in the Georgia Journalism Academy with my full knowledge and consent, and that he or she has my permission to participate in all activities. I also certify that I have read and understood the above. Signature Date Printed Name Signature Date Printed Name Address Address

4 GEORGIA JOURNALISM ACADEMY Grady College of Journalism and Mass Communication The University of Georgia Athens, GA June 9-15, 2013 STUDENT AND PARENT/GUARDIAN CONDUCT AGREEMENT FORMS Student s Agreement I agree unreservedly (1) to obey the regulations of The University of Georgia; (2) to obey all regulations of the Georgia Journalism Academy, its staff and counselors -- written and oral; (3) to arrive on the day of registration and to leave when the Academy ends. I understand that the Academy regulations include, but are not limited to, the following: Drinking of alcoholic beverages or use of illegal drugs will not be tolerated. Smoking will not be permitted. A violation of this policy will result in immediate expulsion from the camp. No exceptions. Students are required to attend their scheduled classes. Instructors will take roll at each session. Absences could result in dismissal from the Academy. For student s safety, it is Academy policy that students are not allowed to enter any vehicle while attending the Academy unless it is an official university vehicle. Furthermore, driving cars to campus is discouraged due to parking constraints and safety concerns. However, if students must drive themselves to and from the Academy, they will be required to turn their keys in to a counselor upon arrival. They will be returned at departure time. They will also be required to pay a $20 parking fee. Student is responsible for any parking tickets received for failure to do so. A dress code will be enforced. Shirts that reveal midriffs or cleavage will not be allowed. Jeans and shorts that are so low rise as to reveal underwear or skin below the lower back will not be allowed. Short and skirt length must be appropriate. (Good rule of thumb: Material should reach the bottom of the longest finger on your hand when arm is by the side). Students who are not dressed appropriately will be given clothes to wear for the week or may be dismissed from the Academy. Cell phones are permitted but during class time, use is restricted to only class purposes with instructor permission. If a student is caught using a cell phone during class time for purposes other than class reasons, the phone may be taken for the remainder of the week and returned at the end of the Academy. Hall counselors will monitor each floor nightly. Students must be in their dorm rooms for the night after the conclusion of each group night outing. After nightly room checks, boys are not allowed on the girls floors and vice versa. Students will be able to mingle on their own floors and in the lobby until midnight each night, at which time they must be in their rooms. Students who deliberately disobey regulations set forth by the hall counselors will be subject to early dismissal from the camp. (continued on back)

5 Students will conduct themselves with discretion at all times, being careful not to act in a manner that could cause harm to themselves, other persons, or property. Students will participate fully in all group activities barring health reasons. If a student must leave before the end of the Academy, he/she will bring a letter from parent/guardians stating when and who will drive him/her home. If a situation arises during the Academy that requires leaving (such as illness or death in the family), the student will notify the Academy Director immediately and will not leave campus without the Director or his designated representative present. No refunds will be given for students who leave the Academy early. Students who received a scholarship to the camp are required to stay the duration of the camp, with the exception of a family emergency or illness. If a student receiving a scholarship leaves the Academy early, they may be charged a prorated amount of tuition at the discretion of the Academy director. I understand that breaking any part of this agreement may result in my early dismissal and the notification of my parent/guardian, adviser and my school principal concerning my conduct. In addition, I understand that should I be dismissed; registration fees will not be refunded. Date Student s Signature Parent s or Guardian s Agreement I understand the condition regarding the conduct of my son/daughter/ward as set forth in the Student s Agreement above, and I agree with them. I also agree that any financial liability incurred by my son/daughter/ward will be paid for by said son/daughter/ward or by me prior to departure from the Academy. I have completed, signed and attached the University Health Service Health Form for Special Programs and I agree to pay for all charges incurred for services and medications administered by the Health Services. If off-campus hospital care should become necessary, I agree to be responsible for all costs incurred. Date Parent s or Guardian s Signature

6 UNIVERSITY HEALTH CENTER The University of Georgia Athens, GA (706) HEALTH FORM for 2013 SUMMER CAMPS and PROGRAMS This form is required for treatment at the University Health Center if the participant should become ill or injured while on campus. FAX to prior to camp/program. Please note, there will be charges for services provided by the University Health Center. NAME DATE OF BIRTH HOME STREET ADDRESS CITY, STATE, ZIP CODE GENDER PROGRAM PHONE ( ) PROGRAM CONTACT PERSON PHONE ( ) PERMISSION FOR DIAGNOSTIC AND TREATMENT PROCEDURES I hereby authorize the physicians of the University Health Center, their agents or consultants, to perform diagnostic and treatment procedures on (Name), which, in their judgment, may become necessary while he/she is a participant in (Program) between (Dates) at The University of Georgia. Privacy Practice Acknowledgement: I understand that, under The Health Insurance Portability and Accountability Act of 1996, I have certain rights to privacy in regards to my protected health information (PHI). By signing below, I acknowledge that I have read and understand the University Health Center's Notice of Privacy Practices (Notice). It is posted on the University Health Center's website at under About UHC, Confidentiality, Patient s Rights and Responsibilities. The University Health Center reserves the right to change the terms of its Notice of Privacy Practices. If such changes are made, I understand that the University Health Center will post a revised Notice on its web site at I also understand that the University Health Center will provide a Notice to me upon request. PARTICIPANT (if over 18) PARENT/GUARDIAN (if under 18) PERSONS TO NOTIFY IN AN EMERGENCY SITUATION 1. Name Relationship Address Work Phone Cell Phone DATE DATE Street Number and Name City State Zip Code Home Phone Address 2. Name Relationship Address Work Phone Cell Phone Street Number and Name City State Zip Code Home Phone Address Date of last Tetanus shot Current medications Allergies to medications Chronic or significant medical conditions

7 PRIMARY INSURANCE INFORMATION Please complete if you wish UHC to file for reimbursement from your insurance company. Providing this information does not guarantee payment of your claim by your insurance company. You are responsible for any charges for services rendered. (Please attach a copy of the front and back of your insurance card.) Please check appropriate boxes below: Medical: HMO PPO POS Other Dental Prescription Policyholder s name: Insured is: Self Parent/Responsible Party Third Party Your Relationship to Insured Medical Insurance Company Name: Insurance Company Street Address: Insurance Company City: State: Zip Code: Telephone Number: Policy Number: Group Number: PARENT/RESPONSIBLE PARTY/THIRD PARTY INFORMATION - Name of Insured/Policyholder: (i.e., parent, step-parent, spouse) Name: Address: Address: City: State: Zip Code: Telephone Number: Home: Work: Cell: Date of Birth: M F Place of Employment: Full Time Part Time Employer Address: City: State: Zip Code: AUTHORIZATION TO PROCESS INSURANCE CLAIMS The University Health Center (UHC) will attempt to file insurance claims on behalf of patients and clients. The filing of claims does not guarantee either full or partial payment by the insurance company. The UHC is a participating provider only for the Student Health Insurance plan available to UGA students. The UHC is not a participating provider for other health insurance plans, including those covering state employees and their dependents. Students and their parents are encouraged to contact their insurance company to request that the UHC be enrolled as a participating provider in their plan. The UHC Pharmacy is approved to file claims on most insurance plans for prescriptions, whether written by UHC providers or others. Students are urged to check with the UHC Pharmacy staff to see if their policy is covered before attempting to fill prescriptions elsewhere. I, the undersigned, authorize the release of any medical or insurance information to the stated insurance company which is necessary to process insurance claims for services rendered by this facility. I hereby authorize my insurance company to distribute the payment of my (or my dependents) medical coverage directly to the provider rendering services. I understand that I am fully responsible for all charges regardless of my insurance benefits. I authorize the use of this signature on all insurance submissions. I may elect to pay any bill in full in lieu of submitting a claim for insurance reimbursement. Signature: Date (Student) Signature: (Parent/guardian if a minor) 12/03 Revised: 9/22/06, 2/23/2010; 2/3/2011; 2/2012; 2/2013 Date For Office Use Only: Date Received: Received by: Entered by:

8 Georgia Journalism Academy Grady College of Journalism and Mass Communication Roommate Preference Form RETURN BY MAY 24 Please fill out the following information, so that we may prepare your room assignments. We will make every effort to place you according to your requests. If this form is not received by May 24, we will match you with a roomate from another school. Forms may be returned with your other information or faxed to NAME SEX: F M SCHOOL ( ) I would like to room with the following person: (Requests must match) Name School ( ) I do not have a roommate request. Signed Date

9 Georgia Journalism Academy 2013 Checklist Required Items: Bed linens for a single bed, including blankets Some beds run extra long, you may want to bring a flat sheet instead of a fitted sheet. The dorms have a tendency to be very cold in the summer, so come prepared with a blanket or sleeping bag. Pillow Towels, washcloths, toiletries (including soap, shampoo, etc.) Shower Shoes Alarm clock Casual clothes for outdoor activities Comfortable shoes and athletic shoes Sweater or jacket for air-conditioned buildings Dressy outfit (business casual) for closing awards banquet Umbrella/rain gear Spending money: vending machines, downtown shopping, bookstore and meals (one lunch is eaten off campus at least $8 is recommended for this meal) School supplies: notebook, pencils, pens and/or markers If possible, extra copies of your school's newspaper, broadcast program, yearbook pages, photography or literary magazine to show instructors or exchange with fellow students Optional Items: Camera Cell Phone Laptop Small TV for your room (the dorm does have a TV in the hall lounge) Bug repellant Sunscreen Snack food/drinks for room

10 Georgia Journalism Academy 2013 Directions Church Hall is located at 880 Lumpkin Street. From Highway 316 Stay straight on 316 all the way into Athens. Hwy. 316 becomes Epps Bridge Pkway which feeds into Broad Street. Stay straight on Broad until you reach Lumpkin Street in downtown Athens and turn right onto Lumpkin. Go through four stoplights and at the fifth stoplight, turn right onto University Court. Follow the road past Oglethorpe House (on your left) and turn right at the W11 parking sign. Turn right in the W11 parking lot and drive to towards the end of the lot. Church Hall is the second building behind Boggs Hall.. Check-in will be inside the main entrance of Church Hall. From 78 Driving East Follow 78 east until you reach the Athens exit. Take that exit and you will be on the Atlanta Highway. Stay on the Atlanta Highway, which eventually becomes Broad Street. Stay straight on Broad until you reach Lumpkin Street and turn right onto Lumpkin. Go through four stoplights and at the fifth stoplight, turn right onto University Court. Follow the road past Oglethorpe House (on your left) and turn right at the W11 parking sign. Turn right in the W11 parking lot and drive to towards the end of the lot. Church Hall is the second building behind Boggs Hall.. Check-in will be inside the main entrance of Church Hall. From 78 Driving West Take 78 west all the way into Athens. As you reach Athens, 78 will become Lexington Road and then Broad Street. When you reach downtown Athens, the UGA campus will be on your left. When you reach the intersection of Broad and Lumpkin in downtown Athens, turn left (a Holiday Inn will be on your right once you turn). Go through four stoplights and at the fifth stoplight, turn right onto University Court. Follow the road past Oglethorpe House (on your left) and turn right at the W11 parking sign. Turn right in the W11 parking lot and drive to towards the end of the lot. Church Hall is the second building behind Boggs Hall.. Check-in will be inside the main entrance of Church Hall. 441 Driving North Take 441 north into Athens. Turn right onto 78 East and go to the Milledge Avenue exit. Turn left onto Milledge Avenue. Go approximately three miles into the Athens Five Points Area and turn right onto Lumpkin St. Go through two stoplights and at the third stoplight, turn left onto University Court. Follow the road past Oglethorpe House (on your left) and turn right at the W11 parking sign. Turn right in the W11 parking lot and drive to towards the end of the lot. Church Hall is the second building behind Boggs Hall. Check-in will be inside the main entrance of Church Hall. If you get lost, contact the Church Hall (Hill Community) information desk at (706)