Georgia Tech North Ave. NW Atlanta Ga

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1 Welcome to Fun Weird STEM Saturdays 2014 The functioning objective of Fun Weird Science STEM Saturdays is to: 1. Provide students with hands-on STEM experience; and 2. Engage students in the exciting ways STEM is used as a problem solving tool; and 3. To Inspire youth to value the opportunity and possibilities of STEM-based careers 4. Provide a collaborative, fun environment for students to build teamwork and leadership skills. STEM Saturdays is a hands- on, relaxed and highly engaging weekend exposure to Science, Technology, Engineering, Art, and Math and how it impacts our lives. Creative thinking and problem solving will be a major focus. Students experience a reoccurring (4) hour session full of hands- on activities, collaborative groups, and engagement. Students are supervised by Georgia Science & Robotics Academy, Inc. and staff. Courses are taught by Certified Teachers and staff. Instructional Hours: 9:00 AM to 1:00 PM STEM Saturdays for 2 nd -11 th Grade Scholars Elementary Site Morehouse College 830 Westview Drive SW Atlanta, Ga Wheeler Hall Room 110 October 4 th and 11 th November 8 th December 6 th Middle and High School Site Georgia Tech North Ave. NW Atlanta Ga October 18 th and 25 th November 15 th November 22 nd Session Focus: To help participants develop an interest in STEM-Based learning activities using hands-on engagement. Program Fee: $ ($8.00 transaction fee for online payments) Fee includes all instruction, *materials and supplies, and activities. *Students may require use of personal smart phone or appropriate device for a portion of the robotics engagement.

2 Admissions Requirements & Application Procedures To apply for STEM Saturdays you must complete the following steps. 1. Complete the following forms found at: Weird-Science-STEM-Saturdays-Registration-Packet1.pdf Online Form: Student Information Form Process online payment or mail in with Registration Packet 2. After completing the online Student Information form print and scan all registration packet documents and them to or mail (with check or money order payable to Georgia Science & Robotics Academy, Inc. to: Georgia Science & Robotics Academy, Inc. P.O.Box 1498 Conley Ga Refund policy: All fees are non-refundable. If you have any additional questions, please contact: Ronnie Thomas (678) or

3 Student Expectations Fun Weird Science has high expectations for all students. These expectations are designed to promote the well being of each student and to ensure that each child is able to reach his/her fullest potential. Each student will be required to do the following: 1. Respect the property and persons of fellow students, teachers and student assistants as well as all others not directly associated with the program. 2. Always act in a manner that will promote opportunities to learn. 3. Have a positive attitude about learning and involvement at summer camp. 4. Politely communicate any concerns directly to summer camp teachers or student assistants. No horseplay of any kind will be tolerated. No weapons of any kind are permitted on the premises. This includes but is not limited to guns, knives, switchblades, pocketknives, and any other instruments that could be used as weapons. Any student who brings a weapon to summer camp will be dismissed from the program immediately. A student who violates any of these rules will be immediately dismissed from the program. Valuables Policy Although some portions of the program will require personal electronic devices, parents should use discretion when sending non-instructional equipment. We cannot guarantee the security of non-instruction valuables, and we would not want to see anyone s summer camp experience ruined by the loss of such item(s). Meal Procedures Students will need to bring their own lunch. There is no refrigeration or microwave available; therefore appropriate steps should be taking to ensure that food maintains desire temperature.

4 Health Insurance and Medical Procedures First aid kits for minor injuries will be available. Students requiring medical assistance for any injury other than a minor cut will be transported by ambulance to the nearest appropriate treatment hospital as determined by ambulance personnel. All students attending STEM Saturdays are expected to have health insurance. Health information forms are included in the forms packet and should be returned prior to the start of the camp. Students taking medication during the day will need to bring a copy of the prescription outlining when and how the medication should be given and leave their medication with the program director when he or she arrives each morning. The staff will then dispense the medication to the student as appropriate. Students will not be allowed to keep medication of any kind with them during the program (Note: If there is a need for an exception to this policy, parents should advise the Camp Directors in writing. Drop Off/Pick-Up, Arrival and Dismissal Procedures All parents are asked to bring students to STEM Saturdays promptly at 8:45 AM and sign-in with a STEM Saturdays staff member. Students must be picked up promptly at 1:00pm Parents (or other authorized adults) must sign students out on a daily basis. Only people authorized to pick up students are allowed to do so. Anyone not listed on the Parent Authorization form attempting to pick up a student will be reported to the Morehouse College and Fulton County Police Department.

5 RELEASE AND WAIVER OF LIABILITY AND COVENANT NOT TO SUE The undersigned hereby acknowledges that participation in risk-oriented programs and activities involves an inherent risk of physical injury and assumes all risks. The undersigned hereby agrees that for the sole consideration of Morehouse College and Georgia Teach allowing the undersigned to participate in these programs and activities for which or in connection with which the business has made available any facilities, equipment, grounds, or personnel for such programs or activities or to the undersigned while participating in any such programs for activities, the undersigned does hereby release and forever discharge the Georgia Science & Robotics Academy, Inc., Morehouse College and Georgia Tech its member individually, and its officers, agents and employees of any and from all claims, demands, rights and causes of action of whatever kind or nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to property, and the consequences thereof, resulting from any participation in any way connected with such programs and activities. I further covenant and agree that for the consideration stated above I will not sue Georgia Science & Robotics Academy, Inc., Morehouse College and Georgia Tech, its members individually, its officers, agents, or employees for any claim for damages arising or growing out of my voluntary participation in above said activities. I understand that the acceptance of this release and covenant not to sue Georgia Science & Robotics Academy, Inc. and Morehouse College and Georgia Tech shall not constitute a waiver in whole or in part, of sovereign or official immunity by said Board, its members, officers, agents, and employees. Further, I understand that this release, waiver of liability, and covenant not to sue shall be effective during the entire period of my enrollment at the camp or participation in risk related activity. I have received a copy of this document and I certify that I am over 18 years of age and suffering under no legal disabilities and that I have read the above carefully before signing. Name (Please Print) Date Signature Signature of Parent or Guardian if participant is under 18 years of age

6 AUTHORIZATION TO PICK UP STUDENT FORM We will not release your child to anyone not previously authorized by you. Please complete this form and return it with your release and other enclosed forms. We must have this form on file before your child begins the STEM Saturdays program. ID WILL BE REQUIRED. Student Name: Transportation Mode: Parents Transport Other explain Names of Parents Authorized To Pick Up Child: Names of Others Authorized To Pick Up Child: Parent s Signature: Date:

7 Medical Release & Emergency Contact Student Information Please Print Student s Name: Date of Birth / / Gender: M F Home Address: City: State: Zip: Emergency Notification Mother: Preferred Emergency Contact Father: Preferred Emergency Contact Legal Guardian: Preferred Emergency Contact Home Phone: Daytime Phone /Cell: Home Phone: Daytime Phone /Cell: Home Phone: Daytime Phone /Cell: Insurance Provider s Information NOTE: PARTICIPANT MUST HAVE MEDICAL INSURANCE or sign a Medical Waiver Provider s Name: Provider s Phone No.: Policy Number: Medical Information Insurer s Name: Primary Care Physician: Physician s Phone: Special Medical Condition(s): Drug Allergies: Current Medications & Dosages: Special Dietary Needs or Food Allergies: Authorization For Medical Treatment (The completed form must be on file before treatment is administered.) I give my permission for such diagnostic, therapeutic, and operative procedures as may be deemed necessary for my son / daughter / ward. Parent or Legal Guardian's signature is REQUIRED below if the student is less than eighteen years of age. Signature of Participant Date Signature of Parent or Legal Guardian Date

8 PHOTO & VIDEO RELEASE Student Name: For good and valuable consideration, the undersigned hereby grants the Georgia Science & Robotics Academy, Inc. the absolute and irrevocable right and permission, in respect to the photographs, video tapes, motion pictures, recordings, or any other media (hereinafter collectively known as Images ) that Georgia Science & Robotics Academy, Inc. has taken of me or my property, or minors in my care, or in which I may be included with others, to copyright the same, in Georgia Science & Robotics Academy, Inc. own name or otherwise, to use, re-use, publish, and re-publish the same in whole or in part, individually or in conjunction with other images, and in conjunction with any printed or electronic matter, in any and all media now or hereafter known, and for any legitimate purpose whatsoever, and to use my name in connection therewith if Georgia Science & Robotics Academy, Inc. so chooses. I hereby waive any right to inspect or approve the Images or any finished version incorporating the same. The undersigned does hereby release and forever discharge Georgia Science & Robotics Academy, Inc. and, their members individually, and their officers, agents, and employees of any kind from all claims, demands, rights, and causes of action of whatever kind or nature, arising from and by reason of any and all known and unknown, foreseen, and unforeseen injuries, damages, and the consequences thereof resulting from the use of the Images, including without limitation any and all claims for libel or invasion of privacy. I understand that the acceptance of this release and waiver of liability by Georgia Science & Robotics Academy, Inc. shall not constitute a waiver, in whole or in part, of sovereign immunity by said entity, its members, officers, agents, and employees. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Georgia Science & Robotics Academy, Inc. I hereby certify that I am suffering under no legal disabilities and that I have read the above carefully before signing. This release shall be binding upon me and my heirs, legal representatives, and assigns. By signing below, I agree to the terms stated above and hereby certify that I am 18 years of age or older. Parent s Signature Date

9 ACKNOWLEDGEMENT AND ASSUMPTION OF RISK I have read the above notice carefully and acknowledge receipt of a copy thereof. In consideration of the benefits received, I hereby assume all risks of damages or injury, including death that I may sustain while participating in or as a result of, or in any way growing out of any aforementioned activity or program, or in travel to and from such activity. Further I hereby certify that I am covered by an accident and health insurance policy that will be in effect at any time I am participating in the Institute related activities or programs. Parent Initials Date

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