West Virginia University 2015 Forensic Science Summer Camp

Transcription

1 Thank you for registering for the! This packet contains the following forms that must be completed and returned before the student will be allowed to attend camp: Participant Information Form Event Participant Waiver and Release Participant Behavior Contract This is a day camp only. There will be no lodging, transportation, or meals other than lunch provided at any time during this camp. Please make sure that all three forms are completed and returned immediately following online registration. Registration will not be considered complete until all forms have been completed and returned. No student may participate in the camp without a completed set of forms on file. Please feel free to contact Chris Bily by at Chris.Bily@mail.wvu.edu or by phone at (304) with any other questions you might have. Once completed, please send the forms to: Chris Bily C/O West Virginia University 886 Chestnut Ridge Road Morgantown, West Virginia 26056

2 Participant Information Form Participant s Name Last, First, Middle Initial Address City State Zip Code Participant s Birth Date Gender Blood Type Participant s t-shirt size Name of participant s physician Office Telephone Number Parent/Guardian Information Name Relationship Name Relationship Day Phone Number Day Phone Number _ Evening Phone Number Evening Phone Number _ Cell Phone Number Cell Phone Number _ Signature Date Signature Date

3 Please provide the information of a responsible adult whom we can contact in an emergency if we are unable to contact you. Name Relationship Address City State Zip Code Day Phone Number Evening Phone Number Does the participant have any health conditions (i.e. allergies, chronic conditions), prescribed medications, or special circumstances that we should be aware of? [ ]No [ ]Yes If yes, please explain in the space provided. Does the participant take any medication, prescribed or otherwise? [ ]No [ ]Yes If yes, please provide a complete list in the space provided.

4 Event Participant Waiver and Release Dear Event Participant, Thank you for your interest in the. Before participating in this Event, you must read, understand, and sign this form. This form tells of some, but not all, of the risks you may face by choosing to participate in this Event. Additionally, by signing this form you are releasing West Virginia University and the Board of Governors of West Virginia University (WVU) and others from all responsibility and liability for any injuries you might suffer. 1. Name and Event I, (print name), desire to participate in the2015 Forensic Science Summer Camp (also referred to in this document as the Event ), on June 22-26, These Events consist of analyzing physical evidence from crime scenes. 2. Disclosure of Risks Involved I understand that there are minor risks/hazards inherent in activities associated with an Event. The nature of these risks/hazards will be explained to me. If I feel uncomfortable with these risks, I will inform the Event staff that I do not wish to participate in the activity. If I choose to participate, I will assume all such risks/hazards associated with my participation in the Event and do so voluntarily notwithstanding any such risks. 3. Assumption of Responsibility I accept full responsibility for my health, safety, and property during the Event. I am in good physical condition and do not suffer from any medical issue that could be exacerbated by my participation. I am covered by medical insurance that will pay for any injuries sustained during the Event. I agree to follow the rules and directions that are given to me by the Event staff. 4. Agreement Not to Sue and Waiver of Rights I, for myself, my heirs, successors, and assigns, hereby RELEASE, DISCHARGE, and agree not to sue the State of West Virginia, West Virginia University, including any component of the University and its Board of Governors, their officers, employees, students, agents, representatives, affiliates, and all persons or entities acting with or in concert with them, and their predecessors, successors, and assigns, from any and all liability, claims, demands, causes of actions, losses or damages, whether known or unknown, for bodily or personal injury or death, or damage to or loss of property, or any other injury, damage or loss of any kind, resulting from, arising out of, or in any way related to my participation in the Event, including any claim based on actual or alleged negligence, gross negligence, intentional, or reckless behavior. 5. Consent to Medical Treatment I consent to any medical treatment that I may require during the Event or as a consequence of my participation in the Event. I accept full responsibility for the costs of any medical care I might receive during the Event or as a consequence of my participation in the Event.

5 6. Minor Children I understand that no minor child (a person under the age of 18 as of the date of the Event) may participate in the Event without the permission of a parent or guardian. If I am signing this form for a minor child, I understand that all of the releases, authorizations, and statements made in this document apply to me and my child, and I consent to my child s full participation in the Event. 7. Severability I understand that every provision of this Event Participant Waiver and Release is severable. If any term or provision hereof is held to be illegal, invalid, or unenforceable for any reason whatsoever, such illegality, invalidity, or unenforceability shall not affect the validity of the remainder of the Event Participant Waiver and Release. I have read this form in its entirety and I understand it fully. By signing it, I agree to all the terms of this document. This form must be submitted to Chris Bily prior to camp in order for registration to be considered complete. No student will be permitted to participate in the Event without a signed form. Please initial each page of this document and feel free to make a copy for your records. Participant Signature: Date: Media Waiver and Release I understand that during the Event I may be recorded on film, audio, video or other media. I waive any claim based on any such recording, broadcast, or other use of my image, speech or personality. I authorize Event organizers and any other person to record, use, publish, sell and own my image, speech and personality. My signature below indicates that I agree to the above statement. NOTE: The participant will not be excluded from this Event if the media waiver is not accepted. Participant Signature: Date:

6 Participant Behavior Contract Parent/Guardian: Please review the following behavior contract with the participant. Ensure that he/she understands that he/she will be expected to follow all parts of the contract while at camp. Failure to follow these rules will lead to disciplinary actions up to expulsion from camp, without refund. The camper must read and initial each statement and sign, along with his/her parent or guardian, at the bottom to show that he/she agrees to abide by the rules and policies of West Virginia University. While at camp, I will do the following: (camper initials) Show respect for camp staff through my attitude and behavior including following directions. (camper initials) Treat fellow camp participants with respect and kindness at all times. (camper initials) Treat West Virginia University s facilities and laboratory equipment with respect. (camper initials) Refrain from the possession and/or use of tobacco products, controlled substances, illegal substances, or alcoholic beverages while on West Virginia University property. (camper initials) Make a strong effort to engage in camp programming and constructively work and interact with other campers. (camper initials) Limit my use of electronic devices to non-instructional time only. I am aware that the loss, damage, or theft of such items is not the responsibility or concern of camp staff, West Virginia University, or West Virginia University employees. (camper initials) Wear clothing that is appropriate and shows respect for myself and others. My clothing will be size appropriate, modest, and not display inappropriate or disruptive slogans, gestures, or brands. (camper initials) Maintain language and decorum appropriate for the classroom setting at all times. (camper initials) Conduct myself in a responsible manner in the laboratory at all times.

7 (camper initials) Refrain from eating, drinking or chewing gum in the laboratory. (camper initials) Refrain from touching laboratory equipment until told to do so by camp staff. (camper initials) Dress properly for working in a laboratory environment: Long hair must be tied back Dangling jewelry and loose or baggy clothing must be secured Shoes must completely cover the foot. No sandals are allowed. Having read and understood the Participant Behavior Contract above, I agree to follow these policies during my time in the Forensic Science Summer Camp. I also understand that failure to comply with these policies will have consequences which may include, but are not limited to being prohibited from participating in some or all activities, being dismissed from the camp and sent home, and being prohibited from returning to this and/or future West Virginia University camps. Participant Signature Date Parent/Guardian Signature Date Parent/Guardian Signature Date