Summer College & Career Exploration Camps Parental Consent Form

Transcription

1 Summer College & Career Exploration Camps Parental Consent Form This form must be completed, signed and returned to TCC one week prior to the camp start date. the completed form to or fax it to Questions about the form or camp registration may be directed to Dr. Emily Richardson at or Child s Name: Address: Date of Birth: City, State, Zip: Parent or Guardian: EMERGENCY CONTACT INFORMATION Telephone numbers where you can be reached during class sessions: Primary Phone: Alternate Phone: Other emergency contacts: Contact Name: Relationship to Student: Primary Phone: Alternate Phone: Contact Name: Relationship to Student: Primary Phone: Alternate Phone: ASSUMPTION OF RISK I agree that as a participant in the TCC College and Career Exploration Summer Camps at Tidewater Community College scheduled for, 2016 to, 2016, I am responsible for my own behavior and well-being. I accept this condition of participation, and I acknowledge that I have been informed of the general nature of the risks involved in this activity, including, but not limited to cuts,

2 trips, falls, slips, punctures, burns, back injuries, bumps and bruises. I understand that in the event of accident or injury, personal judgment may be required by College personnel regarding what actions should be taken on my behalf. Nevertheless, I acknowledge that the College personnel may not legally owe me a duty to take any action on my behalf. I also understand that it is my responsibility to secure personal health insurance in advance, if desired, and to take into account my personal health and physical condition. I further agree to abide by any and all specific requests by the College for my safety or the safety of others as well as any and all of the College s rules and policies applicable to all activities related to this program. I understand that the College reserves the right to exclude my participation in this program if my participation or behavior is deemed detrimental to the safety or welfare of others. In consideration for being permitted to participate in this program, and because I have agreed to assume the risks involved I hereby agree that I am responsible for any resulting personal injury, damage to or loss of my property which may occur as a result of my participation or arising out of my participation in this program, unless any such personal injury, damage to or loss of my property is directly due to the negligence of the College. I understand this Assumption of Risk form will remain in effect during any of my subsequent visits and program-related activities, unless a specific revocation of this document is filed in writing with the program coordinator, at which time my visits to or participation in the program will cease. I acknowledge that I have read and fully understand this document. I further acknowledge that I am accepting these personal risks and conditions of my own free will. If participant is less than 18 years old, please complete the following: My child/ward is under 18 years of age and I am hereby providing permission for him/her to participate in this program. I agree to be responsible for his/her behavior and safety during this event.

3 MEDICAL INFORMATION Does your child take any medications? Yes No Please List: Does your child have any allergies? Yes No Please explain: Does your child carry a respirator, EpiPen or other medical device? Yes No Please explain: Does your child have any special learning or behavioral needs? Yes No Please explain:

4 AUTHORIZATION TO PICK UP CHILD WITH IDENTIFICATION List below the person(s) (must be 18 or older) with permission to pick up your child from class. Your child s instructor or assistant will only release your child to the listed individual(s). Anyone picking up your child (including yourself) will need to provide a driver s license as proof of identity each time you or an authorized person picks up your child. I give permission for the following individual(s) to pick up my child from TCC Summer Camp. I understand that a driver s license will be required as proof of identity EVERY TIME SOMEONE PICKS UP MY CHILD. I ALSO UNDERSTAND THAT MY CHILD WILL NOT BE RELEASED TO ANY INDIVIDUAL(S) NOT ON THIS LIST. Please print or type names clearly. Be sure to include your own name as well as the names of other guardians or relatives. If you need to add names to this list later, please submit an amended list. Name: Name: Name:

5 STUDENT COMPUTER AND INTERNET USE Tidewater Community College provides computers, networks, and Internet access to support the educational mission of the schools and to enhance the curriculum and learning opportunities for students and school staff. TCC believes that the resources available through the Internet are of significant value in the learning process and preparing students for future success. At the same time, the unregulated availability of information and communication on the Internet requires that schools establish reasonable controls for lawful, efficient, and appropriate use of this technology. Student use of school computers, networks, and Internet services is a privilege, not a right. Students are required to comply with this policy and the accompanying rules. Students who violate the policy and/or rules may have their computer privileges revoked and may also be subject to further disciplinary and/or legal action. All Tidewater Community College computers remain under the control, custody, and supervision of the school unit. The school unit reserves the right to monitor all computer and Internet activity by students. Students have no expectation of privacy in their use of school computers. While reasonable precautions will be taken to supervise student use of the Internet, Tidewater Community College cannot reasonably prevent all inappropriate uses, including access to objectionable materials and communication with persons outside of the school in violation of School Committee policies/procedures and school rules. The school unit is not responsible for the accuracy or quality of information that students obtain through the Internet. Before a student is allowed to use school computers and Internet services, the student and the student s parent/guardian must sign and return the Computer/Internet Access Acknowledgment. The signed acknowledgment will be retained by the school. The Camp Coordinator/Instructor shall be responsible for overseeing the implementation of this policy and the accompanying rules, and for advising the School committee of the need for any future amendments or revisions to the policy/rules. The Camp Coordinator/Instructor may develop additional administrative procedures/rules governing the day-to-day management and operations of the school unit s computer system as long as they are consistent with TCCs policy/rules. STUDENT COMPUTER AND INTERNET USE RULES These rules implement School Committee policy Student Computer and Internet Use. The rules are intended to provide general guidelines and examples of prohibited uses but do not attempt to state all required or prohibited activities by users. Failure to comply with TCC policy and these rules may result in loss of computer and Internet access privileges, disciplinary action and/or legal action. A. Computer Use is a Privilege, Not a Right: Student use of the school unit s computers, networks, and Internet services is a privilege, not a right. Unacceptable use/activity may result in suspension or cancellation of privileges as well as additional disciplinary and/or legal action. The building administrator shall have final authority to decide whether a student s privileges will be denied or revoked. B. Acceptable Use Student access to the school computers, networks, and Internet services are provided for educational purposes and research consistent with the school unit s educational mission, curriculum, and instructional goals. The same rules and expectations govern student use of computers

6 as apply to other student conduct and communications. Students are further expected to comply with these rules and all specific instructions from the teacher or other supervising staff member/volunteer when accessing the school unit s computers, networks, and Internet services. C. Prohibited Use The user is responsible for his/her actions and activities involving school unit computers, network, and Internet services and for his/her computer files, passwords, and accounts. Examples of unacceptable uses that are expressly prohibited include, but are not limited to the following: 1.Accessing Inappropriate Materials Accessing, submitting, posting, publishing, forwarding, downloading, scanning, or displaying materials that are defamatory, abusive, obscene, vulgar, sexually explicit, sexually suggestive, threatening, discriminatory, harassing and/or illegal; 2.Illegal Activities Using the school unit s computers, networks, and Internet services for any illegal activity or activity that violates other School Committee policies, procedures and/or school rules; 3.Violating Copyrights Copying or downloading copyrighted materials without the owner s permission; 4.Plagiarism Representing as one s own work any materials obtained on the Internet(such as term papers, articles, etc.). When Internet sources are used in student work, the author, publisher, and Web site must be identified; 5.Copying Software Copying or downloading software without the express authorization of the system administrator; 6.Non-School-Related Uses Using the school unit s computers, networks, and Internet services for non-school-related purposes such as private financial gain, commercial, advertising or solicitation purposes, or for any other personal use; 7.Malicious Use/Vandalism Any malicious use, disruption or harm to the school unit s computers, networks, and Internet services, including but not limited to hacking activities and creation/uploading of computer viruses; and 8.Unauthorized Access to Chat Rooms/News Groups Accessing chat rooms or newsgroups without specific authorization from the supervising teacher. D. No Expectation of Privacy: The school unit retains control, custody, and supervision of all computers, networks, and Internet services owned or leased by the school unit. The school unit reserves the right to monitor all computer and Internet activity by students. Students have no expectations of privacy in their use of school computers, including and stored files. E. Compensation for Losses, Costs and/or Damages: The student and/or the student s parent/guardian shall be responsible for compensating the school unit for any losses, costs or damages incurred by the school unit related to violations of policy and/or these rules, including investigation of violations. F. School Unit Assumes No Responsibility for Unauthorized Charges, Costs, or Illegal Use: The school unit assumes no responsibility for any unauthorized charges made by students including but not limited to credit card charges, long distance telephone charges, equipment and line costs, or for any illegal use of its computers such as copyright violations.

7 G. Student Security: A student shall not reveal his/her full name, address or telephone number on the Internet without prior permission from a supervising teacher. Students should never meet people they have contacted through the Internet without parental permission. Students should inform their supervising teacher if they access information or messages that are dangerous, inappropriate, or make them uncomfortable in any way. H. System Security: The security of the school unit s computers, networks, and Internet services is a high priority. Any user who identifies a security problem must notify the system administrator. The user shall not demonstrate the problem to others. Any user who attempts or causes a breach of system security shall have his/her privileges revoked and may be subject to additional disciplinary and/or legal action. I. Parental Permission Required Students and their parent/guardian are required to sign and return the Computer/Internet PERFORMANCE RELEASE I authorize Tidewater Community College, without restrictions of any kind, to use my son s/daughter s name, biography, photographic image, written testimonial and/or voice, singly or in combination, in a video, television tape recording, digital image, or series of such productions for use by TCC; and to be distributed and exhibited by means of print, radio or television broadcasting the Internet or by any other means of distribution or exhibition. I further agree to allow use of my child s name, biography, photographic image, written testimonial and voice, singly or in combination, in promoting such distribution and exhibition. I agree that no monetary compensation is implied or expected from this release. FIELD TRIP PERMISSION I do hereby willingly give permission for my child to participate in all field trips that are part of my child s registration.

8 STUDENT CODE OF CONDUCT The Summer Camp program offers learning experiences designed to actively engage students in hands-on learning. Courses have a high adult to student ratio and provide students with opportunities to learn and have fun at the same time. In order for all participants to benefit from the program, each student and their parent or legal guardian must sign a Code of Conduct form agreeing to the expectations for behavior during the Career Exploration Camps. Students are expected to observe the following Code of Conduct while enrolled as a TCC Career Exploration Camp student: 1. To treat fellow students, TCC faculty and staff with respect at all times. This includes the following: a. respectful listening during presentations b. participation during hands-on activities c. avoiding behavior that is distracting to others during class time d. following direction from TCC staff as necessary to ensure a safe and enjoyable experience by all 2. To avoid the following during hours of the Camp, including breaks: a. smoking b. chewing gum c. rough-housing d. using swear words 3. To avoid the following except for limited use as permitted during breaks: a. use of cell phones b. video/electronic games Consequences of breaking these rules are (1) a warning from an Instructor (2) a phone call to the parent/guardian (3) being asked to leave the program without a refund. Student: I have read the Code of Conduct and I agree to adhere to the Code while I am a student in the TCC Summer Career Exploration Camp program. I understand that if I do not follow the Code of Conduct, I will be disciplined in the manner described above. Student Signature: Parent: I have read and discussed the Code of Conduct with my child. I understand that if my child does not follow the Code of Conduct, he or she will be disciplined in the manner described above. Signature Approval of All Forms: Parent/Guardian Signature: