2018 Statoil Summer STEM Camp University of Houston Science Technology Engineering Mathematics

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1 ENROLLMENT PACKET FOR (Please print campers first and last name) June 11 15, 2018 (Numbers Ninja 1, Robotics, Crime Scene Investigators) June 18 22, 2018 (Numbers Ninja 2, Crime Scene Investigators and Robotics) June 25 29, 2018 (Numbers Ninja 1, App Inventors, Crime Scene Investigators) July 9 13, 2018 (Numbers Ninja 2, App Inventors, Raspberry Pi) This packet contains the enrollment forms for the 2018 Statoil STEM Camp at the. Everyone must complete the following 2018 forms. Emergency Contact Information Release of Medical Liability Student Media Consent and Release Form Acceptable Computer Usage Policy Form Student Code of Conduct UH Release and Indemnification Agreement All enrollment forms listed above are due within 2 weeks of your paid camp registration. Forms must be received by the Statoil Summer STEM camp Directors, with original signatures (no scanned or electronic signatures will be accepted). Forms can be sent via the USPS or delivered in person to: Dr. Perri Segura, teachhouston 304C Farish Hall Houston, TX Please check each page before returning your campers enrollment forms to make sure that you have provided all of the information requested and you and/or your child have signed where necessary. Please make sure all information is complete, accurate and legible. ***Campers are NOT confirmed for the session which they have registered/paid for until the enrollment packet forms are received by the Statoil STEM Camp directors. Campers may be dropped from their registered/paid camp session if enrollment forms are not received and session closes due to it reaching its maximum attendance. Please send the enrollment forms immediately upon registering/paying for your child s camp session/s to ensure your camper is confirmed for camp. Thank you! If you have questions or need additional information, please contact any of the Statoil Summer STEM Camp Directors: Camp Director Phone number Laura Harlow lmharlow@central.uh.edu Perri Segura psegura@uh.edu

2 Emergency Contact Information Form Please fill out one form for each child attending summer camp. Student name (last, first): M/F: Grade level: Primary home address: Primary parent/guardian name: Cell phone: Preferred In case of the primary parent/guardian cannot be reached, we should contact: Name: Cell phone: In case of a medical emergency that requires personal physician s expertise: Physician s name: Phone: List of allergies: List of medical/other concerns: Who will be picking up this camper each day? (if different than above) Name: Relationship: Cell phone:

3 Release of Medical Liability Statement regarding s Statoil STEM Camp: As the parent/guardian, I am fully aware of the recreational and academic activities my child will participate in while attending the Statoil Summer STEM camp. These activities involve games, academic lessons, building and creating, performing experiments, being outdoors conducting investigations and experiments, and the like. These activities will be supervised and monitored by qualified teachhouston personnel. The Statoil Summer STEM Camp at the will not be responsible for any injuries that occur to campers while participating in this program. I hereby give permission for my child to engage in such activities that are part of the Statoil Summer STEM camp. In the event of a minor injury or illness, the parent and/or person(s) listed as an emergency contact will be notified. For serious injuries or illnesses, the child s physician will be contacted as soon as possible and/or he/she will be taken to the nearest emergency room. The following signature will allow the Statoil Summer STEM Camp at the personnel to exercise their best judgment. Student Media Consent and Release Form Students may be highlighted in efforts to promote classroom activities and achievements. For example, students may be featured on movie projects, design competitions, and special recognitions. In addition, students may be spotlighted in materials to train pre-service teachers, increase public awareness through radio, TV, brochures, newspapers, websites, and other types of media. I, as the parent/guardian, hereby authorize the and its faculty and staff to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital, and printed media.

4 Acceptable Computer Usage Policy Form Please fill out one form for each child attending summer camp. Appropriate Uses Include: Use for educational purposes during instructional time. Limited personal use during non-instructional time to check personal s is allowed. The use of any other websites and/or social media outlets must be approved by a Camp Director. Use for saving, downloading, and/or transferring of specified files onto the computer desktop/laptop is allowed for instructional purposes only. These activities must be approved by camp staff. Inappropriate Uses Include: Use for personal purposes during instructional time. Viewing, downloading, or accessing materials that are deemed obscene, sexually oriented, threatening, abusive, harassing, and/or illegal. Downloading or using copyrighted information without permission from the copyright holder. Saving, downloading, and/or transferring curriculum files onto the computer desktop/laptop or personal storage devices including digital storage is strictly prohibited. Hacking, unauthorized access, and/or other illegal uses of resources. Borrowing someone else s account or computer resources. As a participant in the Statoil STEM Camp at the, I agree to participate in the entire program and conduct myself in a way to bring credit to my family, my school, my community, and myself. I/We understand that violation of any of the above rules and/or prohibited conduct will be cause for immediate dismissal from the camp. Camper Signature:

5 Student Code of Conduct Form Please fill out one form for each child attending summer camp. Campers are expected to obey rules and instructions given by camp staff/directors. Campers are expected to adhere to the dress code at all times. Campers are expected to actively participate in all camp classes and activities. Campers are expected to be in groups and accompanied by a camp staff member. Campers are to check-in with the assigned camp counselor(s) at the times specified. Campers should let at least one camp staff member know where he/she is at all times. Campers are required to be in their assigned class at all times. Bathroom breaks are to occur only between classes and during scheduled breaks. Disruptive behavior in classes will not be permitted. Dangerous or threatening conduct, disrespectful behavior, bullying (persistent, offensive, abusive, intimidating, or insulting behavior, which makes the recipient feel upset, threatened, humiliated, or vulnerable) and hazing (conduct that causes or intends to cause psychological, emotional, or physical harm to any person) will not be permitted. Possessing, using, storing, or transporting firearms, other weapons, explosives, smoke bombs, fireworks, ammunition, or dangerous chemicals are prohibited. Relatives and friends are not permitted to pick up campers during the week unless approved by a Camp Director. Visitation from friends is not permitted. During instructional time, campers are not allowed to have mobile telephones, television sets and hand-held gaming devices and other electronic devices unless otherwise instructed by camp staff. I/We understand that violation of any of the above rules and/or prohibited conduct will be cause for immediate dismissal from the camp with no return of registration fees. Camper Signature:

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