Middle School "Art and Engineering with the Glowforge Pro" Summer Enrichment Program 2021 Registration Form

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Come design and create using a professional grade laser cutter to turn your project vision into a reality!

Participants will each have the opportunity to design, create, and assemble pieces for a fully functional balance scale. Additionally, the class will also explore production art, such as poster and print-making using the equipment.

Class activities and key skills include: design, sculpture, critical thinking, equipment operation, problem-solving, and creativity.

Students will be provided all materials for the course as needed.

Teacher: M.E. Dunlap
Dates: August 9th-August 12th
Times: 9am - 12pm
Location: Madison Middle School
Grades: All students going into 6th-8th grades for the upcoming school year.

Student's LAST Name *

Student's FIRST Name *

Student's 4J Identification Number

Middle School Student Will Be Attending in FA2021: *

Arts and Technology Academy

Cal Young Middle School

Kelly Middle School

Kennedy Middle School

Eugene Online Academy

Madison Middle School

Monroe Middle School

Roosevelt Middle School

Spencer Butte Middle School

Other:

Student Home Address: *

Example: 200 N Monroe St., Eugene, OR 97402

Parent / Guardian Last Name: *

Parent / Guardian First Name: *

Parent/Guardian Email *

Parent/Guardian Phone Numbers - Cell, Home, Work *

Please list all available numbers. Examples: 541-790-7700 (Cell) 541-790-7701 (Home) 541-790-7702 (Work)

Name of Emergency Contact : *

Emergency Contact Relationship: *

Example: Grandmother, Aunt, Family Friend, etc.

Emergency Contact Phone *

Example: 541-790-7700

Health Conditions: Please indicate if any of these or other conditions apply to your child.

Asthma (please list more specific information below)

Diabetes (please list more specific information below)

Heart Condition (please list more specific information below)

Hearing Loss (please list more specific information below)

Orthopedic Condition (please list more specific information below)

Mobility Limitation (please list more specific information below)

Severe Bee Sting (please list more specific information below)

Seizures (please list more specific information below)

Severe Food Allergy (list which food or foods below)

Speech Disorder (please list more specific information in prompt below)

Other Allergies (please list more specific information in prompt below)

Other:

Please indicate if your student is supported by

IEP

504

As appropriate, please provide more specific information on health conditions, including required accommodations.

If the student requires prescription medication while attending this Summer Intensive Course, please list.

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