SUMMER STEM CAMP 2022 REGISTRATION

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PLEASE FILL OUT THIS FORM IN ORDER TO REGISTER FOR THE DEVASTATORS' SUMMER STEM CAMP THAT WILL BE HELD JUNE 20-24 FROM 12:30PM-5:00PM AT
HARMONY SCHOOL OF INNOVATION - WACO
1110 S VALLEY MILLS DR.
WACO, TX 76711

PLEASE FILL THIS FORM OUT FOR EACH CHILD.
THE EARLY REGISTRATION COST IS $35, WHICH IS AVAILABLE UNTIL JUNE 15TH.
AFTER JUNE 15TH, THE REGISTRATION COST IS $45.
A CAMP SHIRT CAN BE PURCHASED FOR $10.

THE CAMP IS LIMITED TO THE FIRST 50 PAID REGISTERED PARTICIPANTS.

PAYMENT CAN BE MADE USING THIS LINK: https://harmonytx.revtrak.net/dfw/harmony-school-of-innovation-waco/harmony-school-of-innovation-waco-misc-/#/v/SMR-STEM-CAMP-REGSTRTIN

Applicant's full name: *

Applicant's preferred name - for a name tag:

Gender: *

Female

Male

Other:

Ethnicity *

White

Hispanic

African-American

Asian

Indigenous

Other:

AGE - PARTICIPANTS MUST BE BETWEEN THE AGES OF 8-12 *

CAMP PARTICIPANT'S BIRTHDATE? *

YYYY

CAMP PARTICIPANT'S EMAIL ADDRESS *

Whichever email address(es) you check.

HOME ADDRESS? *

PARENT NAME *

PARENT EMAIL ADDRESS *

Whichever email address(es) you check.

PARENT CELL PHONE NUMBER *

Whichever email address(es) you check.

ADDITIONAL EMERGENCY CONTACT INFORMATION *

State any allergies, disabilities, medical conditions or restrictions of the student: *

Does the student receive any medication? If yes, please list medications. *

Please detail medical insurance information here. *

Please detail family physician information here. *

Do we have permission to take photos and videos of your child at the camp and post them to social media? *

Yes

Other:

PLEASE CHECK OFF ANY SKILLS WANT TO GAIN FROM THIS CAMP: *

UNDERSTANDING OF THE ENGINEERING DESIGN PROCESS

HAND TOOL KNOWLEDGE

DESIGN SKILLS

POWER TOOL KNOWLEDGE

PROGRAMMING KNOWLEDGE

CIRCUITRY KNOWLEDGE

GRAPHIC DESIGN SKILLS

PRESENTATION SKILLS

TEAM SPIRIT

CAD SKILLS

DESIRE TO LEARN

COMPETITIVE SPIRIT

DESIRE TO IMPROVE SKILLS

GOOD WORK ETHIC

COOPERATIVE/ GOOD TEAM WORK SKILLS

Other:

Required

Is anything else we need to be mindful of during the camp with this participant? *

Please initial the statements below if you agree to abide by these rules.

Parents, please have your child read these statements below and initial themselves. I realize many of you are filling out this form for your child, but I need them to understand what is expected of them as a member of a team.

I understand that I am not expected to come in with knowledge and experience, but it is my responsibility to gain knowledge and experience. *

Liability Release: By signing below I agree that I am the parent/legal guardian of the above student. I further acknowledge and agree that there are certain inherent dangers in working with hand and power tools during a STEM camp and Harmony School of Innovation - Waco shall not be liable for any personal injuries, property damage or loss sustained by me or my child during their participation in activities on the HSI-Waco premises, whether or not said personal injuries or property damage, or other loss sustained by the undersigned is the result of the negligence of the owners, agents or employees of the facility or of any other persons present on HSI-Waco premises. These conditions apply individually and/or jointly with other participants. HSI-Waco does not carry medical insurance for its participants. It is understood that the participants own policy is your only source of reimbursement. We understand that hand and power tools maybe used during this camp and that there may be injuries if safety precautions are not followed. Safety will be discussed and instruction will be provided. Parents please discuss safety, focus, observation, and carefulness with your child prior to attending as well. *

I understand that I am to be respectful and listen to all mentors running the camp and obey all requests and rules. *

I will demonstrate appropriate behavior at all times. This includes respectful sportsmanship and appropriate behavior. Students will be asked to leave if they are becoming a distraction to the others. *

I understand that bullying in any form will not be tolerated. I will be respectful of everyone's ideas and differences. Everyone thinks different and brings different skill sets to the table. That is part of what makes engineering awesome - being creative and thinking out of the box. I will not insult others or their ideas.

I understand that I should treat all materials, tools, technology, and school property with respect and that I am responsible for any and all destruction and/or carelessness caused by me. Waste of materials or destruction of property is not tolerated. *

I understand that I need to speak respectfully and vulgarity or foul language will not be tolerated. *

I will be safe at all times. I will be careful while working with all tools and be mindful of others around me while working. I will pay attention to how I move and place things. I will not horseplay while working on projects. *

We recommend participants bring their own safety glasses, mask, hair tie for long hair, and closed toed shoes in order to make sure to keep themselves safe while working around others.

I understand that I need to be dropped off by 12:30PM and picked up promptly at 5:00PM. There will not be anyone available to chaperone after 5:15PM each day. *

I understand that there is no refund of fees or a prorated registration amount available if days are missed. There is one flat fee that is due prior to attending the camp. $35 before June 15th, $45 after June 15th. *

I understand that not abiding by these rules may cause me to be asked to leave the camp for the day, possibly the rest of the week with no refund of fees. *

Will you be arriving at 12:00PM for the free school lunch? *

Yes

Maybe

Any other information or ideas you would like to share or questions you have?

Please mark the paid selection below once you pay the fee using this webpage: https://harmonytx.revtrak.net/dfw/harmony-school-of-innovation-waco/harmony-school-of-innovation-waco-misc-/#/v/SMR-STEM-CAMP-REGSTRTIN *

Paid

Other:

Would you like to purchase a camp shirt for $10? Payment for the shirt will be made separately. *

Yes

Other:

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