Wufoo
2024 Summer LEGO Camp. July 15-18. Grades 6-8.
This is a four-day LEGO robotics camp for 6th - 8th graders (based on the grade they just completed). Camp will be held at Trine University from 8am - 2pm on July 15-18. Camp is free thanks to a Lily Endowment Grant that Trine University received. Snacks, Lunch, and a Camp T-Shirt will be provided. Space is limited to 40 students (2 classrooms of 20).
Camper Name
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First
Last
Grade (Please enter the grade level the student JUST completed)
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6th Grade
7th Grade
8th Grade
Address
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
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Afghanistan
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Vietnam
Wallis & Futuna
Western Sahara
Yemen
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Country
School
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Parent/Guardian Name
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First
Last
Email (This is where all information regarding camp will be sent)
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Parent/Guardian Phone Number
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Emergency Contact Name (This should be someone available the day of camp)
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First
Last
Emergency Contact Phone Number
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Please list anyone who is authorized to pick up the student from camp.
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Food Allergies, Medical Conditions, Behavioral Concerns, etc.
Camper T-Shirt Size
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Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
I give Trine University permission to record my image and/or voice and I grant Trine University all rights to use these sound, still, or moving images/recordings in any medium for educational, promotional, advertising, or other purposes that support the mission of the university. I agree that all rights to the sound, still, or moving images belong to Trine University.
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Agree
Disagree
ACTIVITY PARTICIPATION AND MEDICAL RELEASE FORM
In consideration of my application to participate in a voluntary camp, clinic or program at Trine University (Trine), I agree to the information below.
I understand that participating in a camp, clinic or program at Trine involves risk. These risks are identified in the following categories:
Learning Environment: I understand that participating in a learning environment involves some risk. I will be moving from location to location on campus and/or in other locations, and learning within facilities at Trine and/or elsewhere. This involves risks and the potential of injury. These risks vary depending on innumerable factors. Injury can occur as a result of equipment failure, weather, acts of other participants or third parties, lack of or improper supervision, or disease. Every type of injury could occur. This may include broken bones, chemical exposure, back or brain damage, death or dismemberment.
Active Participation: I understand that part of my experience at Trine may include active participation, athletic or aerobic activity. Participation in these activities requires rigorous exercise under conditions which are sometimes dangerous. Injuries to the participant can occur in many foreseeable and unforeseeable ways. Injuries can occur as a result of: equipment failure, poor surface and/or field conditions, lack of proper supervision and the negligence of other participants (including but not limited to teammates, opponents, spectators, or officiating personnel). They can occur during periods of free time, strength development exercises, during practices or at athletic events themselves. Injuries can occur even if you, your teammates and opponents are physically fit and participating according to the rules of your chosen sport. They can also occur because you, your teammate or opponent is not physically fit or does not abide by the rules. Every type of injury could occur. This may include broken bones, ligament tears, back or brain damage, death or dismemberment.
Travel & Accommodations: I understand that part of my experience at Trine may include travel to or from event locations, overnight or daytime accommodations. These activities involve risk and the potential of injury. This can occur due to equipment failure, vehicle failure, accidents, facility malfunctions, negligent operation and/or supervision by an agent of Trine or a third party, or acts of others (including camp participants or non-participants). Every type of injury could occur. This may include broken bones, back or brain damage, death or dismemberment.
I wish to participate in the above activity scheduled at Trine University. I am fully aware of the special dangers and risks inherent in participating in the activity, including physical injury, death, or other consequences arising or resulting from the activity. I agree to accept full responsibility for such risks. I agree to accept responsibility for all implied risks and possible acts of negligence by other persons and/or agents of Trine. I further agree to advise activity planners of any physical or mental limitations I may have. I agree to be fully responsible for my own property and equipment related to this activity.
In consideration of my voluntary application and as a requirement to participate in this activity, I hereby release and indemnify Trine University and their staff of any and all liability, claims and causes of actions arising out of or in any way connected with my participation in this activity offered at Trine University.
I also agree to allow any medical personnel the opportunity to treat a illness, injury, or any other medical condition. I agree to accept full responsibility for any medical costs which may result from my participation and for any treatment for any injury sustained while taking part in the program.
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