2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education

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Simon Norman
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1 2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education Welcome to NSU Youth Academy! We are excited to have your child with us. In order to provide the best experience for our students we have a few rules for you to review. We appreciate your compliance with these rules as there is much planning and consistency needed for all of our moving parts to work harmoniously, and these rules help keep the system in order. 1. Registration Fees secure your child s spot in a Youth Academy. This fee is non-refundable and not transferable to another academy. If your child ends up not being able to attend that academy, you may transfer your registration fee to another child for the same youth academy. 2. Youth Academy Fee Balances are due by the Tuesday, two weeks before the first day of the youth academy. You forfeit your spot in the academy if the fee balance is not paid by Tuesday deadline. Reminders will be ed. 3. Our Refund Policy requires a 2-week notice (from the start day of the academy) in order to receive a refund on your $ camp fee. Please remember the $60 registration fee is non-refundable. 4. The Risk and Liability Waiver must be on file for a youth participant to participate. Waivers are due the Tuesday before the first day of the youth academy. Our instructors review these waivers, so please include any information that would be helpful in making your child s summer youth academy experience successful, i.e. attach an IEP, list food allergies, etc. The photo release is optional. 5. If we have permission, we use photos for our website, in promotional materials, CE schedules and brochures. 6. Drop off and Pick up times are strictly enforced as the academies start at 8:30 am and end at 4:00 pm. The R.A.C.E. instructors will provide early drop off and late pick up. The Tahlequah campus location is Bagley Hall (College of Education) and at the Broken Arrow campus Total Academy Fee Registration Fee Academy Fee $160 $60 $100 Refundable? No Transferrable? No Refundable? With a 2 week notice Transferrable? Yes Transferrable- To take the funds applied to one youth academy and apply them to another academy and/or another participant. *This is an example, all academies cost $160. If your $160 Total Academy Fee = $60 Reg. Fee + $100 Academy Fee

2 the academies will be in the Education building. The early/late care costs an additional $25.00 per child per academy. Early drop off is from 7:30 am 8:30 am and late pick up 4:00 pm 5:00 pm. If you do not wish to take advantage of the early/late hours for the $25.00 fee, please do not drop your student off before 8:15 AM, academies start at 8:30 AM. and end at 4:00 pm, please pick up your child before 4:10 PM. Failure to comply may result in additional charge to cover the cost of instructor time. 6. We reserve the right to ask a youth academy participant to be removed from an academy if their behavior is unsafe or unmanageable. No refunds will be given if we have to ask a participant to be removed from an academy. That being said, instructors will make every attempt to fix unsafe or unmanageable behavior before making the decision to remove the participant. Parents/guardians are responsible for picking up a participant that has been removed from an academy. 7. Youth academy participants are expected to be able to participate in group and individual activities with mild direction from the instructor. We reserve the right to refuse registration for anyone not able to meet the minimum requirements for the youth academies. 8. Participants are expected to follow these rules: a. Not jump off of, or over, anything b. Stay with the group c. No hitting, pushing, or fighting d. Use kind words e. Follow instructor s directions Our Promise to you We believe every child has the following rights: To be treated with respect To learn and play in a friendly and safe environment To be safe from bullying All of our lead instructors have a degree in or experience in childhood education and are vetted through background checks. By signing below, I have read and agree to comply with the expectations of myself and my summer youth academy participant. This document is effective for any and all youth academies offered by R.A.C. E. until May 1, Parent of Guardian (Sign) Date Printed Name

3 Northeastern State University Continuing Education s RACE Youth Academies Release of Liability and Medical Treatment Authorization Form I (PRINT PARTICIPANTS NAME), understand that Northeastern State (NSU) Continuing Education events and Robotics Academy of Critical Engagement events, in which I plan to be a participant, involve certain risks and that regardless of the precautions taken by NSU, some bodily injuries may occur. Specific risks/hazards involved in Continuing Education and RACE events include but are not limited to the following: (1) auto accidents while traveling to and from events or traveling on the event premises; (2) dehydration; (3) physical injury sustained while participating in events, both on and off campus (i.e. Tahlequah City Pool); and (4) medical problems such as illness, allergies, etc. 1. In consideration for receiving permission to participate in Continuing Education and RACE events, which are sponsored by NSU, a component member of The Regional University System of Oklahoma (RUSO), I hereby release, waive, discharge, and covenant not to sue, and agree to hold harmless for any and all purposes, NSU, RUSO and its Board of Regents, RACE, and their officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES) from ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, OR INJURY, INCLUDING DEATH, that may be sustained by me while participating in such activity, or while on the premises that is owned, leased, or controlled by RELEASEES, including travel to and caused from by NSU intentional Continuing or grossly Education negligent events, conduct. including injuries sustained as a result of the negligence of RELEASEES. I understand this release does not apply to injuries 2. I am fully aware that there are inherent risks involved with Continuing Education and RACE events and the student chooses to voluntarily participate in said activity with full knowledge that said activity may be hazardous to the student and possibly property. I acknowledge there may be physically strenuous activities. I know of no medical reason why my child should not participate. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, which may be sustained by me as a result of participating in said activity including injuries sustained as a result of the negligence of RELEASEES. I further agree to indemnify and hold harmless the RELEASEES for any injury, death, loss, liability, damage or costs, including court costs and attorney s fees, that may occur to any person(s) or property as a result of my participation in said activity including injuries sustained as a result of the negligence of RELEASEES. I understand this agreement to indemnify and hold harmless does not apply to injuries caused by intentional or grossly negligent conduct. 3. I understand that RELEASEES may not maintain any insurance policy covering any circumstance arising from my participation in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. 4. It is my express intent that this Release shall bind the members of my family and spouse if I am alive, and my heirs, assigns, and personal representatives if I am deceased, and shall be governed by the laws of the State of Oklahoma. 5. I understand RELEASEES cannot be expected to control all of the risks articulated in this form but RELEASEES may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required during my participation with the understanding that the cost of any such treatment will be my responsibility. I agree to indemnify and hold harmless RELEASEES for any costs incurred to treat me, even if a RELEASEE has signed hospital documentation promising to pay for the treatment due to my inability to sign the documentation. 6. In signing this Release, I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing agreement that has been reduced to writing have been made. I execute this document for full, adequate, and complete consideration fully intending to be bound by the same, now and in the future. I represent that I am eighteen (18) years of age or older and am otherwise competent to execute this agreement. If the participant is younger than 18 then his/her parent or legal guardian must sign where indicated on page 2 below. I consent to the information on this form being shared with the NSU Continuing Education Executive Director, Director Staff, RACE Director and Staff, and Emeritus.

4 I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY INJURY OR DEATH OR DAMAGE TO MY PROPERTY THAT OCCURS WHILE PARTICIPATING IN THE DESCRIBED EVENTS OR ACTIVITIES AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT OR INTENTIONAL ACT OR OMISSION. PRINT (child s) NAME DATE OF BIRTH GENDER (please check): Male Female ADDRESS CITY STATE ZIP CODE PHONE NUMBER DRIVERS LICENSE # STATE OF ISSUE PARTICIPANT SIGNATURE DATE Additional signature required if participant is younger than 18 years old during registered event dates I am the parent or legal guardian of the participant indicated above, who is under the age of 18 during the registered event dates. I agree on behalf of my child or ward to all the terms contained in this Release. PRINT PARENT OR LEGAL GUARDIAN NAME PARENT OR LEGAL SIGNATURE DATE In the event of an emergency, contact Phone Health Insurance company Policy # (Indicate NONE if not covered by a health insurance plan.) Doctor s name Phone Please list any special services you may require due to an existing medical condition or physical disability, or any physical condition limiting your activities: List any allergies to drugs, food, insects, plants, etc.: List any medications you are taking: List any dietary restrictions: Health History, please check that apply: Heart Condition/Disease Psychological Conditions Asthma Physical Disability Seizure Disorder Epilepsy Diabetes Other Disability If any of the above are checked, please provide additional details: Do you wear glasses? Yes or No Do you wear contacts? Yes or No

5 NSU Continuing Education s RACE Youth Academy PHOTOGRAPHIC CONSENT AND RELEASE FORM I hereby authorize Northeastern State University, and those acting pursuant to its authority to: (a) Record my likeness and voice on a video, audio, photographic, digital, electronic or any other medium. (b) Use my name in connection with these recordings. (c) Use, reproduce, exhibit or distribute in any medium (e.g. print publications, video tapes, CD-ROM, Internet/WWW) these recordings for any purpose that Northeastern State University, and those acting pursuant to its authority, deem appropriate, including promotional or advertising efforts. I release Northeastern State University and those acting pursuant to its authority from liability for any violation of any personal or proprietary right I may have in connection with such use. I understand that all such recordings, in whatever medium, shall remain the property of the Northeastern State University. I have read and fully understand the terms of this release. Name: Address: Street City State Zip Phone: Participants Signature: Date: (if 18 years of age or older) Parent/Guardian Signature: Date: (if younger than 18 years old)

6 NSU Continuing Education s RACE Youth Academy Minor Pick-Up Release I (parent s print name), give the individuals listed below permission to pick up the following student(s): Name (s) of alternate adults to pick up children Phone Number: Parent Signature Date

CAMP & ENRICHMENT PROGRAM WAIVER, INDEMNIFICATION, AND MEDICAL TREATMENT AUTHORIZATION FORM

Participant Name: County: CAMP & ENRICHMENT PROGRAM WAIVER, INDEMNIFICATION, AND MEDICAL TREATMENT AUTHORIZATION FORM 1. EXCULPATORY CLAUSE. In consideration for receiving permission for my/my child s