Registration Form. DigiPen Institute of Technology Singapore ProjectFUN Workshops 2016 I) PERSONAL INFORMATION. II) FEES AND CONDITIONS Page 1 of 9

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1 Registration Form SELECT WORKSHOP(S) COST: $ per workshop (inclusive of 7% GST). TIME: Starts at 9:00 a.m, Ends at 5:00 p.m. Introduction to 2D Video Game Programming Level 1: 30 November to 2 December 2016 Introduction to 2D Video Game Programming Level 2: 7 December to 9 December 2016 Stop Motion Animation: Storytelling and Character Creation: 14 December to 16 December 2016 I) PERSONAL INFORMATION (All fields are compulsory) a) Student Information: First Name: Last Name/Surname: NRIC Number / Passport Number: _ Gender: Male / Female Date of Birth: / / Age: Student Phone No: Address: Postal Code: Current School: b) Parent/Guardian Information: First Name: Last Name/Surname: Parent Phone No: c) Where did you hear about the DigiPen Singapore ProjectFUN Workshops? Internet Ads Google Search Friend/Family DigiPen Student School Career Fair Prior Summer Workshop Other: II) FEES AND CONDITIONS Page 1 of 9

2 1. Applications received must be accompanied by the full workshop fee in order to secure a seat. Please note that there is no refund of tuition for voluntary withdrawal or cancellation. For Cheque Payments, please make cheque payable to DIGIPEN INSTITUTE OF TECHNOLOGY SINGAPORE PTE LTD. Please indicate FULL NAME as per NRIC at the back of the cheque and deposit into the Cheque Deposit Box at the Front Desk or mail it to the following address. Receipt will be issued and sent out by mail. Mailing Address: DigiPen Institute of Technology Singapore, 510 Dover Road, #03-01, SIT@SP Building, Singapore For Cash Payment, please proceed to the Administration Office. 2. The total cost for each workshop is S$ per student (inclusive of 7% GST). 3. If a class is cancelled for any reason, you will be notified no later than seven days in advance of the start date. All fees paid will be refunded if the session you applied for is full or cancelled. Please note that there is no refund of tuition for voluntary withdrawal. Students who wish to withdraw and request a partial tuition refund due to medical emergencies must submit the request in writing along with a physician s note for a refund review. If approved, refunds can take 3-4 weeks for processing. 4. This workshop will be conducted from Monday - Wednesday, from 9:00 a.m. to 5:00 p.m. All workshops are located at DigiPen Institute of Technology Singapore s Campus, 510 Dover Road, #03-01, SIT@SP Building, Singapore All works and projects produced at the premises of DigiPen Institute of Technology Singapore are the sole property of DigiPen Institute of Technology Singapore. All ownership and copyrights of all such works also belong to DigiPen Institute of Technology Singapore. Students who complete their projects will be given an electronic copy of their projects. 6. Students shall not use any work produced at DigiPen Institute of Technology Singapore to receive any financial compensation for their work. Such work product shall be the sole property of DigiPen Institute of Technology Singapore. 7. Students are expected to behave in a professional manner and must abide by the then current student rules and regulations. Students who disregard the student rules and regulations may be expelled without reimbursement. 8. DigiPen Institute of Technology Singapore accepts applications until seven days prior to the start date of the workshops, provided that there are still seats available. 9. Contents of courses and terms and conditions can change at any time without notice. I have read and understand the above conditions. I understand that by registering for DigiPen Institute of Page 2 of 9

3 Technology Singapore ProjectFUN Workshops ( ProjectFUN Workshops ), I agree to abide by the conditions as outlined within this registration. Signature of Student: Date: Signature of Parent/Guardian: Date: Page 3 of 9

4 Please mail completed forms and payment to: Admissions Office DigiPen Institute of Technology Singapore 510 Dover Road, #03-01, Building, Singapore Main: , Fax: III) SAFETY AND LIABILITY AGREEMENT I/my child, ( Student ), am/is attending DigiPen Institute of Technology Singapore s one-week ProjectFUN Workshops ( Workshops ) during the period of to, 2016, at DigiPen Institute of Technology Singapore ( Institute ). Acknowledgement of Risk: I voluntarily choose to [allow my child] to attend the Workshops and understand the risks involved. I recognize that the Workshops and its activities may under some circumstances involve risk of injury to myself/my child, and I agree to accept any and all risks associated with it, including, but not limited to, property damage or loss, minor or severe bodily injury and death, and any and all health risks, including death. Furthermore, I recognize that my/my child s participation in the Workshops involves activities incidental thereto, including, but not limited to, travel to/from the Workshops, limited availability of medical aid and the possible reckless conduct of other students. I voluntarily [allow my child to] participate in the Workshops fully aware of the risks involved. I hereby agree to accept any and all inherent risks of property damage, bodily injury or death to myself/my child. Hold Harmless: In consideration for allowing my child/me to participate in the Workshops and to the fullest extent permitted by law, I agree to hold harmless the Institute, its trustees, officers, directors, employees, agents, volunteers and assigns from and against all claims arising out of or resulting from my/my child s participation in the Workshops. Claim as used in this agreement means any financial loss, claim, suit, action, damage or expense, including but not limited to attorney s fees, attributable to bodily injury, sickness, disease or death or injury to or destruction of tangible property, including loss of use resulting therefrom. In addition, I hereby voluntarily hold harmless the Institute, its trustees, officers, directors, employees, agents, volunteers and assigns from any and all claims, both present and future, that may be made by my child, myself, my family, estate, heirs or assigns. Housing: I understand and agree that it is my responsibility to research and ensure the safety and reliability of the housing accommodations where I/my child will reside while attending the Workshops. Any housing arrangement is solely between the housing provider and me. DigiPen Institute of Technology Singapore neither approves nor endorses, and assumes no responsibility whatsoever for, any housing accommodation arrangements. The student/parent/guardian assumes full responsibility for any loss, injury or claims arising outside of the Institute facilities. The Institute is not responsible for providing any supervision while the Student is outside the school premises or outside of scheduled class times. Supervision: DigiPen Institute of Technology Singapore strives to provide a safe environment for all of its students, employees and visitors. I acknowledge and understand that, despite the Institute s best efforts, students may leave the Institute s premises without permission and/or otherwise act in ways that do not conform to the rules and regulations. I understand and agree that the Institute cannot be responsible for the behavior of any child, which does not conform to the rules and regulations. Accordingly, I waive any related claims to the fullest extent allowable by law. Page 4 of 9

5 Attendance: I agree to cooperate with the Institute by notifying the administration office in advance if I/my child cannot attend a class. I agree to provide contact information, including, but not limited to, my/my child s local address and telephone number to the Institute s administration office upon registration. Consent to Arrange Emergency Treatment: I understand and acknowledge that on rare occasions an emergency may develop which necessitates the administration of medical care, dental care, hospitalization or surgery to me/my child. Therefore, in the event of injury or illness, which necessitates emergency medical or dental care, I hereby authorize the Institute and its staff in charge of the Workshop to arrange any necessary emergency treatment including the administration of anesthetics and surgery to me/my child. In the event of injury or illness that does not necessitate emergency medical care, I understand that the Institute does not have facilities for the care of ill students. Medical, Dental, Health and Insurance Responsibilities: I understand and acknowledge that the Institute will not assume responsibility for determining my/my child s medical, dental or health condition. I have consulted with a medical doctor and/or dentist, as I have deemed necessary, with regards to my/my child s individual medical or dental issues or needs, and find me/my child physically and mentally fit to participate in the Workshops. If I/my child require/s medical, dental or hospital services while attending the Workshop, I acknowledge and accept that the Institute cannot and does not assume legal responsibility for payment of such costs. Therefore, I confirm that I assume all risk and responsibility therefor and that [I have/my child has] the necessary insura nce to meet any and all exigencies requiring such services while participating in the Workshops. Code of Conduct: The Student agrees to abide by the Institute s Student Rules & Regulations attached hereto while attending the Workshops as well as staff instructions. The Student understands that violation of any of the rules and regulations is grounds for immediate dismissal, without refund, and may subject the violator to prosecution. College Campus: I acknowledge that I am [allowing my son/daughter] to attend programs at the college campus of the Institute with potential social interactions with college students and members from the public. Permission to Use Photography or Likeness: I hereby give my permission to the Institute to use my/my child s photographic image, in whole or in part, for the Institute s marketing activities at the sole discretion of the Institute. I further acknowledge that there were no promises of any compensation for such use by the Institute or by anyone associated with the Institute and that the Institute exclusively owns all rights to the photographic image(s), regardless of the form in which they are produced or used. I have read and understood and agree to all the terms and conditions set forth in this Safety and Liability Agreement. Signature of Student Print Student Name Date Signature of Parent/Guardian Print Parent/Guardian Name Date Page 5 of 9

6 IV) STUDENT RULES & REGULATIONS In order for everyone s rights to be respected and for these activities to be beneficial to everyone, DigiPen Institute of Technology Singapore ( the Institute ) has established the following rules. In order to protect the health and safety of its students ( Students ), the Institute reserves the right to take any action it considers to be warranted under the circumstances, up to and including expulsion from the program and sending the Student home at his or her own expense if, in the Institute s sole discretion, a Student s actions adversely affect the health and safety of any Student. Students are not permitted to do the following: Copy or to attempt to copy any software and/or data that is found on the premises. Use cigarettes or any other form of tobacco products. Steal, gamble or vandalize. Use vulgar language. Consume or possess alcoholic beverages of any sort on campus grounds. Use or possess drugs, drug paraphernalia or any other abusive substances. Possess guns, knives or other weapons of any type, or other things that may be harmful or hazardous on campus. Damage anyone s personal property or DigiPen Institute of Technology Singapore s campus, equipment or other property. Threaten fellow Students, Counselors, Directors, Teachers, Teaching Assistants and Administration personnel. Leave the immediate area without the permission from Counselors, Directors, Teachers or Teaching Assistants. Run through hallways or horse-play in rooms. Tamper with the emergency exit doors, any safety devices and/or alarm systems. Engage in any other inappropriate behavior or illegal activities. Bullying: Bullying in all forms (including through cyberspace) is not tolerated at the Institute. Any students participating in these activities are subject to immediate dismissal from the program. Cooperation: Program Directors, Teachers, Teaching Assistants, Counselors, and Administration are extensions of the Workshops and, as such, are responsible for helping conduct the programs. Students are to respect their authority and give them full cooperation at all times. Approval/rules for production: All student projects must receive approval from the Institute s instructors prior to commencement of any production. The Institute reserves the right to reject ideas or stop production of any student game, animation, or project for reasons deemed appropriate to the Institute. DigiPen Institute of Technology Singapore will not allow the production of any student work that makes a direct or indirect reference to any of the following material/subjects and contains: Inappropriate religious content or symbols Violence Pornographic material Sexual and Nudity content Illegal substances References to racism or hate crimes References that are demeaning to any group of society Page 6 of 9

7 Lost/stolen property: Please be advised that the Institute is not responsible for any lost or stolen property. I have read, understood, and agree to all terms and conditions of DigiPen Institute of Technology Singapore s Student Rules and Regulations. I agree to pay all expenses relating to my/my child s violation of any of these Rules and Regulations, to indemnify the Institute and its directors, officers, agents and employees for any claim arising out of my/my child s violation of any of these Student Rules and Regulations and to release the Institute from any liability relating thereto. Signature of Student Print Student Name Date Signature of Parent/Guardian Print Parent/Guardian Name Date Page 7 of 9

8 V) STUDENT HEALTH AND EMERGENCY CONTACT FORM Please fill out this form in its entirety. It is important that the information be complete, accurate, and current. In the event that a parent/guardian or emergency contact cannot be located, medical treatment for you/your child will not be delayed or denied. DigiPen Institute of Technology Singapore staff and medical personnel will use this information in caring for you/your child. Parent/Guardian First Name: Last Name/Surname: Relation: Address: City: Postal Code: Home Phone: Work Phone: Mobile Phone: Present or continuing physical, mental, or psychological health problems of child: Family Physician: Phone Number: If Parent or Guardian cannot be reached in an emergency, please notify: Alternate Emergency Contact Name: Last Name/Surname: Relation: Please list all medications that you/your child take/s. Name of Medication(s) Type Dosage Prescriptive Special Instructions Yes/No Yes/No Yes/No Page 8 of 9

9 Please list all allergies (including food, medication, environmental). Please note: Parent/Guardian must provide medication for student allergies. Allergy(s) Treatment Procedures Dietary Restriction (If Any): I hereby request and authorize the Institute s employees to administer first aid to me/my child, contact the physician or 995 if [myself or] the emergency contact cannot be reached immediately and action is needed. I understand that the Institute is not responsible for costs incurred for medical care. If you know you/your child will be absent from class please notify the Institute immediately. Students will be counted absent if they do not show up to class. Attendance will be taken at the beginning of class each day. If a minor student is marked absent, the parent/guardian will be contacted. If the parent/guardian cannot be located the emergency contact will be notified of the child s absence at the telephone number provided on the online health form. I agree that the health and emergency contact information above is 100% accurate and complete. I understand it is my responsibility to keep DigiPen Institute of Technology Singapore updated with current health information for [myself/my child]. Signature of Student Print Student Name Date Signature of Parent/Guardian Print Parent/Guardian Name Date Page 9 of 9