CRIMINAL JUSTICE SUMMER CAMP 2015 at Glenville State College Sunday, July 19th - Thursday, July 23rd Demonstrations from different types of law enforcement Learn about identifying suspects Use state-of-the-art forensics lab Process evidence for fingerprints Investigate a mock crime scene Cyber crime investigations...and much more! Open to students in ninth grade and above various state and local law enforcement agencies are scheduled to present information and take part in this camp Registration Fee: $400 Glenville State College Glenville, WV For more information or to register contact Camp Leader Ron Taylor at Ronald.Taylor@glenville.edu or (304) 462-6451 Center for Criminal Justice Studies
Criminal Justice Camp 2015 All Students Entering 9 th Grade and Above Welcome July 19 (Sunday) July 23 (Thursday) Entry Deadline: July 1, 2015* Cost: $400.00 Mail this completed application and check/money order to: Department of Social Science, Glenville State College, 200 High Street, Glenville, WV 26351 ATTN: Marissa Fox, Administrative Assistant, ph (304) 462-6280 *Applications will be accepted on a first come-first serve basis attendance is limited. Student Information First Name M.I. Last Name Preferred Name Mailing Address City State Zip Home Phone ( ) E-mail Address Grade Next Fall Age Birth-date (mm/dd/yyyy) Male Female Current School The GSC Criminal Justice Camp does not tolerate cases of vandalism, fighting, substance abuse, or other violations of camp and University safety regulations. No refunds are given for cases of expulsion from camp. The camp reserves the right to expel a student on these or any other grounds. 1 of 6
PARENT/GUARDIAN INFORMATION Mother s name Mother s day phone Night phone Father s name Father s day phone Night phone Alternative Emergency Contact Name(s) & Phone Number(s) EDUCATION INFORMATION What is your current GPA (on 4.0 scale)? List your extracurricular activities: CRIMINAL JUSTICE EDUCATION INFORMATION Have you ever taken a criminal justice class before? Yes No If yes, please state what classes you have taken and when: The National Guard will be offering firearms training, during camp, by a certified firearms instructor. Will you participate? Yes No Parent/Guardian Approval Signature Date The Underwater Recovery Team will be offering Scuba diving training in the pool by a certified instructor. Will you participate? Yes No Parent/Guardian Approval Signature Date T-Shirt size: S M L XL 2XL (Circle One) 2 of 6
PERSONAL STATEMENT This is a one page explanation by the student stating why they wish to attend the camp and what they hope to gain from the experience. Please TYPE or PRINT your answer on this sheet only. 3 of 6
Glenville State College Criminal Justice Camp 2015 Medical Release Form Student Name PARENT/GUARDIAN INFORMATION Mother s name Mother s day phone Night phone Father s name Father s day phone Night phone Alternative Emergency Contact Name(s) & Phone Number(s) CONSENT FOR THE TREATMENT OF A MINOR The following release must be signed by the parent or guardian before the student can attend the GSC Criminal Justice Camp. I, the undersigned, as the parent or legal guardian of (a minor), hereby authorize such diagnostic, medical and/or surgical treatment of a minor as may be considered necessary or appropriate under the circumstance for the treatment of any illness or injury of the minor. I hereby release and otherwise hold harmless the attending physician, appropriate staff, and Glenville State College and its officers, regents and employees from legal liability or any consequences from said diagnostic, medical, and/or surgical treatment, and thereby released from any and all claims and causes of action that may arise, grow out of, or be incident to such diagnosis, treatment, or surgery insofar as the law allows and provides that these services are performed with ordinary care and the best of their ability. Parent/legal guardian signature Print name Date MEDICAL INFORMATION RELATED TO MINOR Allergies Current Medications Date of last Tetanus booster Pertinent medical history (attach additional documents if necessary) 4 of 6
I, the undersigned, as the parent or legal guardian of the minor child, hereby acknowledge that the forenamed minor is covered by medical and prescription drug coverage as follows: MEDICAL INSURANCE PRESCRIPTION INSURANCE Name of Insured Name of Insured Insurance Company Insurance Company Phone Phone Employer/Group name Employer/Group name Group number Group number ID # ID # Medical Release Cont d It is further understood that Glenville State College does not provide medical insurance covering injuries any nature incurred at the Criminal Justice Camp. The undersigned hereby releases Glenville State College, its successors, assignees, officers, agents, and employees from any and all claims, demands and causes whatsoever in any way growing out of or resulting from participation of the released parties in the Criminal Justice Camp, except for claims caused by the gross negligence of the released parties. I understand that Glenville State College is not liable for any accidents, medical charges, emergency room charges, or medications or pharmaceutical charges incurred during the Criminal Justice Camp. Parent/legal guardian Signature Date Please include a copy of your insurance card with this form and be certain that the medical release is submitted with the application. Failure to supply this information will result in being declined for the camp. Please mail this medical release form to: Department of Social Science * Glenville State College * 200 High Street * Glenville, WV 26351 * ATTN: Marissa Fox, Criminal Justice Camp 5 of 6
Glenville State College Criminal Justice Camp 2015 July 19(Sunday) July 23(Thursday) Entry Deadline: July 1, 2015 Application Check List Your application packet should include the following items when sent in: Check: Application Education Information Personal Statement Medical Release Form (with copy of insurance card) Check or money order (payable to GSCRC) Application should be mailed to: Department of Social Science ATTN: Marissa Fox Criminal Justice Camp Glenville State College 200 High Street Glenville, WV 26351 6 of 6