10-14 July 2022
Texas Tech University
US/Central timezone
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Registration Form

Please, note that fields marked with * are mandatory


Parent/Guardian Information
 
First Name: *
Last Name: *
Home Address: *
City: *
State: *
Zip Code: *
Cell Phone Number: *
555-555-5555
Email Address: *
Would you like to receive emails or mailings
about upcoming events?
*

Camper Participant Information
 
Camper  800.00 USD

Personal Information

Student First Name: *
Student Last Name: *
Preferred Name: *
Student Cell Phone Number (if applicable): *
555-555-5555
Gender: *
Female
Male
DOB: *
 MM/DD/YYYY
Ethnicity: *

Survey Questions

T-Shirt Size: *
Have you participated in any of our programs before? *
Grade in Fall 2022: *
School Currently Attending: *

Medical and Insurance Information
 
Does the Student have any limiting medical conditions that you or your doctor feel would limit camp participation? *
Is the Student currently taking medication that may interfere with their ability to safely participate in camp? *
Does the Student have a history of allergies or reactions to medications, foods, insect stings, or plants? *
Does the Student have a history of, or currently suffer from, medical condition(s) with which we should be aware of? *
If "yes" was selected in questions above, identify and explain
If applicable, Health Insurance Provider:
Policy:
Group Number:
Name on Insurance Card:
Emergency Contact: First & Last Name and Phone Number *
Please note if this poses a hardship, please call our offices. Insurance is encouraged but will not jeopardize participation.

TTU Summer Camp Student Rules
 
TTU Summer Camp Student Rules

It is a priviledge to be guests on the TTU campus and to participate in its summer camp programs. The camp had adopted a No Tolerance policy for student misbehavior. Any violation of these rules may result in immediate dismissal from the camp or program.
- The following rules and regulations have been designed with the safety of students and camp participants ("Students") in mind.
- Students must follow these rules at all times or risk being dismissed from the camp or program.
1. Students are now allowed to leave TTU Campus for any reason. (If it is necessary for a Student to be taken off-campus in case of an emergency, the parent must authorize their leave, fill out the appropriate form, and note that the person picking up the student will have to present proper identification.)
2. Students are not allowed to ride in any vehicles, other than University vehicles, with anyone during the duration of the program for any reason.
3. Students are not allowed to walk alone on campus. If a Student needs to get somewhere, they must notify a Camp Counselor to escort them.
4.Students must attend all classes, breakfast, lunch, and dinner. No exceptions! If for any reason you are not able to attend due to feeling ill, please notify a Camp Counselor.
5. Any prescription medications are to be self-administered by the Student as outlined in the Medication/Prescriber/Parent Authorization Form. Over-the-counter medications will be provided by Camp Staff as authorized in the Medication/Prescriber/Parent Authorization Form.
6.Students are not allowed to use a cell phone during class or during planned activities. Any disruptive cell phone usage will result in the phone being taken away for the remainder of the day.
7. Students will be responsible for any lost or stolen items, such as jewelry and electronics, which they bring to camp.
8. Many programs require closed-toe shoes, such as tennis shoes.
Students must also adhere to their program dress code and wear appropriate clothing during all classes and planned activities of the summer program. If any issues arise due to inappropriate clothing or attire, action may be taken.

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY. AS A STUDENT, PARENT, OR GUARDIAN, I UNDERSTAND THAT: The information is requested on this form is intended to help inform staff of any pre-existing medical conditions. If your child has a pre-existing medical condition, participation in any strenuous or recreational time may not be recommended. This information will be kept in strict confidence and will not be shared without your permission. TTU requests the information below so that, in case of emergency, we will have accurate information so that we can provide and/or seek appropriate treatment. You are accountable for providing an accurate medical history. Final determination about whether to participate is the responsibility of you and your physician (and your parent/guardian if you are a camp participant or Student under the age of eighteen(18)). If you have any medical issue that is not addressed below, but which you think is important, please include that information. I have read the foregoing and fully understand the contents herein.

I acknowledge and represent that the above information is correct. By signing my name, I consent to the foregoing on Student's behalf.

Parent/Guardian Signature (Full Name): *
Today's Date: *
 DD/MM/YYYY hh:mm

Acknowledgment and Release Agreement
 
ACKNOWLEDGMENT AND RELEASE AGREEMENT

This Acknowledgment and Release Agreement is entered into as of the date of signature below between TTU and the adult parent or guardian named below, on behalf of such parent/guardian and the minor Student named below.
Activity and Acknowledgment of Risk. Parent/guardian desires Student to enter the TTU campus to participate in a Summer Camp program ("Activity"). Parent/guardian acknowledges that the nature of the Summer Camp Activity may expose Student to hazards or risks that may result in personal injury, illness, or death, caused by: (a) engaging in the Activity or events associated with Activity; (b) traveling via any means of transportation to or from the Activity or during the duration of the Activity; (c) exposure to or use of materials, tools, supplies, equipment, machinery, or other items that are associated with or utilized during the Activity or related activities; or (d) exposure to other dangerous conditions associated with the Activity.
Representations of Parent/Guardian. Parent/guardian represents: (a)_parent/guardian is at least eighteen (18) years of age; (b) parent/guardian has the requisite capacity and legal authority to execute this Release on behalf of parent/guardian and Student; (c) Student is physically and mentally able to participate in all aspects of the Activity or other related activities; and (d) Student is able to be in the presence of, as well as use, the materials, tools, supplies, machinery, or equipment or other items associated with or utilized during the Activity or related activities.
Conduct and Compliance. Parent/guardian represents Student will comply with the TTU Summer Camp Student Rules above, all applicable federal, state, and local laws, and TTU operating policies and direction in Student's conduct while engaging in the summer camp Activity.
Release. Parent/guardian understands and agrees that TTU cannot be expected to control or avoid all risks associated with the Activity and related activities; therefore, in consideration of the benefits parent/guardian and Student will receive through Student's participation in the Activity, parent/guardian on behalf of parent/guardian and Student, does hereby RELEASE, PROTECT, INDEMNIFY, AND HOLD HARMLESS, TTU AND ITS AFFILIATES, REGENTS, EMPLOYEES, AGENTS, AND VOLUNTEERS FROM AND AGAINST ALL CLAIMS AND CAUSES OF ACTION (INCLUDING COSTS AND ATTORNEY FEES) FOR ANY AND ALL DAMAGE TO PROPERTY, PERSONAL INJURY, ILLNESS, DEATH, AND THOSE THAT OTHERWISE OCCUR, ARISING OUT OF ANY ACTIVITIES CONDUCTED BY, WITH, OR UNDER THE AUSPICES OF TTU, WHETHER CAUSED BY STUDENT'S NEGLIGENCE, OR THE NEGLIGENCE, GROSS NEGLIGENCE, WILLFUL MISCONDUCT, OR ACTS OR OMISSIONS OF TTU OR ITS AFFILIATES, REGENTS, EMPLOYEES, AGENTS, VOLUNTEERS, OR OTHER PERSON RELATED THERETO.
Miscellaneous. This Release shall be construed in accordance with the laws of the State of Texas. If any term or provision of this Release is held invalid or unenforceable, the validity or enforceability of the remaining provisions shall not be affected. Parent/Guardian expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Texas. The sole proper place of venue for any dispute arising out of this Release shall be in Lubbock County, Texas. By their signature below, parent/guardian now agrees to be bound by the terms of this Release for the duration of the Activity or related activities, whether such Activity began prior to, on, or after the date of signature.

PLEASE READ: I have read the foregoing and fully understand the contents herein. I acknowledge and represent that the above information is correct. By signing my name, I consent to the foregoing on Student's behalf.

Parent/Guardian Signature (Full Name): *
Today's Date: *
 DD/MM/YYYY hh:mm

Authorization for Medical Care
 

Unless prior arrangements have been made, medical needs will be handled through the nearest hospital. If traveling off campus, Campus Staff will select a qualified facility. In cases where medical attention is necessary, parents will be contacted for approval when possible. However, before medical treatment can be provided, we are required to have a medical release signed by the parent. Medical facilities will not perform services unless this medical release form is signed.
_________________________ (Student's Name) has my permission to receive medical attention in the event of an illness or medical emergency while participating in this TTU Summer Camp. I will assume financial responsibility for any cost of health care that may occur during this Camp.
PLEASE READ: As a Student, parent, or guardian, I understand and acknowledge that my failure to disclose relevant information may result in harm to myself/my child and/or others during this Camp. By signing my name, I represent and warrant that I have provided all materials and important information to TTU pertaining to my/my child's medical, mental, and physical condition and that it is accurate and complete. I agree to notify TTU of any changes in my/my child's mental, physical, or medical condition prior to my/my child's scheduled Camp. By revealing or disclosing the above medical information, it will not by used by TTU personnel or employees to determine my/my child's ability to participate safely in activities. I understand that, if I/my child choose(s) to participate in activities, I/he/she do/does so voluntarily and of my/his/her own accord, and the final decision regarding participating is solely my responsibility/the responsibility of myself and my child.

Parent/Guardian Signature (Full Name): *
Today's Date: *
 DD/MM/YYYY hh:mm

Housing and Lost Key Agreement
 
Housing and Lost Key Agreement 

The following policies apply to all Students and summer camp guests. TTU will issue keys to Students tp access their residence hall rooms. Student(s) and their parent(s)/guardian(s) will be responsible for all key-related fees, as outlined below.
For lost keys:
- Report lost keys to Camp Supervisor and the Residence Hall's front desk immediately - For safety reasons, each lost key will result in a $50 per door fee - Lock changes cannot be canceled once a work order is submitted
Lock-Out Policy:
- If a key is lost, a lock-out key is available at the Residence Hall's front desk - A photo ID or Student/guess access card must be provided to check out a lock-out key - Students under eighteen (18) years of age must be accompanied by a camp supervisor or chaperone to check out a lock-out key - Lock-out keys must be returned within 15 minutes or a full charge of $50 per door will be assessed - Lock-out keys may not be loaned to a third party and are the full responsibility of the Student while checked out

Parent/Guardian Signature (Full Name): *
Today's Date: *
 DD/MM/YYYY hh:mm

Waiver and Consent for Self-Administration of Prescription Medication
 

I authorize and recommend a self-medication by my child. I also affirm that he/she has been instructed in the proper self-administration of the prescribed medication by his/her attending physician. I shall indemnify and hold harmless the University, its governing board, officers, employees, and representatives against any claims that may arise relating to my child's self-administration of prescribed medication(s). I/We have legal authority to consent to medical treatment for the Student named above, including the administration of the medication at the above referenced Camp.

Parent/Guardian Signature (Full Name): *
Today's Date: *
 DD/MM/YYYY hh:mm

Waiver and Consent for Over the Counter Medication
 
Over-the-Counter (OTC) Medication may at times be administered, if approval is indicated by the Student's parent or guardian. Please complete the following section to save time if your child needs any of these OTC medication during their stay. NOTE: Unless we have parental authorization, we cannot administer ANY medication.

Camp staff reserves the right to use generic equivalents when available. I understand that such administration will not be done under the supervision of medical personnel. I also agree that any first aid treatment may be given as needed.
Any condition which is associated with fever, significant inflammation, and/or does not respond to the above outlined treatment will be followed up by a consultation with the Student's parents.
Parent/guardian will be contacted if any conditions develop requiring treatment with any of the above OTC medications that are not checked.
I understand that these OTC medications are not necessarily kept on hand and may not be available to be administered immediately. I authorize the administration of OTC medications to my child as indicated above. I shall indemnify and hold harmless the University, its governing board, officers, employees, and representatives against any claims that may arise relating to my child being administered the above indicated OTC medications.
I/We have legal authority to consent to medical treatment for the Student named above, including the administration of medication at the above referenced Camp.

No, my child does not need to take any OTC medication while at Camp.
Yes, my child may need to take OTC medication while at Camp (if yes, read the section below)
Parent/Guardian Signature (Full Name): *
Today's Date: *
 DD/MM/YYYY hh:mm

Camp Leave Release Form
 

Camp Participants ("Student") are not allowed to leave campus with anyone not previously authorized by their parent(s) or legal guardian(s). To ensure the safety of your child, please provide the program with a list of names that you (Parent/Guardian) approve to pick up your child in case of an emergency and only if you are not able to pick up your child yourself.
A Government-issued ID or parent pick-up authorization card (if provided by the Camp) will be required to pick up Students.
I, ______________ YOUR NAME _______________, as the Parent or Legal Guardian of ____________ STUDENT'S NAME ___________, hereby authorize the TTU Camp Staff to release my child to the below-listed persons and release the TTU Camp Staff from any liability that may arise by them releasing my child to them. I fully understand that once my child is released to any of the authorize individuals, it will be their responsibility and not the responsibility of TTU or the TTU Camp to ensure my child's safety and well-being. Should you have any concerns or questions about picking up your child, please discuss them with the Camp Director.

Listed Person's Full Name *
Listed Person's Driver's License # *
Listed Person's Phone Number *
Listed Person's Relationship to Student *

COVID-19 Notice and Acknowledgment Agreement
 
COVID-19 NOTICE AND ACKNOWLEDGMENT AGREEMENT

This COVID-19 Notice and Acknowledgment Agreement ("Agreement") is entered into as of the date of signature below between TTU and the adult parent guardian named below, on behalf of such parent/guardian and the minor Student named below.
Activity and Acknowledgment of Risk. Parent/guardian desires Student to enter the TTU campus to participate in a Summer Camp program ("Activity"). Parent/guardian acknowledges and agrees that Student will be attentive to the particular COVID-19-related restrictions associated with the Activity by engaging in behaviors and actions appropriate to safe participation in the Activity ("Safety Measures"). Safety Measures include, but are not limited to: following all Centers for Disease Control and Prevention ("CDC"), public health, and University guidelines, policies, and directives. Parent/guardian acknowledges and agrees that Student will strictly adhere to the Safety Measures as a requirement for participation on the Activity. Parent/guardian acknowledges that the nature of the Activity taking place during the ongoing COVID-19 pandemic may require and prompt change(s) in Activity plans or rules due to COVID-19-related restrictions, and Activity schedules are subject to change to ensure compliance with CDC and/or TTU directives. Parent/guardian acknowledges that Activity participation may expose Student to an elevated risk of contracting COVID-19.
Representations of Parent/Guardian. Parent/guardian represents: (a) parent/guardian is at least eighteen (18) years of age; (b) parent/guardian has the requisite capacity and legal authority to execute this Agreement on behalf of parent/guardian and Student; and (c) Student will comply with the outlined Safety Measures.
Conduct and Compliance with Laws and Policies. Parent/guardian represents Student will comply with all applicable federal, state, and local laws; public health directives; and University operating policies, directives, and Safety Measures while engaging in the summer camp Activity.
PLEASE READ: I have read the foregoing and fully understand the contents herein. By signing my name, I acknowledge and agree to the foregoing on the Student's behalf.

Parent/Guardian Signature (Full Name): *
Today's Date: *
 DD/MM/YYYY hh:mm

Photo and Media Authorization and Release
 

This Photo and Media Authorization and Release is executed between the adult parent or guardian named below, on behalf of such parent or guardian and the minor Student named below, in order to authorize TTU to use certain images, videos, and other media of or relating to Student, as more fully described below. This Release is effective as of the date of signature below on this page.
Authorization. Parent/guardian authorizes TTU and its affiliates, departments, employees, contractors, and agents, the right and unrestricted permission to take, use, publish, reproduce, edit, exhibit, display, broadcast, or copyright photogenic images, pictures, videos, testimonials, audio, and biographical data of minor Student (including but not limited to Student's likeness, words, voice, activity, performance, or artwork) through any form of media (print, electronic, digital, broadcast, or otherwise) for news, art, marketing, fundraising, recruiting, publicity, social media, archival, or any other lawful purpose ("Media").
Release. Parent/guardian on behalf of parent/guardian and Student, waives any right to inspect or approve such Media and waives any right to royalties or compensation arising from or related to the use thereof. Guardian, on behalf of Guardian and Minor releases and agrees to hold harmless TTU and its affiliates. Regents, employees, and agents from liability related to or resulting from the taking, capture, use, publication, reproduction, editing, exhibit, display, broadcast, or copyright of the Media.
Certification. Parent/guardian certifies that they are at least 18 (18) years of age or older, and that this Release is signed voluntarily, under no duress, without expectation of compensation in any form either now or in the future.
PLEASE READ: I have read the foregoing and fully understand the contents herein. I acknowledge and represent that the above information is correct. By signing my name, I consent to the foregoing on Student's behalf.

May NOT be photographed or used in media
May be photographed and used in media
Parent/Guardian Signature (Full Name): *
Today's Date: *
 DD/MM/YYYY hh:mm

Acknowledgment of Risk and Hold Harmless Agreement
 
I Hereby acknowledge that I have voluntarily chosen to participate in the activities of the TTU-National Wind Institute-Landsailer Group at Texas Tech University.

I understand the risks involved in the program and recognize that the program activities involve risk of injury and I agree to accept any and all associated risks.
In consideration of my participation in the program, which activity will take place at the Lubbock Reese Technology Center ("Reese Center"), I also release, indemnify, and hold harmless Lubbock Reese Redevelopment Authority ("LRRA") its agents, officers, servants, or employees, Texas Tech University, and the TTU-National Wind Institute, to include its officers, directors, employees, agents, volunteers, and assigns from any and all liability or claims for injury, damages, or death arising by reason of LRRA's granting TTU's Landsailer program access to, or presence on, or use of Reese Center property.
I understand that Texas Tech University does not provide any medical or dental insurance or life insurance; nor insurance for personal property damage or loss, nor insurance for liability and I acknowledge that I am completely responsible for this coverage and any related expenses.
I also agree as a voluntary member to abide by the policies, rules, regulations, and safety guidelines of the LRRA access agreement, Texas Tech University and the TTU-National Wind Institute Landsailer Program.
My Student may participate in the Landsailer Program
My Student may NOT participate in the Landsailer Program
Parent/Guardian Signature (Full Name): *
Today's Date: *
 DD/MM/YYYY hh:mm

Additional Information