Student Registration Form
PLEASE READ THIS PARTICIPATION AGREEMENT, PARENTAL PERMISSION AGREEMENT, ASSUMPTION OF RISK, RELEASE OF LIABILITY and EMERGENCY MEDICAL INFORMATION CAREFULLY. It is a legal contract and affects any rights you/your child may have if your child is injured or otherwise suffers damages while participating in the Adventure into Computing Workshop youth program. This form must be read and completed by each participant (under the age of 18) and their parent or legal guardian who takes part in this program.
This is a workshop at Pearson Hall on the Iowa State University campus aimed at K-12 students, parents and teachers to teach computational thinking to model concepts learned in the K-12 classroom. Workshops run from 9am-12:30pm on Saturdays. Computers, a workbook, a flash drive, pencils, snacks,and water are provided. Participants are supervised by ISU Computer Science faculty and staff, ISU student volunteers and parents and/or guardians attending this event.
BEHAVIOR EXPECTATIONS OF THE PARTICIPANTS (TO BE READ AND SIGNED BY PARTICIPANT)
It is important to follow the directions of the ISU Computer Science Department faculty and staff and student volunteers in charge of this event at all times. You must also abide by the University's rules and conduct expectations. I understand that as a participant I have the responsibility to help make the activities of this event a safe experience for everyone through good behavior and conduct. I also understand the danger of not following the rules and directions and agree to follow them.
During this event photographs and/or video/audio recordings may be taken of you. Unless you request otherwise, your initial below will be considered permission for Iowa State University and ISU faculty, staff, or volunteers in charge to photograph, film, audio/video tape, record and/or televise your image and/or voice for use in any publications or promotional materials, in any medium now known or developed in the future without any restrictions. If you object to ISU using your image or voice in this manner, please notify the ISU event faculty or staff contact prior to participating.
MEDICAL EMERGENCY PERMISSION
I understand that I must be healthy and reasonably fit in order to safely participate in the Adventure into Computing Workshop activities and I will inform the program leader(s) of any medication, ailment, condition, or injury that may effect my ability to participate safely. If an injury or other medical condition occurs or arises, I hereby give permission to the ISU Computer Science Department faculty and staff or student leaders in charge to provide routine first aid and seek emergency treatment including x-rays or routine tests, I agree to release of any records necessary for treatment, referral, billing or insurance purposes. I understand that I am financially responsible for charges and hereby guarantee full payment to the attending physicians or health care unit. In the event of an emergency where the Emergency Contact listed above cannot be reached, I give permission to the physician/hospital selected by the ISU Computer Science faculty and staff or student volunteers in charge to secure and administer treatment for me, including hospitalization. I understand that the event coordinators will make every attempt to ensure safety of youth participants and provide properly trained and experienced faculty and student to supervise this event. (If you cannot sign this section of the form for any reason, contact the Office of Risk Management [515-294-7711] regarding a legal waiver in order to attend and participate.)
INSURANCE INFORMATION: Iowa State University does not provide health insurance for participants in this event/activity
If you select No, you understand that you do not have health insurance and are aware that Iowa State University does not carry any health insurance for you.
ASSUMPTION OF RISK AND RELEASE OF LIABILITY (Please read carefully.)
By clicking the submit button below, I, the parent or legal guardian of the participant named above, grant permission for his/her participation in the ISU Adventure into Computing Workshop. This Participation Agreement, Parental Permission Agreement, Assumption of Risk, Release of Liability, and Emergency Medical Information must be read carefully and electronically signed by submission of the form by all participants and the parent or legal guardian of each participant under 18 years of age who will take part in the ISU Adventure into Computing Workshop. The ISU Computer Science Department is offering my child a voluntary opportunity to participate in activities during the Adventure into Computing Workshop. I acknowledge that my child will be under the supervision of the ISU Computer Science Department faculty and staff, student volunteers and parents and guardians during this event. I understand that this event is designed to introduce students to critical thinking skills and problem solving techniques to solve problems. These activities may involve certain risks and possible injury and that Iowa State University and the ISU Computer Science Department will provide each participant with reasonable care and safety instructions, but that ISU cannot guarantee that participants will remain free of injury. Participants will not be discriminated against for using protective equipment. I nonetheless wish to participate in the ISU Adventure into Computing Workshop and ASSUME the RISK of participating. I agree to RELEASE from LIABILITY, INDEMNIFY and HOLD HARMLESS the State of Iowa, the Board of Regents – State of Iowa, Iowa State University and ISU Computer Science Department, and their officers, employees and agents (herein after referred to as RELEASES) from any and all claim and/or cause of action arising out of and related to any injury, loss, penalties, damage, settlement costs or other expenses or liabilities that occur as a result of my participation in the ISU Adventure into Computing Workshop. This release, however, is not intended to release the above-mentioned RELEASES from liability arising out of their sole negligence.