PROFESSIONAL DEVELOPMENT

INFORMATION FORM

Thank you for your interest in the Caminada Headlands Virtual Field Trip experience!

The Caminada Headlands Virtual Field Trip experience highlights the role that Louisiana's Barrier Islands play in coastal preservation and protection. This experience uses both online resources (website, videos, and a virtual tour) as well as printed materials to immerse middle school learners in this critical area of envirionmental science.

By filling out this form you may be offered the opportunity to participate, at no cost, in the upcoming professional development.

If you accept the offer, you must agree to use the information and resources received to teach the Caminada Headlands Field Trip experience during the 2022-23 school year at your school site(s).

You will also be asked to participate in a data tracking program that evaluates the efficacy of this form of classroom instruction. Your feedback is important to us and is a requirement for this experience. Further details will be discussed at your training.

Upon successful completion of your training, you will receive one classroom tote filled with pre-packaged resources for a classroom of up to 30 students, as well as a complete set of teacher resources.

Additional resources may be purchased from your LaSTEM regional hub, if requested.

Opportunities for free professional development will be offered on a first come, first served basis. If you are not selected for the free instruction, please feel free to use the online resources as needed. You will be contacted as additional opportunities become available.

Warning: This field trip has an accompanying materials kit. If you are completing the activities without the kit, make sure every participant wears safety glasses and be certain that any sand you use does not contain glass, crystalline silica dust, or other toxins or foreign objects.

TEACHER INFORMATION

Emergency Information

Please reach out for any dietary restrictions, allergies, or special concerns that you would like us to be aware of.

Contact Us:

lleonpacher@contractor.usgs.gov

Consent and Confirmation

Informed Consent and Acknowledgement

I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless CWPPRA, its partner organizations, and all their respective officers, agents, and representatives from any and all liability for injuries arising out of traveling to, participating in, or returning from selected professional development sessions.

By clicking the NEXT button below and completing the ordering process, I hereby waive all claims against CWPRRA and its partner organizations, including all teachers and affiliates, mentors, subject matter experts, teaching assistants, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all scientific activities, including those STEM-based activities contained here. Some of these injuries include, but are not limited to: damage to vision, lacerations, food poisoning, damage to lungs, choking hazards, or unkown allergic reactions.

Medical Release and Authorization

While at a CWPPRA or partner organization location (in-person or remote), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of my life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, or x-ray examination. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to receive my consent in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to communicate with me.

Permission is also granted to CWPPRA and its partner organizations ,as well as their affiliates including Directors, teachers, mentors, and volunteers to contact medical professionals and request medical care be sent to my physical location if I am attending the event virtually and am deemed non-responsive and seem to be in medical distress. Permission is granted to authorize said emergency personnel to perform the needed emergency treatment prior to my admission to the medical facility.

This release is authorized on the dates and/or duration of the registered training.

By clicking the NEXT button below and completing the ordering process, I acknowledge that this release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of my life and limb.

Media Release and Authorization

I do hereby give permission to be photographed and/or videotaped by CWPPRA or its representatives. I understand and agree that the photographs and/or videotapes containing my image and/or voice may be used in the production of instructional and/or promotional materials produced by or on behalf of CWPRRA and that such materials may be distributed or broadcast to the public and displayed publicly. I also understand that my permission to use the photographs and videotapes is for an unlimited duration and that I will not receive any compensation for granting this permission or for the use, if any, by CWPPRA of my image and/or voice.
I acknowledge that CWPPRA has no obligation to use my image or voice in connection with the Program.

I hereby unconditionally release CWPPRA and its representatives from any and all claims and demands arising out of the activities authorized under the terms of this agreement.

Confirmation