2025 AIE Chaperone Consent Form

ADVENTURES IN ENGINEERING - November 13th, 2025

Chaperone Name*

First NameLast Name

Chaperones Position Title*

Counselor, Teacher, Parent

Phone Number*

Please enter a valid phone number.

Chaperones Email Address*

example@example.com

School Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

School Principal*

School Phone Number*

Please enter a valid phone number.

DIRECTIONS: Place your initials in the blanks below to indicate that you understand the statements, you grant permission, you agree, and you will comply.

Adventures in Engineering was created to allow 11th grade students an opportunity to explore math, science, engineering and technology (STEM) career fields. Adventures in Engineering is a full day event that starts registration from 7:30-8:30 and program start at 8:30 a.m. and ends at 2:30 p.m. The University of Alabama in Huntsville, Chan Auditorium at 4832 Holmes Ave NW in Huntsville will serve as the starting and ending point for Adventures in Engineering. Participants (chaperones and adults) are required to provide their own transportation to and from UAH. Riding on the tour bus is a requirement for participation in this event. At each stop, participants will be required to walk or stand for or a significant amount of the day. The Adventures in Engineering Chair, must be made aware of any accommodations via e- mail at 2023ASMDA@gmail.comand an additional, separate written request, signed by the parent/ guardian, must be attached to the student's permission form. Students and chaperones will not be allowed to drive personal vehicles to follow the tour bus or transport themselves to the tour stops. Students and chaperones must be able to participate in the entire day's events and are unable to depart early from the event. Students will visit organizations and entities during normal business day. Business casual attire (khakis, casual dress slacks, knee-length or longer skirts, button-down shirts, polos, blouses, etc and comfortable, closed-toe and low/no-heel shoes are required. Torn denim, shorts, open-toed shoes (flips, sandals, clogs, etc and the like are unacceptable. Lunch will be provided for chaperones and students. Participants with religious, medical, dietary, and / or allergic restrictions should bring a lunch that can withstand at least five hours in transit unrefrigerated. All participants must conduct themselves in a professional manner at all times, on the bus and at event sites. Students are expected to stay with their tour group. Trespassing into other work space, which are not part of the official tour, is forbidden. Cellular phones, cameras, and any other digital device, including Fitbits, etc, if not required by a medical condition, are prohibited for the entire activity day. Submit completed and signed Chaperone forms to the 11th grade school counselor. Counselors must submit all participant forms at one time to the Adventures in Engineering planning staff, on or before October 4th. Please contact the counselor for your school's deadline.

CHAPERONES SIGNATURE*

DATE*

Date

Adventures in Engineering: Chaperone Form Page 1

Chaperones Name First and Last

{initials} - I understand that I must carry official government-issued identification and, at most sites, wear a visitor’s badge, at all times.

{initials} - I understand that I must be a U.S. Citizen and have proof of such to participate and/or serve as chaperone.

{initials} - I am responsible for all students from my school for the entire day, from the time the first student arrives at UAH Chan Auditorium, until the last student departs from UAH Chan Auditorium.

{initials} - I understand that I must remain with my students in the morning before the event begins, after drop-off / arrival, and after the event officially ends, until pick-up / departure.

{initials} - I understand that transportation on event day, October 16th, is organized by, and said entity is not liable for any seen and unforeseen accidents or injuries.

{initials} - I understand that I, as a chaperone, and students will tour multiple buildings and facilities; and that I will hold harmless any organization or entity involved, including its staff or agents, for any foreseeable and unforeseeable accidents or injuries.

{initials} - I understand and agree to all Adventures in Engineering participants, including chaperones, will bephotographed and/or videotaped the day by staff or agents for any of the participating businesses, organizations, agencies, and colleges/universities.

{initials} - I understand all photographs/videotapes may be used for event documentation, promotionalpurposes, and other reasons related to education, outreach, K-12 initiatives, recruitment, and general publicity.

{initials} - I understand that photographs and videotapes may be used without any additional permission and/or consent.

{initials} - I understand electronic devices are prohibited in all buildings, including cellular phones.

{initials} - I understand personal cameras, including cellular phone cameras, are prohibited in all buildings.

{initials} - In the event that medical attention is required for a student/student(s), it will be my responsibility to provide the medical attention and / or secure medical attention.

Initials*

CHAPERONES SIGNATURE*

DATE*

Date

Adventures in Engineering: Chaperone Form Page 2

{initials75} - In the event that medical attention is required for a student/student(s), it will be my responsibility to maintain physical copies for any specific medical requirements, restrictions (including allergies), instructions,accommodations, and any other related medical information.

{initials75} - In the event that I require medical attention, involved event organizations and entities, and their staff or agents, have my permission to use their best judgment to provide or obtain medical treatment or services for me.

Initials*

Please contact the following person in case of an emergency*

Relationship

Name*

Emergency Phone Number*

Please enter a valid phone number.

Primary Physician Optional

Physician Phone Number Optional

Please enter a valid phone number.

{initials74} - In the event that a student/students fail to dress appropriately, it is my responsibility to ensure their safe and proper transportation back to the school, before the Adventures in Engineering event begins.

{initials74} - In the event that a student/students fail to bring proper identification with them, it is my responsibility to ensure the student’s proper transportation back to the school, before the Adventures in Engineering event begins.

{initials74} - In the event that a student/students fail to behave properly, it is my responsibility to ensure thestudent’s proper transportation back to the school, before the Adventures in Engineering event begins.

Initials

Driver License Front*

Driver License Back*

CHAPERONES SIGNATURE*

DATE*

Date

Adventures in Engineering: Chaperone Form Page 3

CHAPERONE PERMISSION FORM