STEM Coding Camp at the Hazleton LaunchBox

STEM Coding Camp at the Hazleton LaunchBox

Please use the form below to sign your child up for the two-day STEM Coding Camp! Camp Dates - Monday, January 26th and Tuesday, January 27th from 9:30 AM to 1:00 PM. This camp is free to attend and open to students in 5th-8th grades.
Child's Name*

First NameLast Name
What grade is the child in?*
What school does the child attend?*
Does the camper have any allergies or medical conditions? If so please list. *
Parent/Guardian Phone number*
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Parent/Guardian e-mail*
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Emergency Contact Person*

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Emergency Contact phone number*
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Please list anyone who is allowed to pick up your camper, and their relation to the camper. *
How did you hear about this camp?*
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Johnson College during the selected program. In exchange for the acceptance of said child’s candidacy by Johnson College ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Johnson College. and all its respective officers, agents, and representatives from any and all liability for injuries to the said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Johnson College . including all instructors, staff and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Photo Release

I hereby give Johnson College the absolute and irrevocable right and permission, with respect to the quotations/photographs/video/film/audio recording that he/she has taken of me or in which I may be included with others:

(a) To copyright the same in his or her own name or any other name that he or she

may choose. (b) To use, reuse, publish and republish the same in whole or in part, individually or in

conjunction with other quotations/photographs/video/etc., in any medium and for any purpose whatsoever, including (but not by way of limitation) illustration, promotion,

advertising and trade (c) To use my name in connection therewith if he or she so chooses.

I hereby release and discharge Johnson College from any and all claims and demands arising out of connection with the use of the quotation/photographs/video/film/audio recording, including any and all claims for monetary compensation, damages, libel, slander, invasion of privacy or for any other claim based on the use of the said materials.

This authorization and release shall also ensure to the benefit of the legal representatives, licensees and assigns of Johnson College, as well as the person(s) for whom he/she took the quotations/photographs/video/film/audio recording.

Covid release:

I certify that I feel healthy and show no signs of COVID-19. To the best of my knowledge, I have not been exposed to any individuals with COVID-19 during the past 14 days.

Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

Fever or chills, Cough, Shortness of breath or difficulty breathing
Fatigue ,Muscle or body aches ,Headache
New loss of taste or smell, Sore throat
Congestion or runny nose, Nausea or vomiting, Diarrhea

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
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