WCIP: RC Engineering STEM Summer Camp

Child's First Name

Child's Last Name

Child's Birthdate

Child's Age

Child's Grade Level (grade level refers to the grade your child will enter in the 2024-2025 academic year)

First Parent/Guardian

First Name

Last Name

Mailing Address

Country

Street

City

Region

Postal Code

Primary Phone Number

Alternate Phone Number (optional)

Email Address

Second Parent/Guardian (optional)

First Name

Last Name

Mailing Address

Country

Street

City

Region

Postal Code

Primary Phone Number

Alternate Phone Number

Email Address

Alternate Contact Name & Phone Number

Medical Information ***We will not administer medicine during the duration of the camp. Emergency medicine (inhaler, EpiPen, etc.) can be brought to camp with a valid doctor’s note. If your child becomes ill during camp, you will be required to pick them up.***

Physician's Name, Address, and Phone Number

Tell us about your child (allergies, strengths, challenges, goals, etc.)

Will your child bring emergency medicine (inhaler, EpiPen, etc.)

If Yes, indicate medication type

Upload a valid doctor's note

Do you wish to purchase a daily bagged lunch (includes sandwich, drink, and snack) for $50/week?

This summer camp is a partnership between the Center for Workforce, Community & Industry Partnerships and the Adirondack North Country Association, with funding support from NYSERDA. As part of the funding support, if you are eligible for NYSED free or reduced meals through your home school district, based on the NYSED 2023-2024 income eligibility guidelines, you are also eligible for reduced summer camp tuition.

Reduced Price Eligibility – 50% summer camp tuition
Free Eligibility – 75% summer camp tuition

Do you wish to qualify for the reduced summer camp tuition?

Please upload a copy of your home school district's "letter to parents", indicating that you qualify.

Release and Waiver Form for a Minor

I am the parent or legal guardian of the named participant in this SUNY Canton camp. I understand the nature of the activities that my child will be involved in, including activities inside and outside of the main camp building. I represent that my child is physically fit and that he or she does not have a medical condition that would restrict he or she from participating in this type of activity. I understand and acknowledge that there are inherent risks with my child’s participation. I hereby assume all dangers and risks associated therewith. I acknowledge that the instruction and supervision provided by SUNY Canton may not prevent injury and does not guarantee that injury will not occur. My child and I understand that he or she is responsible for his or her own behavior. I understand that SUNY Canton will not cover any medical expenses due to injury received through my child’s participation in the summer camp. In partial consideration of my child’s acceptance as a participant in the SUNY Canton camp, we hereby agree to waive all claims we have or may have against SUNY Canton, and agree to release and hold harmless SUNY Canton along with their respective employees, counselors, or other representatives, from any and all claims for any and all expenses, personal injury, loss, or damages incurred during or in connection with my child’s participation in SUNY Canton summer camp.

By checking this box, I agree to the waiver policy of SUNY Canton.

Release and Waiver Form for a Minor

I am the parent or legal guardian of the named participant in this SUNY Canton camp. I understand the nature of the activities that my child will be involved in, including activities inside and outside of the main camp building. I represent that my child is physically fit and that he or she does not have a medical condition that would restrict he or she from participating in this type of activity. I understand and acknowledge that there are inherent risks with my child’s participation. I hereby assume all dangers and risks associated therewith. I acknowledge that the instruction and supervision provided by SUNY Canton may not prevent injury and does not guarantee that injury will not occur. My child and I understand that he or she is responsible for his or her own behavior. I understand that SUNY Canton will not cover any medical expenses due to injury received through my child’s participation in the summer camp. In partial consideration of my child’s acceptance as a participant in the SUNY Canton camp, we hereby agree to waive all claims we have or may have against SUNY Canton, and agree to release and hold harmless SUNY Canton along with their respective employees, counselors, or other representatives, from any and all claims for any and all expenses, personal injury, loss, or damages incurred during or in connection with my child’s participation in SUNY Canton summer camp.

By checking this box, I agree to the waiver policy of SUNY Canton.

Yes

Admitted Students

Pay Your Deposit

Open House

Request Information

One-Hop Shop

Departments

WCIP: RC Engineering STEM Summer Camp