Richardson CodeHER

APPLICATION INSTRUCTIONS

The parent/guardian should complete this form. If the student completes the form, they should do so in the presence of and with the understanding of their parent/guardian. In order to complete this form and submit you must have the following: 


  • Student contact information

  • Parent/Guardian contact information

  • Student Allergies (not applicable for virtual camps)

 

Additional Notes:

 

  • Items marked with a red asterisk are required.

  • There are multiple pages of this form.

  • Please click through to the final page and hit "Review and Sign" button for your information to be saved. 

  • The parent/guardian will then be asked for their digital signature.  

  • After submission, the parent/guardian will receive a verification email. The guardian must confirm that they received the verification email before the digitally signed response and registration can be finalized.

STUDENT INFORMATION

MEDICAL INFORMATION (not applicable in virtual camps)

In case of emergency, we will attempt to contact the guardian. 

PARENT/GUARDIAN INFORMATION

COST of CAMP

Because of generous donors and received grants, we are able to offer the majority of our camps at no-cost to the participants including the camp to which you are applying.

DCC CONSENT

DESIGN CONNECT CREATE SUMMER CAMP PARTICIPATION AGREEMENT AND RELEASE OF LIABILITY


I, the parent or legal guardian of student registrant ("Participant"), give my permission for my child to participate in the summer STEM camp program (“Activity”) offered by Design Connect Create (“DCC”) and I acknowledge and agree as follows: 

I acknowledge and accept that the nature of the Activity could possibly expose my child to known and unknown risks, including, but not necessarily limited to, the danger of damage, injury or loss, such as property (personal or real) damage, illness, mental anguish, emotional distress, personal/bodily injury or death and I understand and appreciate the nature of such risks. My child is in sufficient physical and mental health to participate in the Activity and does not have any physical or mental conditions that could affect their ability to participate in the Activity.  

I grant DCC and their representatives’ full authority to take whatever actions they may consider to be warranted under any circumstances regarding the protection of Participant’s health and safety. I understand that if my child requires medical treatment while participating in the Activity, an attempt will be made to call me once. In the event that I cannot be reached, I consent to such treatment for my child as may be deemed necessary under the circumstances. 

I understand that my child is expected to: 

  • Act and speak positively and be courteous to all students and staff
  • Remain on campus for the duration of the camp day (no leaving for lunch or breaks)
  • Have fun

I will notify the teacher or camp director of any absences or appointments prior to the first day of camp. If my child’s participation in the Activity is at any time deemed detrimental to the Activity or its other participants, as determined by the Activity’s organizers in their sole discretion, I understand that they may be expelled from the Activity without DCC or the organizers incurring any liability. 

I grant DCC, their funders and program partners permission to collect information via pre-camp and post-camp surveys to measure the impact of the Activity. DCC will not share any personal data or the identity of participant’s comments. All survey data will be reported only in aggregate format. 

I grant DCC, their funders and their program partners the irrevocable right to use my child’s image, voice and name in photographs and video and audio recordings of the Activity. I understand that this use includes publication and distribution in printed, electronic and digital media, including, but not limited to materials and brochures, video and television broadcasts, websites, social media and online communications. I also understand that my child shall not receive any compensation in connection with this release. 

I knowingly and voluntarily hereby accept and assume all risk to my child that may arise from, relate to or result from participation in the Activity without limitation, all adjunct activities. I knowingly waive, acquit, release and forever discharge and covenant not to sue and shall indemnify, defend and hold harmless DCC, their respective directors, officers, employees, independent contractors, agents and representatives (collectively, the “Released Parties”) from any and all losses, liabilities, claims, damages, penalties, fines, judgments, awards, settlements, costs, fees and expenses (collectively, the “Losses”) that directly or indirectly, arise from, relate to or result from my child’s participation in the Activity including, without limitation, (a) any and all illness, mental anguish, emotional distress or injury to Participant’s person, including his or her death, (b) damage to Participant’s real or personal property and (c) any Losses caused in whole or in part by negligence or strict liability of the Released Parties. 

This Agreement constitutes the entire agreement and shall be governed by the laws of the State of Texas. If any provision of this Agreement is held unenforceable, this will not affect any other provision and this Agreement shall be construed as if the unenforceable provision had not been incorporated in this Agreement. 

I (i) have read and fully understand this Agreement and (ii) intend that this Agreement be legally binding and enforceable upon me and my family, estate, heirs and legal representatives.


You will be asked for a digital signature at the end of this registration. You will then receive a verification email.You must confirm that you received this verification email before the signed response and registration can be finalized.