Six sessions once a week at the GLRC from 4:00 - 5:30 pm.  

Please list all people who may potentially pick up your child along with their phone number and relationship to the student.

If your child has an inhaler, epi-pen, or insulin injections, please specify.

LIABILITY RELEASE AND PARENTAL CONSENT ~ Students (or their parents, if a minor) participating in programs offered through Michigan Tech (“the University”) and coordinated by the Michigan Tech Center for Science & Environmental Outreach (“the Center”) must sign and submit this LIABILITY RELEASE AND PARENTAL CONSENT form.  Participants will engage in a variety of educational programs led by Michigan Tech faculty, staff and students, and invited community educators/specialists, that may be held at the Great Lakes Research Center, on Michigan Tech's Campus, aboard the Agassiz research vessel, at the Nara Nature Center, or at the Marsin Center, and/or on field trips.  Consent, Waiver, Release and Assumption of Risk. I, the undersigned participant, or parent or guardian of a minor participant, understand that there are inherent risks associated with this activity that cannot be eliminated, and that each participant must assume the risk of injury or disabilities that could result. I hereby acknowledge that I am aware of these risks and I agree that I will, or if signing as a parent or guardian, to, follow all safety instructions and ask questions if I or they do not understand.  In consideration of the acceptance of myself or the minor as a participant in the Michigan program, I assume the risk of and full responsibility for any bodily injuries, death, damages or expenses to me or the minor for whom I am signing which may occur in the course of or as a result of my or their participation.  I do hereby fully and forever release and discharge, covenant not to sue and agree to indemnify and hold harmless  Michigan Technological University and its Board of Control, employees, and agents from and against any and all claims, demands, damages or rights of action due to bodily injury, death, or property damage, present or future, whether the same be known or unknown, anticipated or unanticipated, resulting from or arising out of my participation or the minor’s participation in the Michigan Tech program and all related activities and tours.   I hereby further consent to and authorize the University, Center staff or program leader(s) to obtain whatever medical treatment and/or care is deemed necessary by such staff for the health and well-being of myself or the participant during the term of program participation, including the consent to obtain and have administered any emergency medical or surgical treatment.   I have read the foregoing, explained its meaning to my child or ward if the participant is a minor, and hereby do approve and consent to the terms and conditions stated. If the participant is a minor I consent to the participation of my child in the Michigan Tech program, transportation in Michigan Tech vans, as needed, and all related activities and tours.  In lieu of the signature of a Parent/Guardian, please type your name in the box provided below. Thank you.