2019 Advanced Manufacturing Camp June 18-20, 2019 - Registration
This camp is designed to introduce current 7th and 8th grade students to careers in manufacturing. Joining together in this effort are Genesis: Pathways to Success, Ivy Tech Community College, Batesville Tool & Die, Hill-Rom, Hillenbrand, Batesville (Casket), Wood-Mizer, and Thrive Market. There is no fee to attend this camp.
Student Name *
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Current School *
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Current Grade Level *
Parent/Guardian Name *
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Parent/Guardian Email *
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Home Address *
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Home Phone
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Work Phone
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Cell Phone *
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Other Emergency Contact *
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Relationship to Student *
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Emergency Contact Phone (home)
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Emergency Contact Phone (work)
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Emergency Contact Phone (cell) *
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T-shirt Size *
Required
Student's Regular Physician *
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Physician Phone Number *
Your answer
My student has the following health/medical concerns: *
Allergies to food or materials: *
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Other health concern(s) we should be aware of: *
Your answer
My child will need to take medication while at camp *
My child has ________ which needs to accompany him/her: *
I agree that as part of the 2018 Advanced Manufacturing Summer Camp:
My student will be participating in various activities, including team-building exercises, educational opportunities, and field trips to local industry locations. At various times, students may be photographed or video- taped for the parent night and other publicity purposes, including online social media such as Facebook, Instagram, and Twitter.

I hereby grant to any and all camp sponsors the absolute right to take, use, publish, copyright any and all photographic and video images of the above named minor child during the child's participation in the camp and all camp activities, in whole or in part, in any and all media forms now or hereinafter known, and for any purpose whatsoever. I hereby waive any right I may have to inspect or approve the finished product(s) and any copy to which it may be applied or the use to which said photographs or images may be applied. I hereby forever release and discharge all camp sponsors and their employees, officers, representatives and assigns from any and all liability associated with the taking, using and publishing any and all photographic images of the minor child captured during the child's participation in the camp and all camp activities.

• I give my student permission to participate in all Summer Camp activities.
• I give my student permission to be transported to any off-site activity.
• I am responsible for providing him/her with daily transportation to/from the program location.
. I am responsible for providing my student with closed-toe/closed back shoes each day prior to camp starting.
. I am responsible for making sure may student wears long pants each day to camp.
. My student will wear safety glasses and hearing protection that will be provided at each facility for him/her.
. I agree that my student will follow directions and conduct him or herself with respect at all times.
• Advanced Manufacturing Summer Camp is not responsible for any items lost or stolen.
• Advanced Manufacturing Camp reserves the right to dismiss any student from the program for disciplinary reasons, not wearing the required long pants, for not wearing closed-toe/closed-back shoes each day to camp, and/or for not wearing the provided safety glasses and hearing protection at each facility.

Electronic Signature *
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