2018 eCamp Registration
Green Solutions SKN International Incorporated (referred to hereafter as GSI) is excited to accept your application for eCamp 2018! The camp will be held from July 16 - 20. You have much to offer to our camp and we look forward to your contributions during the week.
Completion of this application packet and parental guardian approval is required to hold your place in the camp. GSI's eCamp is open to 3rd through 6 form (or CFBC) students. Snacks, water, juice and lunch will be provided. Please note that there will be a $150 registration fee that will be due on the first day of the camp.
Camp activities include age-appropriate sessions with opportunities for hands-on project-based
tech activities, renewable energy workshops, and a startup pitch competition.
Date of Birth
Which school do you attend?
What grade are you in?
6th Form or CFBC
Parent or Guardian Full Name:
Can you attend all 6 days of the camp?
Do you have reliable access to a computer?
Medical Authorization and Medication Requirements
In the event of injury or illness, I authorize GSI staff to take whatever action is deemed necessary for my child’s health or welfare. I understand that GSI staff will document these events and notify me as soon as possible if there is a need for medical attention. I consent to whatever medical treatment is required for my child, including admission to an emergency
medical treatment facility, and I release the Parties Released from all costs incurred, and any claims arising from that medical treatment. Furthermore, I agree to defend and indemnify the Parties Released from and against any and all claims arising from medical treatment required by my child.
I understand that GSI staff will not administer over-the-counter or prescription medication to my child without my written approval. I understand all medication generally will be placed in a locked cabinet for the duration of the school day and administered only to my child as directed on the medication’s label and only by GSI staff. I understand that it is a violation of GSI rules for my child to possess over-the-counter or prescription medication without the knowledge of GSI staff.
Does the camper (your child or guardian) have any health conditions (e.g. allergies, chronic conditions), prescription medications, or special circumstances (e.g. religious convictions or legal arrangements) that we should be aware of?
Yes, if yes please explain
GSI is requesting parental/guardian consent. Please read this document carefully and feel free
to ask an GSI staff member for more information as needed.
Consent for Services/General Release of Liability
I, the undersigned parent/guardian, agree that my child can participate in the services provided
I release GSI from all liabilities to my child for all damages, expenses (including attorney fees),
claims, judgments, actions or causes of action as a result of any loss or injury to the person or
property which my child may sustain or suffer during or arising out of services provided by GSI
or transportation provided by GSI, whether caused by the acts or omissions of GSI officers,
directors, employees, representatives, advisors, affiliates, divisions, departments, related
entities, contractors, funding source and/or other agents (“Parties Released”). I agree to defend
and indemnify the Parties Released from and against any and all liabilities.
I, the undersigned parent/guardian, hereby give my consent for the release of reports, stories, videos, or pictures (“Materials”) that may identify my child. These Materials may be used for educational, informational, promotional, marketing, commercial or other activities. I acknowledge GSI’s right to prepare the Materials for publication or other use, including cropping, altering or changing the Materials at its discretion. I hereby release the Parties Released from all claims and liabilities arising out of or in connection with the use of the Materials. I understand that I do not have a right to royalties or payment in any form for these Materials, neither today nor at any future date.
Camper Behavior Contract
Please review the following behavior contract with the camper. Ensure that he/she understands that he/she will be expected to follow all parts of the agreement while at camp. Failure to follow these rules will lead to disciplinary actions up to and including expulsion from camp.
The camper must read and initial each statement and verify, along with his/her parent or guardian, at the bottom to show that he/she agrees to abide by the rules and policies of the GSI program.
• Make a strong effort to engage in camp programming, work constructively and interact with other campers.
• Respect the needs and feelings of others and show kindness to all with whom I come in contact.
• Show respect for camp staff through my attitude and behavior, including by following directions.
• Demonstrate a high level of responsibility and care with school property (including room keys), my property, and the property of others. I understand that the destruction or defacement of property will result in disciplinary actions and monetary compensation for the damaged items.
• Wear clothing that is appropriate and shows respect for myself and others. My clothing will be size-appropriate, modest, and not display inappropriate or disruptive slogans, gestures, or brands.
• Limit my use of electronic devices, including, but not limited to, cell phones, music players, and hand-held games to non-instructional time. I am aware that loss, damage, or theft of such items is not the responsibility or concern of camp staff or employees.
While at camp, i will not:
• Use physical violence, violent language, or threats, which are disruptive or unlawful, including but not limited to:
- Fighting or using “Fighting words”
- Roughhousing or wrestling
- Physical or verbal threats
- Bullying or intimidation
- Use of weapons or other objects as weapon
• Bring items which are unlawful or prohibited, including but not limited to:
- Weapons of any kind
- Fireworks or explosives
- Drugs (including alcohol, cigarettes or any medication not listed on health forms)
• Abuse substances – including alcohol or drugs – or engage in inappropriate and/or dangerous use of classroom or household materials.
• Engage in behavior which is sexually inappropriate, threatening, or harassing. This can include, but is not limited to, sexual misconduct, exposing one’s body or inappropriate nudity, and touching oneself or others in a sexual manner.
• Leave the camp without camp staff or notifying the appropriate camp point of contact.
• Use profanity, but will maintain language and decorum appropriate for the classroom setting at all times.
• Bring video gaming systems, laptop computers, or televisions unless otherwise specified.
GSI camp staff will exercise a zero-tolerance policy concerning physical and verbal violence, illegal and prohibited substances and items, and sexually inappropriate activities.
Having read and understood the Camper Behavior Contract above, I agree to follow these policies during my time in the GSI camp program. I also understand that failure to comply with these policies will have consequences, which may include, but are not limited to, being prohibited from participating in some or all activities, being dismissed from the camp and sent home, and being prohibited from returning to this and/or future GSI camp programs.
By entering my (your) initials in the box below, I affirm that I am the parent or legal guardian of the student specified above and agree to the terms and conditions of eCamp 2018.
A copy of your responses will be emailed to the address you provided.
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