Engineering Disclosure and Forms 2018-2019 (Required)
JATC Engineering Class *
First Name *
Your answer
Last Name *
Your answer
Home High School *
Your answer
Advanced Engineering: Utah State University A# (USU student number if received)
Your answer
Which session will you attend the JATC? *
Contact Information
Even though this contact information is often available in Skyward we have found it useful to include this in our forms to ensure we have the most up to date information of the students at our school.
Parent Email *
Your answer
Parent Phone Number *
Your answer
Parent Cell Phone Number *
Your answer
Student Email *
Your answer
Student Cell Phone Number
Your answer
Home Address (Number and Street) *
Your answer
Home Address (City) *
Your answer
Home Address (Zip Code) *
Your answer
Disclosure for Engineering
I have received and read the Engineering disclosure and agree to follow the policies that are listed within it.
(Link to disclosure can be found on the Engineering page)
Parent Signature (Typed Name) Disclosure for Engineering *
Your answer
Student Signature (Typed Name) Disclosure for Engineering *
Your answer
Equipment Checkout
Equipment Release Policy and Procedures Policy:
An Equipment Usage Agreement and Sign-Out Request Form must be completed and approved by the instructor prior to using JATC equipment (as specified below). All equipment officially approved must be used exclusively for JATC educational projects.

Definition: "Equipment" is defined as all non-expendable items regardless of cost:
Computer/Laptop and Peripheral Equipment
VEX Robotics
Construction Supplies
Shop Tools

Specific purpose type of equipment should be released and approved in advance.

EQUIPMENT USAGE AGREEMENT AND SIGN-OUT REQUEST FORM PLEASE READ CAREFULLY BEFORE SIGNING. THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS.

“PARTICIPANT” MEANS THE INDIVIDUAL USING THE EQUIPMENT AS LISTED ON THIS FORM. THE “UNDERSIGNED” MEANS ONLY THE PARTICIPANT WHEN THE PARTICIPANT IS AGE 18 OR OLDER OR IT MEANS BOTH THE PARTICIPANT AND THE PARTICIPANT’S PARENT OR LEGAL GUARDIAN WHEN THE PARTICIPANT IS UNDER THE AGE OF 18. THE UNDERSIGNED UNDERSTAND AND AGREE THAT USING THE EQUIPMENT LISTED ON THIS FORM IS FOR COMPLETING AND EDUCATIONAL ASSIGNMENT ONLY AND AGREE TO RETURN THE EQUIPMENT IN WORKING CONDITION.

The Undersigned accept full responsibility for the care of the equipment during the usage period and accept responsibility for the replacement and/or repair which ever is cheaper of any equipment not returned or returned in a damaged condition.

Parent Signature (Typed Name) Equipment Checkout *
Your answer
Student Signature (Typed Name) Equipment Checkout *
Your answer
AUTHORIZATION FOR PARTICIPATION IN A STUDENT LEADERSHIP ORGANIZATION
Leadership Organization: TSA, tsaweb.org

I am the custodial parent or legal guardian of the above named student. I understand that my student wishes to participate in the above named, student leadership organization at the Jordan Applied Technology Center. I understand that membership and participation in this organization are voluntary. During approved student leadership meetings, a supervisor will be present to provide supervision and sponsorship and to ensure compliance with applicable school policies.

This student leadership organization has been authorized by the school based on its stated purposes and activities as set forth in the organization’s application and charter. I understand that I may make arrangements to inspect a copy of the application and charter of this organization which describes the nature, purposes, structure, and other information about this organization. I am satisfied that by either obtaining this information from my student and/or inspecting the organization’s charter, I have sufficient information about this organization to make an informed decision regarding my student’s participation. With all of these considerations in mind, I authorize my student’s participation in this student leadership organization. I further understand that my consent may be withdrawn at any time if I notify the school in writing of that withdrawal of consent.

Parent Signature (Type Legal Name) Authorization for Participation in a Student Leadership Organization *
Your answer
TSA Participation Agreement
This agreement is required by all students, advisors and participants in any and all TSA conferences, and/or activities. No attendee will be allowed to participate unless this form is on file at the state TSA office. Copy’s to: State Advisor, Chapter Advisor, and Attendee.

Utah TSA Code of Ethics
Every Participant is responsible for proper conduct at all times according to this code of ethics.

Conference attendees:
1. Official dress or business-like attire is required by all conference attendees.
2. Identification badges must be worn at all times by all persons in conference attendance.
3. Students should be prompt and prepared for all activities and competitions.
4. Students shall keep their advisors informed of their activities and/or whereabouts at all times.
5. No student shall leave the conference without permission from their chapter advisor.
6. There shall be no defacing of public property. Any damages to property or furnishings must be paid by the individual(s) or chapter(s) responsible
7. No alcoholic beverages, narcotics, firearms or weapons, in any form, shall be possessed by students, alumni, or other conference attendee’s at any time, under any circumstances.
8. Smoking or gambling in public will not be permitted since a conference attendee in TSA dress is officially representing a state and/or national association of TSA.
9. Students are responsible for proper conduct at all times.
10. The Utah State TSA Advisor reserves the right to dismiss any student or attendee from the conference for inappropriate actions.

PERSONAL ITEMS:
Please be advised that personal items brought for use at TSA activities are the sole responsibility of the attendee who chooses to bring the items. If a participant chooses to bring items of value he/she is responsible for their safe keeping at all times. This includes any item of monetary value, including items used in competitive events. TSA accepts no responsibility for replacement of lost, misplaced, or stolen items and will not replace such items.

DRESS CODE:
Chapter advisors are responsible for seeing that during all competition and the awards ceremony, students must wear TSA dress or business-like attire. Conference identification badges must be worn by attendees at all times.

MEDIA RELEASE
I permit Utah TSA to use photographs and/or video footage of my student for publicity that might include but is not limited to: State TSA website, PowerPoint presentations, social media, promotional videos, flyers or news publications. Students may participate in media interviews (radio, newspaper, TV). Winners’ names and schools may be posted on the state TSA website, social media, and/or in the newspaper

• I hereby agree to release the Utah Technology Student Association Inc., its representatives, agents, and servants from liability for any injury to above named person at any time while attending any and all TSA conferences, contests, and or activities, including travel to and from the activity, excepting only such injury or damage resulting from willful acts of such representative, agents, servants, and employee’s.
• I do voluntarily authorize the TSA local chapter advisor, state advisor, assistants, and/or designees to administer and/or obtain routine or emergency diagnostic procedures and/or routine or medical treatment for the above named person as deemed necessary in medical judgment.
• I agree to indemnify and hold harmless the Utah Technology Student Association and said state conference director and/or assistants for any and all claims, demands, actions, rights of action, and/or judgments by or on behalf of the above named person arising from or on account of said procedures and/or treatment rendered in good faith and according to accepted medical standards.
• I hereby authorize any physician member of the department of Emergency Medicine of an accredited hospital to render medical treatment, which in his/her judgment is deemed necessary in the care of the above named person while attending TSA conferences, contests, and activities including time traveling to and from the activity

Parent Signature (Type Legal Name) TSA Participation Agreement *
Your answer
Student Signature (Type Legal Name) TSA Participation Agreement *
Your answer
Student Known Allergies (drug or otherwise)
Your answer
Student Current Medication
Your answer
Describe any history of heart condition, diabetes, asthma, epilepsy, rheumatic fever, or physical restrictions.
Your answer
Physician's Name
Your answer
Physician's Phone
Your answer
Medical Insurance Company
Your answer
Insurance Policy Number
Your answer
MEDIA RELEASE FORM
Students at the Jordan Applied Technology Center are periodically filmed, photographed or interviewed regarding programs and/or activities at the school. These are used for educational purposes including: the school web site, news articles, pamphlets, brochures, class activities and projects or to promote the courses offered at the school.
Media Release Permission: I am the parent/legal guardian of the student named above, and agree to the following: *
Parent/Guardian Permission for use of Student Information
The Engineering program at the JATC is dedicated to providing effective college and career readiness. In order to accomplish this objective, students will participate in activities/websites throughout the year that may require the assessment and sharing of student information to education-related entities outside of the Jordan School District. In addition, information such as testing scores are communicated to the Utah State Board of Education (USBE).

PARTICIPATION OF THESE ACTIVITIES IS REQUIRED AS A STUDENT IN THE ENGINEERING PROGRAM.

Listed below are the programs and activities that the students will be engaged in. Most of these sites simply involve creating a free account with a personalized login and password. If you have any questions, please feel free to contact the instructor.

autodesk.com
canvas.instructure.com
google.com/drive
kahoot.it
linkedin.com
pltw.org
quizlet.com
tsaweb.org
utahfutures.org
arduino.cc

Parent Signature (Typed Name) Permission for use of Student Information *
Your answer
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