Cyber Camp Registration
2019 Cyber Camp will be held the week of June 24, 2019, at Jac-Cen-Del High School, 4586 N. US 421, Osgood, IN.

AFA CyberCamps emphasize fun, hands-on learning of cybersecurity principles that are relevant and applicable to everyday life. At CyberCamp, students learn the importance of cyber safety and how to protect their personal devices and information from outside threats.

The Camp will run from 8:00 am until 12:00 pm each morning EXCEPT for Wednesday. On Wednesday, June 26, campers will attend camp from 8:00 am until noon, have lunch, and then travel to Muscatatuck Urban Training Center (MUTC) for a tour of the MUTC Cyber Academy. Students will be provided with more information about this tour after registration and payment of fees. Students MUST wear close-toed shoes on this day - no sandals or open-toed shoes!

Fees: $50 per Camper to cover curriculum and materials. Space is limited.

Student Name *
Your answer
For which Camp are you registering? (Standard AFA CyberCamps teach beginner students the basics while Advanced AFA CyberCamps incorporates more complex concepts geared towards students who have previous participated in a CyberCamp or participated on a CyberPatriot team.) *
Current Grade Level *
Current School *
If you do not attend a Ripley County school, what is your current school?
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Email *
Your answer
Home Address *
Your answer
Home Phone
Your answer
Work Phone
Your answer
Cell Phone *
Your answer
Other Emergency Contact *
Your answer
Relationship to Student *
Your answer
Emergency Contact Phone (home)
Your answer
Emergency Contact Phone (work)
Your answer
Emergency Contact Phone (cell) *
Your answer
T-shirt Size *
Student's Regular Physician *
Your answer
Physician Phone Number *
Your answer
My student has the following health/medical concerns: *
Allergies to food or materials: *
Your answer
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 2019 Cyber Camp:
My student will be participating in various activities, including team-building exercises, educational opportunities, and a field trip to Muscatatuck Urban Training Center in Butlerville, Indiana. At various times, students may be photographed or video- taped for 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.
• CyberCamp is not responsible for any items lost or stolen.
• CyberCamp reserves the right to dismiss any student from the program for disciplinary reasons.

Further, I acknowledge that I have reviewed the AFA CyberCamp Participant Code of Conduct with my child and that my child will be required to sign the AFA Participant Code of Conduct on the first day of camp. The AFA CyberCamp Participant Code of Conduct is as follows:

1. I will consider the ethical and legal implications of my online actions during my time in the AFA CyberCamp.
2. I will not conduct, nor will I condone, any actions that attack, hack, penetrate, or interfere with another team’s or individual’s computer system, nor will I use the cyber defense skills I learn in the AFA CyberCamp to develop hacking or other offensive skills.
3. I will not disclose any of the training material or any other confidential information that I will receive to anyone but my peers enrolled in this specific AFA CyberCamp session.
4. I will protect all the confidential information that I receive and will not make any efforts to recreate, sell or design a product that contains the confidential information.
5. I will not keep or download any instances of the images used during the AFA CyberCamp after the conclusion of the event.
6. I will not visit inappropriate Web sites while participating in the AFA CyberCamp.
7. I will not participate in or condone cyberbullying which includes such behaviors as teasing, threatening, intimidating, humiliating, sexual harassment, racial harassment, and stalking.
8. I understand that failure of myself or any of my teammates to participate actively in all AFA CyberCamp activities will render our team ineligible for any team recognition, regardless of our recorded score.

Electronic Signature *
Your answer
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