CINSAM Robotics Program

WELCOME
To register for the CINSAM 4-Week Robotics Program for Middle School aged Homeschool students, complete the form below and on the next few pages.

Payment REQUIRED to reserve a seat in the program.

Does the participant have any allergies (including food allergies), of which camp leaders should be aware? Does this participant have any dietary restrictions?

Does this participant have any physical limitations, or behavioral, or health complications of which leaders should be aware? Will the participant require any special assistance?

Will the participant have medication to be administered during the program? Please include items such as epi-pens, which may only need to be administered under specific conditions.

*An additional medical form will be required to be completed and turned in when medication is dropped off to program staff. NKU staff cannot administer medication (prescription or over-the-counter) unless a form is completed and signed. If you answered yes to the questions above, then the form will be provided to you at a later date.

Students may be photographed or recorded during the camp. These images/videos may be used in Northern Kentucky University marketing, publications and/or presentations. Does Northern Kentucky University have permission for this student's photograph and/or video footage to be so used? By selecting yes, you hereby release Northern Kentucky University and its legal representatives for all claims and liability relating to said images, and waive your right to any compensation for the imagery.

Students may be surveyed before, during, and after the camp. The surveys will question student knowledge and attitudes especially related to the topics offered in the camp. The completely anonymous results of these surveys may be used in professional publications, grant applications, Northern Kentucky University publications, and/or presentations. Does Northern Kentucky University have permission for this student to be surveyed?