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Thank you for your interest in our 2013 Solar Camp!
Camp information and application are below.
Camp Information
Eligibility Requirements:
13 to 15
years of age,
80 or higher
yearly average in all subject areas,
Level 3 or 4
on prior year
EOG scores,
Good behavior & attendance
record,
Interest
in Science, Technology, Engineering, and Math
Camp Dates:
July 8-11 and July 15-18 (8 days)
Hours:
9:30-1:00
Location:
Wayne Community College
Cost:
No charge
Due Date:
Wednesday, July 3
(Extended)
Kinetic Minds 2013 Solar Camp Application
*
Indicates required field
Student's Name
*
Address
*
Date of Birth, Gender & Race
*
2012-2013 School & Grade
*
Favorite Subject/Hobbies & Extracurricular Activities
*
What do you hope to gain by attending this camp?
*
Why should you be selected to attend this camp?
*
Do you work well with others? Explain.
*
Are you able to attend all 8 days of the camp?
*
No
Yes
Not Sure
Science Average 2012-2013
*
C
B
A
Math Average 2012-2013
*
C
B
A
Reading Average 2012-2013
*
C
B
A
Social Studies Average 2012-2013
*
C
B
A
Number of absences 2012-2013
*
More than 15
11-15
6-10
0-5
Number of in-school and out-of-school suspensions 2012-2013
*
More than 5
3-5
1-2
0
Parent(s) Name:
*
Parent Phone & Email:
*
Emergency Contact Name & Number
*
Does your child receive free/reduced lunch?
*
No
Yes
Does your child have reliable tranportation
*
No
Yes
Not sure
If selected, will your child be able to attend all 8 days of the camp?
*
No
Yes
Not sure
Child's t-shirt size
*
Adult Small
Adult Medium
Adult Large
Adult XLarge
Adult 2XL
List any allergies, medications, and special medical needs of your child:
*
I understand that Kinetic Minds does not carry any health, accident, or other similar insurance for students involved in student camps and that Kinetic Minds assumes no liability for any such medical expenses. Based on this understanding, I certify as follows:
*
My child is covered under my personal insurance policy which coverage is now in effect.
My child is covered under medical services provided by the United States Military and/or other governmental agency or organization, or otherwise through my employment.
My child has no medical insurance and I agree to be fully responsible for all uninsured expenses for medical services and treatment resulting from any accident or injury during the camp.
I grant permission for my child to participate in the summer camp named above. As the custodial parent, I hereby give permission for my child to receive proper medical attention while attending this camp, and authorize those supervising the camp to do any acts and give any required consents which may be necessary or proper to provide for the health care of my child at any hospital or other institution by any physician, dentist, nurse, or other person whose services may be needed for such health care. This consent to provide health care shall be effective with the date the camp commences and extend through the last day of the camp. I authorize my child's school to release his/her records to Kinetic Minds. I allow the sharing and exchanging of information regarding my child between his/her teachers/school staff and Kinetic Minds staff. I grant Kinetic Minds and outside TV, camera, and photography crews the right to photograph, record and film my child in connection with camp learning experiences. I relinquish all rights, title, and interest in such photographs, films, recordings, and negatives. I authorize Kinetic Minds to copyright, use, and publish the same in print and electronically for such purposes as publicity, illustration, advertising, and Web content.
*
No
Yes
Submit
Copyright 2012 Kinetic Minds NC
