7/26/2019 GEARS Camp Application

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Get excited for

GEARS Summer Camp

Connect with other like-minded female students.

Experience the trades with hands-on learning.

Hands-on experience while you learn from trade professionals.

Skills are beneficial to learn and applicable to everyday life.

No cost to attend; lunch is provided every day.

Who: Girls (ages 1417)

Location: M-TEC, 60 Livingston Blvd., Gaylord

Dates: 6/20-6/23

Time: 9:00 AM-3:00 PM

Questions or to register TODAY: mtec@kirtland.edu, (989)705-3600

Limited seats available.

www.kirtland.edu | @kirtlandcc

Want to explore occupations in the skilled trades?

Or, are you interested in a STEM-related career?

7/26/2019 GEARS Camp Application

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2016 GEARS SUMMER CAMP

June 20 23, 2016

APPLICATION FORM

First Name: _______________________________ Last Name: ___________________________________

Date of Birth: ________________ Home Phone: ___________________ Cell Phone: ________________

Street: ________________________________ City: __________________ State: _____ Zip: __________

Grade Entering Fall 2016: _____ School Name: ________________________ Year of Graduation: ______

Parent/Guardian Email Address: __________________________________________________________

T-Shirt Size (Adult) ___Small ___Medium ___Large ___XL ___XXL ___XXXL

Lunch will be provided all week. (If there are any allergies, please let us know.)

Student Health Concerns: ________________________________________________________________

_____________________________________________________________________________________

NO Camp Registration fees

Return Registration form to:

Kirtland M-TEC, Attn: Luann Mabarak

60 Livingston Blvd.

Gaylord, MI 49735

Or email: mtec@kirtland.edu

Parent/Guardian Name: _________________________ Day Phone: _____________ Cell: _______________

Parent/Guardian Address if different that student: ________________________________________________

Emergency Contact Name: ___________________________________ Phone: ___________________

Participant Liability Agreement:By signing below, participant (or parent/guardian if participant is a minor)

acknowledges and accepts the risks of physical injury associated with participation in the activity described above.

Except for gross negligence on the part of sponsors, participant (or parent/guardian) accepts personal financial

responsibility for any injury sustained during the activity. Further, participant (or parent/guardian) promises to hold the

sponsoring organizations and their representatives harmless for any injury sustained during the time involved for the

activity. If a dispute over this agreement or any claim for damages arises, participant (or parent/guardian) agrees to

resolve the matter through final and binding arbitration.

___ I Agree ___I Disagree

Photo/Video Release:You have my permission to take pictures or video of me (or my child/ward) for future publicitypurposes related to the camp: ___Yes ____No

Medical Authorization:Is the participant covered by health insurance? ___Yes ___No

If yes, name of insurance provider: _________________________________ Policy/Group Number: _________________

Is Kirtland Community College authorized to approve medical treatment? ___Yes ___No

Parent/Guardian Signature:____________________________________ Signature Date:__________