Summer Tech Camp

Application Form

The purpose of the camp is to...

Student Name: _____________________________________________ Parent(s)/Guardian Names: (Mr., Mrs., Ms.) _____________________________________________ _____________________________________________ Current School _____________________________________________ Are you interested in bussing from your local school? _____________________________________________ Mailing Address: _____________________________________________ _____________________________________________ _____________________________________________

Bring together middle-school students from the greater Upper Valley community. Expose each student to experiential learning labs through a variety of hands-on projects.

Physical Address: _____________________________________________ _____________________________________________ Parents’ email addresses: _____________________________________________ ____________________________________________ Home Telephone number: __________--___________--____________ Legal Town of Residence: _____________________________________________ Gender: M F

At the HACTC, we value creative thinkers and hands-on learning. Come see why our students love coming to school.

Summer Tech Camp For students entering 7th, 8th or 9th grade

Date of Birth: _____/______/_______ Grade Level (as of 9/1/14) 7th, 8th, 9th Home School: _____________________________________________ Name of school counselor: _____________________________________________

June 22 -June 26 9:00am - 12:30pm

Summer Tech Camp

Application Form IN CASE OF EMERGENCY

Summer Tech Camp! Come explore 10 exciting hands-on labs in a week- long, 1/2 day camp. Students will be grouped into teams and each team cycles through all programs over the course of five days. Each student tries all of the 10 labs and no one misses out!

Camp Schedule:

Arrival 9am - Departure 12:30pm Monday - Friday: Block I Block II Depart HACTC

9:05-10:40am 10:45-12:25pm 12:30pm

Cost: $25.00 Make checks payable to: Hartford Area Career & Technology Center

Past Projects Have Included: basic welding bat house construction plasma cutting photoshop poster design cake decorating excavator operation solar powered derby races lego robotics video production ipod app clinic

Scholarships available

Registration must be completed by: June 3rd Enrollment is Limited. Please return all registration materials to guarantee enrollment.

Contact Person: _____________________________________________ Contact Person Phone Numbers: Home: _________----_________----___________ Work: _________----_________----___________ Cell: _________----_________----___________ Does the student have allergies? Y N If yes, to what? ________________________________ Does the student require an EPI pen? Y N Does the student have any chronic illness(s)? Y N If yes, please list. Does the student take medications regularly? Y N If yes, please list all medications. ** As parents/ guardians, I authorize the HACTC to have my child treated at the nearest medical facility during any emergency. Y N ** It is permissible to photograph/ videotape my son/daughter while at HACTC for any media publication. Y N Parent Signature: _____________________________________________ Date: _____/______/______ ** All information must be completed HACTC does not discriminate on the basis of race, creed, national origin, religion, sex, disability or sexual orientation.

Please Return application and fee to: Havah Walther, Outreach Coordinator HACTC 1 Gifford Road White River Junction, VT 05001 1(802)-295-8630