8/7/2019 Registration Form Summer Youth Program
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13450 Lake Fretwell Street, Jacksonville, FL 32221 1
A week-long summer youth program of STEM-related aviation and
space learning experiences!
ApplicationDeadline: April 22, 2011
June 20th to June 25th from 9:00 a.m. to 3:30 p.m. Monday
Saturday
Florida State College at Jacksonvilles Aviation Center of
Excellence
Student Name: Parent/Guardian Name:
Address: Email:
Home Phone: Work Phone: Cell Phone:
EmergencyContact: Phone:
School: Grade Entering This Fall:
Release Information
ACKNOWLEDGEMENT AND ASSUMPTION OF RISK: The undersigned
acknowledges that the activity may involve risks and the
undersigned
assumes the risk of any and all bodily injury and all property
loss or damage arising in any way from said activity. The
undersigned agrees
that Florida State College at Jacksonville (FSCJ) is not in any
way a guarantor of safety in connection with the activity.
RELEASE: The undersigned agrees to release, indemnify, and hold
FSCJ harmless from any such suits, actions, or claims which may
be
asserted except those claims wherein FSCJ is determined to be at
fault through its wrongful act(s) or omission(s).
INSURANCE: The undersigned is not relying on FSCJ for any manner
of insurance for protection in connection with this activity.
The
undersigned shall be responsible for providing all insurance to
be relied upon for protection in connection with this activity and
the
undersigned shall not hold FSCJ responsible for proving any
insurance coverage.
PHOTOGRAPHY RELEASE: I hereby give my consent to all written
materials, photographs, audio and/or video recordings taken of me
or my
child during the activity. I understand that any such
photographs, audio, video recordings or their derivatives will
become the property ofFSCJ and may be used by the college or others
with their consent for educational, instructional, or promotional
purposes determined by the
college in formats now existing or in the future created.
______________________________________________________________________________________________________________
Parent/Legal Guardian Signature Date
8/7/2019 Registration Form Summer Youth Program
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13450 Lake Fretwell Street, Jacksonville, FL 32221 2
Participants Letter of ApplicationInclude a paragraph for each
of the following questions
Why do you want to attend the Aerospace Adventures Summer Youth
Program?
What aviation experiences, education, or training do you have to
date?
What aviation experiences would you like to gain from your
Aerospace Adventures Summer Youth Program experience?
What aviation related career goals do you have that could be
further advanced from your experiences at the AerospaceAdventures
Summer Youth Program?
SIGNATURES
Participant __________________________________________________
Date__________________
Parent/Guardian______________________________________________
Date__________________
8/7/2019 Registration Form Summer Youth Program
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13450 Lake Fretwell Street, Jacksonville, FL 32221 3
Application Checklist
STEP I Completed Application Form and Participants Letter of
Application must be receivedNO LATER than April 22,2011in order for
your child to have a complete application to the program.
o Signatures by the applicant, parents and/or legal guardians
are required.o ALL applications are subject to maximum capacities
and applicants eligibility qualifications for the
program.
STEP II Please send signed, completed application and
Participants Letter of Application to:Aerospace Adventures Summer
Youth ProgramAviation Center of Excellence13450 Lake Fretwell
StreetJacksonville, FL 32221.
STEP III If your child has been accepted into the program, you
will be notified by May 2, 2011
A packet of information including the Permission to Participate
form, Authorization Release form, EmergencyMedical form, Rules for
Participants form, and other pertinent information will be
sent.
STEP IV These forms and program payment are due no later than
May 20, 2011. Keep a copy of all forms forreference.
For more information, contact Judith Rice [email protected]
(904-317-3840)
mailto:[email protected]:[email protected]:[email protected]:[email protected]
