Medical Authorization and Medication Requirements: In the event of injury or illness, I authorize LINGO Solution's  staff to take whatever action is deemed necessary for my child’s health or welfare. I understand that LINGO Solution's  staff will document these events and notify me as soon as possible if there is a need for medical attention. I consent to whatever medical treatment is required for my child, including admission to an emergency medical treatment facility, and I release the Parties Released from all costs incurred, and any claims arising from that medical treatment. Furthermore, I agree to defend and indemnify the Parties Released from and against any and all claims arising from medical treatment required by my child.

I understand that LINGO Solution's staff will not administer over-the-counter or prescription medication to my child without my written approval. I understand all medication generally will be placed in a locked cabinet for the duration of the camp day and administered only to my child as directed on the medication’s label and only by LINGO Solution's  staff. I understand that it is a violation of LINGO Solution's rules for my child to possess over-the-counter or prescription medication without the knowledge of LINGO Solution's staff.

Consent: LINGO Solution's  is requesting parental/guardian consent. Please read this document carefully and feel free to ask an STEM Lingo staff member for more information as needed.

Consent for Services/General Release of Liability

I, the undersigned parent/guardian, agree that my child can participate in the services provided by LINGO Solutions.

I release LINGO Solution's  from all liabilities to my child for all  damages,  expenses  (including attorney fees), claims, judgments, actions or causes of action as a result of any loss or injury to the person or property which my child may sustain or suffer during or arising out of services provided by LINGO Solution's  or transportation provided by LINGO Solution's , whether caused by the acts or omissions of LINGO Solution's  officers, directors, employees, representatives, advisors, affiliates, divisions, departments, related entities, contractors, funding source and/or  other agents (“Parties Released”). I agree to defend and indemnify the Parties Released from and against any and all liabilities.

Release of Supervision Consent: I understand that my child could work with staff or volunteers that may be pursuing counseling degrees, professional licenses or other certifications (“Supervised Staff”). I understand that Supervised Staff may be gaining required experience by providing services to my child under supervision of other licensed professionals (“Supervisors”). I consent to the release of information to Supervisors for supervision purposes. I understand that Supervisors are under the ethical and legal guidelines which require information about the services provided to my child to be treated as confidential.

Media Consent : I, the undersigned parent/guardian, hereby give my consent for the release of reports, stories, videos, or pictures (“Materials”) that may identify my child. These Materials may be used for educational, informational, promotional, marketing, commercial or other activities. I acknowledge LINGO Solution's right to prepare the Materials for publication or other use, including cropping, altering or changing the Materials at its discretion. I hereby release the Parties Released from all claims and liabilities arising out of or in connection with the use of the Materials. I understand that I do not have a right to royalties or payment in any form for these Materials, neither today nor at any future date.

Camper Behavior Contract: Please review the following behavior contract with the camper. Ensure that he/she understands that he/she will be expected to follow all parts of the agreement while at camp. Failure to follow these rules will lead to disciplinary actions up to and including expulsion from camp.

The  camper  must  read  and  initial  each  statement  and  verify,  along  with  his/her  parent  or guardian, at the bottom to show that he/she agrees to abide by the rules and policies of the LINGO Solution's program.

-Make a strong effort to engage in camp programming, work constructively and interact with other campers.

-Respect the needs and feelings of others and show kindness to all with whom I come in contact.

-Show respect for camp staff through my attitude and behavior, including by following directions.

-Demonstrate a high level of responsibility and care with school property (including room keys), my property, and the property of others. I understand that the destruction or defacement of property will result in disciplinary actions and monetary compensation for the damaged items.

-Wear clothing that is appropriate and shows respect for myself and others. My clothing will be size-appropriate, modest, and not display inappropriate or disruptive slogans, gestures, or brands.

-Limit use of electronic devices, including, but not limited to, cell phones, music players, and hand-held games to non-instructional time. I am aware that loss, damage, or theft of such items is not the responsibility or concern of camp staff or employees.

While at camp, I will not:

-Use physical violence, violent language, or threats, which are disruptive or unlawful, including but not limited to:

    -Fighting or using “Fighting words”
    -Roughhousing or wrestling
    -Physical or verbal threats
    -Bullying or intimidation
    -Use of weapons or other objects as weapon

Bring items which are unlawful or prohibited, including but not limited to:

    -Weapons of any kind
    -Fireworks or explosives
    -Drugs (including alcohol, cigarettes or any medication not listed on health forms)

-Abuse substances – including alcohol or drugs – or engage in inappropriate and/or dangerous use of classroom or household materials.

-Engage in behavior which is sexually inappropriate, threatening, or harassing. This can include, but is not limited to, sexual misconduct, exposing one’s body or inappropriate nudity, and touching oneself or others in a sexual manner.

-Leave the camp without camp staff or notifying the appropriate camp point of contact.

-Use profanity, but will maintain language and decorum appropriate for the classroom setting at all times.

-Bring video gaming systems, laptop computers, or televisions unless otherwise specified.

LINGO Solution's camp staff will exercise a zero-tolerance policy concerning physical and verbal violence, illegal and prohibited substances and items, and sexually inappropriate activities.

Having read and understood the Camper Behavior Contract above, I agree to follow these policies during my time in the LINGO Solution's camp program. I also understand that failure to comply with these policies will have consequences, which may include, but are not limited to, being prohibited from participating in some or all activities, being dismissed from the camp and sent home, and being prohibited from returning to this and/or future LINGO Solution's camp programs.

A copy of your responses will be emailed to the address that you provided.