Going for Gold The Science Behind the Olympics

February 25, 2017

What is the Goal? The mission of GROW is to increase girls’ interest in science, technology, en-

gineering, and math (STEM) fields.

Who Should Attend? This event is intended for students currently in the 6th—8th grades. Students

can come on their own or with friends from their school or community.

What Will We Do? Come prepared to meet new friends! You will participate in hands-on ac-

tivities led by Kansas State University faculty, staff, and students. Prepare to

explore the science behind the Olympics. Topics include health, nutrition,

kinesiology, physics, etc. Lunch is included in the registration fee.

When & Where? Saturday, February 25, 2017. We will begin the day at 9:00 am and end at

3:30 pm. All events will take place at the K-State campus in Manhattan.

How Do I Sign Up? To register, complete the registration form on the next page. Please make

additional copies for each person attending. Mail in the form along with

payment (check/money order) to the address provided. Please DO NOT SEND CASH.

Registrants will be e-mailed a confirmation packet once the GROW team

receives a completed registration. Registration is on a first come first serve

basis and will be limited; we will waitlist additional applicants if necessary.

Registration deadline is February 10, 2017 Registration must be received by the KAWSE office by this date at 5:00 pm.

What if I have to cancel? Should you need to cancel, please do so as soon as possible. This will allow

those on the waitlist to participate. Unfortunately, we cannot issue refunds

except to those waitlisted applicants we cannot accommodate.

I still need more information! Please contact the KAWSE office, home of the GROW program, at

(785)-532-6088. You can also send us an email at kawse@ksu.edu or visit

our website at www.ksu.edu/grow.

Going for Gold Saturday, February 25, 2017

GROW REGISTRATION FORM

Kansas State University is committed to making program activities accessible to all participants.

If you have special requirements due to disabilities or dietary restrictions, indicate your needs on

the application form or contact the Division of Continuing Education Registrar at (785) 532-5566

at least three weeks before the start of the program. After this date, we will make every effort

to provide assistance, but cannot guarantee that requested services will be available.

Notice of Nondiscrimination: Kansas State University is committed to nondiscrimination on the

basis of race, color, ethnic or national origin, sex, sexual orientation, gender identity, religion,

age, ancestry, disability, military status, veteran status, or other non-merit reasons, in admis-

sions, educational programs or activities and employment, including employment of disabled

veterans and veterans of the Vietnam Era, as required by applicable laws and regulations. Re-

sponsibility for coordination of compliance efforts and receipt of inquiries concerning Title VI of

the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the

Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the Americans With Disabili-

ties Act of 1990, has been delegated to the Director of Affirmative Action, Kansas State Universi-

ty, 214 Anderson Hall, Manhattan, KS 66506-0124, (Phone) 785-532-6220; (TTY) 785-532-4807.

$30.00 Registration Fee enclosed

Send form & payment to: GROW Program Kansas State University 125 Seaton Hall Manhattan, KS 66506-2905

Registration Deadline:

February 10, 2017

Please make checks payable to K-State

Student (full name) Parent/guardian (full name)

Home Address Parent/guardian Email —All confirmation information will

be sent to this address. You will also be added to our GROW

listserv. City State Zip Code

Current Grade (please circle one)

6th 7th 8th

Daytime Phone (parent/guardian)

Anticipated college entry year Cell Phone (parent/guardian)

Student Ethnicity (please circle only one)

White

Black

Hispanic

Asian

American Indian

Mexican American

Hawaiian Pacific Islander

Multiracial

Prefer not to answer

Friend(s) you would like to be grouped with, if applicable:

Please tell us how you heard about this event:

For Participants with Disabilities or Dietary Requirements -

Please indicate any special requirements and/or assistance

needed:

GROW: February 25, 2017 – Going for Gold Consent Form

This form may be completed electronically or printed and completed, please print clearly. Completed form can be faxed to (785) 532-2627 or given to staff during the event.

Name of Participant: ____________________________________________________________________

Birthdate: _____________ Age: _______ Expected High School Graduation Year: ________

Address: _____________________________________________________________________________

_____________________________________________________________________________

Parent or Guardian Name: _______________________________________________________________

Address (if different from above): __________________________________________________________

Home Phone: _________________________________ Work Phone: _________________________

Insurance Company: ____________________________ Policy No.: ____________________________

Name of Insured: _______________________________ Relationship to Child: ____________________

Family Physician’s Name: ________________________________________________________________

Address: ________________________________________________ Phone: _____________________

Date of last tetanus immunization or booster shot: _____________________________________________

State Medical Condition(s) for which your child is being treated at the present time:

______________________________________________________________________________________

List all medications your child is currently taking: _______________________________________________

List all medications your child is allergic to: ____________________________________________________

List any restrictions of physical activity: _______________________________________________________ ________ I, the undersigned parent or guardian, do hereby grant permission for my child to receive necessary medical treatment initial here in the event of an injury or illness while attending the GROW event sponsored by Kansas State University. I accept

responsibility for the full payment of such medical treatment. I hereby hold Kansas State University and its representatives harmless in the exercise of the authority.

_________ I further grant permission for my child to participate in all activities related to the event, including any transportation initial here provided or other activities.

_________ I am aware that I will be required to pick my child up from the event in the event that my child is dismissed early because of initial here violation of event rules.

_________ I understand that Kansas State University assumes no liability for injury or damages arising from the result of initial here participation unless due to willful fault or gross negligence on the part of the university.

_________ I give my permission to allow GROW to use photographs taken of my child during the workshop in promotional initial here materials (including the GROW website, presentations, brochures, etc.)

_________ I give my permission to allow GROW to share my child’s contact information with other programs on the initial here K-State campus that offer a variety of opportunities for students.

_________ I agree to allow my child to create an account on the Scratch website (www.scratch.mit.edu), which will be need to carry out initial here some GROW activities. Scratch is a programming environment developed by the Massachusetts Institute of Technology

specifically for children. Information for parents can be found here (http://scratch.mit.edu/parents/).

_________ I hereby give my permission for my child to participate in all evaluation activities conducted in conjunction with the GROW initial here Program. I understand that my child will be asked to complete surveys both before and after workshop activities. These

surveys may explore my child’s interest in, attitude, and understanding toward science. I give my permission for this data to be used for research and publication. A number will be assigned to those surveys to enable the evaluators to compare my child’s responses before and after the workshop activities, so that my child’s name will not be used in any publications developed from the information gathered. I understand that my child is not required to participate in these evaluation activities as a condition of being accepted to participate in the workshop and that I may withdraw my permission at any time.

_________________________________________________ _________________ Signature of Parent or Guardian Date

Street Address

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