Project Aerospace ACE Academy Application

Transcription

1 Project Aerospace ACE Academy Application Location: (s): The OBAP Aviation Career Education (ACE) Academy is designed to provide a more in-depth look at the aviation industry for students who truly want to continue their dreams. This program will provide a more in-depth classroom discussion, field trips to aviation related entities, to include college/universities, hangars, towers and possibly small airplane flight. The target age group is middle to high school students, target ages years. Each academy capacity is approximately 30 students. There is a non-refundable application processing fee of $ Fees vary by academy. Please check the detail of your Academy of choice to determine the fee. Payment is payable via credit card or electronic check if the online application process is used. The fee is payable via check or money order if you are mailing this application. Mailing your application and fee will take longer to confirm academy acceptance. Your check must be cleared before acceptance, therefore be sure make sure you allow ample time for processing. Mail to: Organization of Black Aerospace Professionals Attention: OBAP Summer Programs One Westbrook Corporate Center Suite 300 Westchester, Illinois

2 Part I: Student Information: completing application: of Birth: Address: City: State: Zip: Phone: ( ) Alternate Phone Male Female_ Grade Level in Fall 2017: Current GPA: School in Fall 2017: Have you attended this program before? Yes No If yes, How many years? Student s shirt size: Adult Small Adult Medium Adult Large Adult XL Adult 2XL How did the student find out about the Academy? Has the student had any flight experience? If yes, how many hours? List community activities, hobbies and interests: Part II: Essay Please briefly describe why would like to attend our Summer ACE /Solo Aviation Academy. Attach additional sheets for your essay. Enclose with your application and the processing fee of $50.00 via check or money order and mail to the address below. 2

3 Parental/Guardian Information and Approval(s) Please make sure your parent or guardian review and complete this section. Important this part of the application MUST be completed and signed for consideration of admission to the academy. Student s Parents / Guardian Information Address: City: State: Zip: Home # Work # Cell / Other # _ Emergency Contact (other than parent or guardian) Relationship to student: Phone: ( ) Cell / Other # _ Student s Medical History: Does the student have any health concerns/allergies/medications that we need to be aware of? Yes No If yes, please explain: _ Does the student have any dietary needs / food allergies that we need to be aware of? Yes_ No If yes, please explain: _ Please list/describe any physical limitations:_ Emergency Medical Contact Information Name of Primary Physician: Phone: Insurance Provider: Persons Authorized to Pick Students up: Phone: Home Phone: Home _Relationship to Student: Cell/Work _Relationship to Student: Cell/Work 3

4 CONSENT FORM AND RELEASE STATEMENTS Student s Name (Please Print): The undersigned ("Participant") hereby acknowledges that he/she has voluntarily chosen to participate in the summer aviation or flight academy sponsored by the Organization of Black Aerospace Professionals ("OBAP") and the National Black Coalition of Federal Aviation Employees ( NBCFAE ) or any additional collaborating partners of OBAP. Participant acknowledges and understands that the OBAP/NBCFAE summer aviation or flight academy will involve strenuous physical activity that could potentially be dangerous or harmful. Participant has chosen to participate in the academy voluntarily, with the full knowledge of this potential danger and harm. By signing this document, Participant represents and warrants that he/she does not have any physical condition, which could be aggravated or worsened by strenuous physical activity or stress. In consideration of OBAP/NBCFAE permitting Participant to participate in this summer aviation academy, Participant waives all claims, demands, actions, causes of action, and liabilities of any kind or nature, whether based in law or in equity, against OBAP/NBCFAE or other collaborating partners of OBAP including without limitation, its parent and its successors, subsidiaries and affiliates ("Affiliated Companies") arising out of or in any way related to the OBAP/NBCFAE summer aviation or flight academy or Participant's participation in the event, including without limitation claims for physical or other personal injury ("Claims"). Participant releases OBAP/NBCFAE and its Affiliated Companies from such Claims, regardless of when such Claims arise or when Participant discovers any injury or damage that does or may give rise to such Claims. I hereby give consent for my child to participate in the OBAP/NBCFAE Aviation Career Education (ACE) Academy or Solo Flight Academy and travel on all field trips. Print Name MEDIA RELEASE I hereby grant permission to OBAP and its partners to take and reproduce photographs, videos or program comments of my son/daughter to be used in connection with the making, promotion or public relations for educational programs, trade, advertising and other purposes as determined by OBAP/NBCFAE. OBAP or various other media may choose to take pictures or videotape of participants in OBAP activities. These images may be used for OBAP displays, brochures, newsletters, archives, new releases, publicity and website. 4

5 MILITARY INSTALLATION VISIT and MILITARY RECRUITER PRESENTATION RELEASE I understand and acknowledge that during the OBAP/NBCFAE ACE or Solo Flight Academy that my son/daughter, may enter and tour a military installation and/or fly on a military aircraft as part of the camp s itinerary. Additionally, recruiters from the U.S. Military may visit and speak on behalf of their respective organizations. I hereby grant permission to OBAP/NBCFAE and/or its agents to allow my Son/ Daughter to visit such installations, listen to their presentations, and to speak to their representatives. PARENT/GUARDIAN ACADEMY AGREEMENT -Parents will ensure that students arrive at the academy on time every day -Parents will ensure that students are picked up on time at the end of every day -Parents will ensure that students bring all required materials to the academy every day -PARENTS WILL SIGN STUDENTS IN/OUT OF THE ACADEMY EVERY DAY 5

6 STUDENT ACADEMY AGREEMENT Please read the information listed below and sign at the bottom of the page STUDENT GUIDELINES - Drugs, alcohol, tobacco products, weapons, beepers, laser pointers, electronic devices/games, IPods, mp3 players, radios, are not permitted and will be confiscated. Cell phones must be turned off except during breaks. - Students must report on time each day or risk missing the field trips. - Students must participate in all daily activities. - Students must wear ACE/Solo Flight Academy T-shirt, appropriate shorts, slacks, jeans or skirts, tennis or sport type shoes and nametag everyday. - On field trips, we ll be in airport hangars, climbing in and out of airplanes and other types of activities, so, for your safety, no sandals or open toe shoes, no short shorts, short skirts, baggy oversized style jeans, and no facial jewelry such as nose or eyebrow rings. - Parents must sign Students IN and OUT of the academy daily. Students are not allowed to leave early without prior coordination between parents and ACE/ Solo Flight program directors. - Students must use the sponsor-provided transportation for field trips. SAFETY TIPS - This is a fast-paced week Pay attention to what is going on around you. - Watch out for sharp objects around aircraft/equipment--especially at eye level. - Take care entering and exiting: 1. Bus 2.Aircraft 3. Other facilities. - Your Academy Directors and designated Flight Instructors will brief you on all special emphasis safety items for the day. Pay close attention to these briefings and abide by all of the rules to ensure maximum safety. Reckless behavior will not be tolerated. - Our Academy Coordinators have designed the week of activities to ensure your safety throughout the academy; however, you are ultimately responsible for your own safety and assuring you have a safe week. I have read and understand all of the information listed above, and I agree to follow all student guidelines and safety tips while attending the ACE Academy. Student Name Signature/ 6

7 OBAP would like to enroll the graduates of our /Solo Flight Academy in our ACE/SFA Membership category. The purpose is to track the progress of our graduates toward their career goals. The membership is free until the students reach age 18. Students over 18 may elect to join OBAP in the Student category for $25 per year until reaching the age of 23. All information will be kept confidential. I consent to having my child become an ACE or SFA member of OBAP _. I do not wish to have my child become a member of OBAP. Disclaimer: The undersigned ("Participant") hereby acknowledges that he/she has voluntarily chosen to participate in the summer ACE or Solo Flight Academy sponsored by the Organization of Black Aerospace Professionals' ("OBAP"). Participant acknowledges and understands that the OBAP summer ACE or Solo Flight Academy will involve strenuous physical activity that could potentially be dangerous or harmful. Participant has chosen to participate in the Academy voluntarily, with the full knowledge of this potential danger and harm. By signing this document, the Participant represents and warrants that he/she does not have any physical condition which could be aggravated or worsened by strenuous physical activity or stress. In consideration of OBAP permitting Participant to participate in this summer ACE or Solo Flight Academy, Participant waives all claims, demands, actions, causes of action, and liabilities of any kind or nature, whether based in law or in equity, against OBAP, including without limitation, its parent and its successors, subsidiaries and affiliates ("Affiliated Companies") arising out of or in any way related to the OBAP summer ACE or Solo Flight Academy or Participant's participation in the event, including without limitation claims for physical or other personal injury ("Claims"). Participant releases OBAP and its Affiliated Companies from such Claims, regardless of when such Claims arise or when Participant discovers any injury or damage that does or may give rise to such Claims. I hereby give consent for my child/youth to participate in the 2017 OBAP Summer Academy and travel on all field trips. (Please initial one of the blanks) ACE Solo Mother/ Guardian s Signature Print Name Father/ Guardian s Signature Print Name 7