Summer 2017 Education and fun at Penn State Altoona for kindergarten through 9th grade. June 26-30 Fun with S.T.E.A.M. (Entering grades 4-6)... 4 Lego Mindstorms Robotics Camp (Entering grades 4-6)... 4 New Technologies (Entering grades 6-9)... 5 Science of Star Wars (Entering grades 6-9)... 5 Space Camp (Entering grades 2-4)... 3 Strategies for Success: Brain Power (Entering grades 2-4).. 3 Universal Gaming (Entering grades 4-6)... 4 Summer 2017 Calendar of Camps July 17-21 continued Everything Pokemon (Entering grades K-1)... 2 Games Galore (Entering grades 2-4)... 3 Minecraft with Ceramics (Entering grades 4-6)... 4 Minecraft: Mental Blocks (Entering grades 4-6)... 3 Lego EV3 Robotics (Entering grades 6-9)... 5 Railroad Engineering (Entering grades 6-9)... 5 Sense-ational Endeavors (Ages 4-12)... 2 July 10-14 Around the World (Entering grades K-1)... 2 Around the World (Entering grades 2-4)... 3 Cupcake Creations (Entering grades 2-4)... 3 Faces of the Past: Vikings (Entering grades 4-6)... 4 Road Trip with Ceramics (Entering grades K-1)... 2 Science Makes Art (Entering grades 6-9)... 5 Space Camp (Entering grades 4-6)... 3 July 17-21 Dr. Seuss on the Loose (Entering grades K-1)... 2 Dr. Seuss on the Loose (Entering grades 2-4)... 3 July 24-28 Brain Power: Keys to Success (Entering grades 4-6)... 4 Digging Into Dinosaurs (Entering grades K-1)... 2 The Great Outdoors with Ceramics (Entering grades 6-9)... 5 Junior Engineers (Entering grades 4-6)... 4 Minecraft: Mental Blocks (Entering grades 2-4)... 3 Pinterest Creations (Entering grades 4-6)... 4 Pinterest Creations (Entering grades 6-9)... 5 Spectacular Science (Entering grades 2-4)... 3 You be the Scientist (Entering grades K-1)... 2 All camps are conducted at Penn State Altoona, 3000 Ivyside Park, Altoona, PA 16601. Campers staying all day should bring a lunch each day. Supervision is provided and campers are walked to and from camps. Penn Mont Academy Childcare at Penn State Altoona Summer Camps Children ages 3-6 explore topics in science, music, art, dramatic play, language arts, and math. For more information, contact the Penn State Altoona location at 814-949-5439 or the main office 814-696-8801.
Camp Details Early Bird Discount: Register by May 12, 2017 and receive a 10 percent discount on your entire bill. All early bird registrations must be received or postmarked by May 12, 2017 for the discount. Please mark the appropriate box on the registration form. Scholarships: Scholarship money is limited and will be awarded on a first-come, first-served basis based on financial need. Each child in a family may attend one camp on a scholarship; camp fee not to exceed $200. Please complete registration form on page 6 and the scholarship application on page 8. Deadline for applying is Friday, May 19, and applicants will be notified of scholarships by the week of May 22. Program Expectations/Releases: Children are expected to respect and be courteous to one another and all staff members. Disruptive behavior such as hitting, biting, name-calling, and destruction of property will not be tolerated, nor will behavioral problems. These behaviors will be handled as follows: Incident 1-warning and discussion with student; Incident 2-parent discussion; and Incident 3- student will be withdrawn from the camp. Limited Enrollment: Enrollment is limited to ensure quality. Register early to ensure a place in the camp that fits your plans. The University may cancel or postpone any camp because of insufficient enrollment or unforeseen circumstances. No refunds are given after the first day of camp. To Register or For More Information: Register online at altoona.psu.edu/kids; in person at the Continuing Education Office, 1431 12th Avenue, Altoona, PA 16601; FAX to 814-863-2765; or mail the registration form beginning on page 6 to Penn State, Noncredit Registration Office, PO Box 410, State College, PA 16804. For more information call 814-949-5535 or 1-800-848-9843. Entering Grades K 1 Bring a lunch and stay all day by registering for two half-day camps. After Care Camp $25 MTWRF, 3:30-5:30 p.m. Session 1-July 10-14 Session 2-July 17-21 Session 3-July 24-28 Can t be here for pick up after camp? No problem. Register for after care. Counselors will escort your child from their afternoon camp to after care. Campers are provided an afternoon snack and opportunity to participate in a daily craft project along with board games, books and art supplies. Under counselor supervision, campers will spend some time outside each day (weather permitting) exploring the beautiful campus or playing games. Before Care Camp $25 MTWRF, 7:30-9:30 a.m. Session 1-July 10-14 Session 2-July 17-21 Session 3-July 24-28 Need to drop your child off at camp before 9:30 a.m.? Plan to attend before care camp. Campers will have the opportunity to participate in a daily craft project. Board games, books, and art supplies are available each day. Under counselor supervision, campers may spend some time outside each day (weather permitting) exploring the beautiful campus or playing games. Campers will be provided a snack and be escorted to their morning camp each day. 2 Penn State Altoona Continuing Education Around the World $125 MTWRF, 9:30 a.m.-noon, July 10-14 Get your passport ready and come along with me on our trip around the world. Each day we will immerse ourselves in a new country s culture, play games, taste foods, learn songs, make crafts, and so much more! Get ready for an adventure of a lifetime! Digging into Dinosaurs $125 MTWRF, 9:30 a.m.-noon, July 24-28 Instructor: Veronica Berry Get ready to sink your teeth into the giant land of dinosaurs as we explore the life of the T-Rex, triceratops, stegosaurus, and more. We will dig like paleontologists, make our very own fossils, and even hatch some dinosaur eggs. This is an expedition that you don't want to miss, so join us as we go digging into dinosaurs. Dr. Seuss on the Loose $125 MTWRF, 9:30 a.m.-noon, July 17-21 "The more that you read, the more things you will know. The more that you learn, the more places you'll go." -Dr. Seuss Join me for a week of adventurous fun and learning the Dr. Seuss way! We will explore a new Dr. Seuss book each day and complete various crafts, games, activities, and make snacks that go along with the book theme. Don't miss out on this Seussical week of fun! Everything Pokemon! $125 MTWRF, 1:00-3:30 p.m., July 17-21 Instructor: Veronica Berry Who doesn't want to catch them all? Join us as we spend our days looking for Pokemon, making Pokemon crafts, playing Pokemon games and more. You'll have so much fun, you'll think you have just became the next Pokemon master. Road Trip with Ceramics $185 MTWRF, 1:00-3:30 p.m., July 10-14 Instructor: Kathy Brua Be ready this summer for your next road trip! This week we will be teaching ceramic paint and hand sculpting with air drying clay. We will be painting some fun games to play in the car including tic tac toe, finger twister, and don't forget the punch car bank to save up for your road trip. We will have fun making a tote bag to store your games in, learn finger weaving, and so much more! Be ready for your next road trip! You Be the Scientist $125 MTWRF, 1:00-3:30 p.m., July 24-28 Instructor: Kathy Brua Have you ever thought that being a scientist was cool? Do you like to do experiments and get messy? Have you ever wondered why there was a cold spot while swimming? If you answered yes to any of the questions, then this camp is for you! Come join your fellow scientist to create cave icicles, gooey oobleck, lava, bouncy balls, lava lamps, and much more. Each child will record their hypothesis, findings, and recipes throughout the week.
Entering Grades 2 4 See page 4 for more camps. Bring a lunch and stay all day by registering for two half-day camps. After Care Camp $25 MTWRF, 3:30-5:30 p.m. Can t be here for pick up after camp? No problem. Register for after care. Counselors will escort your child from their afternoon camp to after care. Campers are provided an afternoon snack and opportunity to participate in a daily craft project along with board games, books, and art supplies. Under counselor supervision, campers will spend some time outside each day (weather permitting) exploring the beautiful campus or playing games. Before Care Camp $25 MTWRF, 7:30-9:30 a.m. Having trouble dropping your child off at camp in the morning? Don t worry, we have you covered. Plan to attend before care camp. Campers will have the opportunity to participate in a daily craft project. Board games, books, and art supplies are available each day. Under counselor supervision, campers may spend some time outside each day (weather permitting) exploring the beautiful campus or playing games. Campers will be provided a snack and be escorted to their morning camp each day. Games Galore $135 MTWRF, 9:00 a.m. noon, July 17-21 Instructor: Melissa Dively Game on! Who doesn t love to play games? Campers will have the opportunity to play various types of games. Game shows we will play and create them ourselves. Board games you will have opportunities to bring in your favorites and teach others how to play. You will even get the opportunity to create your own board game to play and take home. Like to get physical? We will spend some time outside each day (weather permitting) competing in physical games, relays, and obstacle courses. Too hot outside? Don t worry, we have a few water games that are sure to cool you off! We will even play a few sports that are probably familiar to you. Join us for a week of fun! Around the World $135 MTWRF, 1:00-4:00 p.m., July 10-14 Get your passport ready and come along with me on our trip around the world. Each day we will immerse ourselves in a new country s culture, play games, taste foods, learn songs, make crafts, and so much more! Get ready for an adventure of a lifetime! Cupcake Creations $135 MTWRF, 9:00 a.m.-noon, July 10-14 Instructor: Kathy Brua Become a baker for the week! Come learn the basics of cake decorating through this fun filled week of cupcakes. Campers will fill their own cupcakes, learn piping techniques, make cake pops, and decorate cupcakes beyond their wildest imagination. Bakers will learn about baking supplies and the tools used to make our creations. We will even make a few cupcake crafts throughout the week as well. Bring your creativity and appetite for a week full of cupcake creations. Dr. Seuss on the Loose $135 MTWRF, 1:00-4:00 p.m., July 17-21 The more that you read, the more things you will know. The more that you learn, the more places you'll go." -Dr. Seuss Join me for a week of adventurous fun and learning the Dr. Seuss way! We will explore a new Dr. Seuss book each day and complete various crafts, games, activities, and make snacks that go along with the book theme. Don't miss out on this Seussical week of fun! Minecraft: Mental Blocks $135 MTWRF, 1:00-4:00 p.m., July 24-28 Instructor: Eric Kincaid Minecraft is the digital sandbox where the only limit is your creativity. Campers will have the opportunity to experience the very best puzzles the Minecraft community has to offer. Campers will work in teams to solve puzzles and maneuver obstacles. Teams will compete for prizes throughout the week. Space Camp $135 MTWRF, 9:00 a.m.-noon, June 26-30 Instructor: Sarah Barr Get ready to blast off into some fun! We will learn all about our solar system and the things that make it so cool. Do you want to learn more about astronauts and explore the galaxy? Do you ever wonder what it would be like to live on another planet? These are just some of the questions answered during our fun week. There are lots of experiments to try and crafts to make so get ready to get messy! Spectacular Science $135 MTWRF, 9:00 a.m. noon, July 24-28 Instructor: Melissa Dively If you love experiments, exploration, and engineering, you will enjoy this camp. We will learn about astronomy, physics, chemistry, meteorology, geology, and biology. We will create projects to learn about space. We will build simple machines to study physics and we will create various concoctions including oobleck, gak, and even ice cream to learn about chemistry. Plan to be a meteorologist? We will learn and discover about weather phenomenons. We will even discover more about the earth and rocks with the study of geology. Strategies for Success: Brain Power $135 MTWRF, 1:00-4:00 p.m., June 26-30 Instructor: Adam Plucinski Come and learn to be a well-rounded student. Enjoy daily nature walks, games, painting, and more. Exercise your brain with activities designed to increase brain power! Unlock the power of your brain through natural discover, classification exercises, creativity, and more. Sense ational Endeavors $135 (For children with Autism Spectrum Disorders) MTWRF, July 17-28 Instructor: Kim Parker Session 1 (Ages 4 7) 9:30 a.m.-noon Session 2 (Ages 8 12) 1:00-3:30 p.m. Sensory integration is an important tool in facilitating learning and sensory processing in children with Autism Spectrum Disorders. A combination of sensory experiences including touch, sight, sound, smell, taste, and bodily movement promote learning in new and exciting ways. This camp provides sensory activities that allow children with disabilities to explore, engage, and create using their six senses. The structured activities provide a variety of sensory experiences including physical movement, arts and music, and social skill development. Activities are modifiable for each child and his or her abilities, skills, and strengths. Children can traverse old barriers in a comfortable environment while finding new opportunities for mastery, success, and fun! Families/caregivers are invited to attend on the last day of camp. Summer 2017 Kids College 3
Entering Grades 4 6 Grades may vary per camp. See pages 3 and 5 for more camps. Bring a lunch and stay all day by registering for two half-day camps. After Care Camp $25 MTWRF, 3:30-5:30 p.m. Can t be here for pick up after camp? No problem. Register for after care. Counselors will escort your child from their afternoon camp to after care. Campers are provided an afternoon snack and opportunity to participate in a daily craft project along with board games, books, and art supplies. Under counselor supervision, campers will spend some time outside each day (weather permitting) exploring the beautiful campus or playing games. Before Care Camp $25 MTWRF, 7:30-9:30 a.m. Having trouble dropping your child off at camp in the morning? Don t worry, we have you covered. Plan to attend before care camp. Campers will have the opportunity to participate in a daily craft project. Board games, books, and art supplies are available each day. Under counselor supervision, campers may spend some time outside each day (weather permitting) exploring the beautiful campus or playing games. Campers will be provided a snack and be escorted to their morning camp each day. Fun with S.T.E.A.M $135 MTWRF, 9:00 a.m.-noon, June 26-30 Instructor: Kelly Grassmyer Do you like to have fun while learning? If so, then Fun with S.T.E.A.M is for you. You will get hands-on activities that will involve Science, Technology, Engineering, Arts, and Mathematics. During the week-long camp, you will be challenged to solve problems in creative ways. Campers will discover how things work, build problem solving skills, improve critical thinking skills, and engage in real world problems. Some of the projects include building a raft, creating a windpowered coach, building a bridge, making a cylinder flier, and creating a parachute. Brain Power: Keys to Success $135 MTWRF, 1:00-4:00 p.m., July 24-28 Instructor: Adam Plucinski Exercise your brain with activities designed to increase brain power! Unlock the power of your brain through natural discover, classification exercises, painting and more. Junior Engineers $135 MTWRF, 9:00 a.m.-noon, July 24-28 Instructor: Jennilynn Vallejera, Jordan Sell, Adam Ross Plucinski How does engineering affect you and your surroundings? Is engineering all numbers or can it be fun? Campers will be introduced to a variety of engineering disciplines through amusement park themed projects. We will introduce topics in civil, electrical, mechanical, and computer engineering. Throughout the week, campers will build a bridge, make a water filtration system, program signals for a park ride, and build a roller coaster. The camp closes out with a Rube Goldberg class project that friends and family are invited to attend and watch the final demonstration. What s the Rube Goldberg project s objective? Come to camp to find out! Lego Mindstorms Robotics Camp $135 MTWRF, June 26-30 Section 1: 9:00 a.m. noon, $135 Section 2: 1:00 4:00 p.m., $135 Instructor: Timothy Dzurko Using the LEGO Mindstorms Robotics Invention System, teams of participants will learn to design their own robot inventions in this hands-on workshop. Learn to combine Legos, motors, sensors, and computer software to create moving robots that react to light, avoid obstacles, and do amazing things. Minecraft: Mental Blocks $135 MTWRF, 1:00-4:00 p.m., July 17-21 Instructor: Eric Kincaid Minecraft is the digital sandbox where the only limit is your creativity. Campers will have the opportunity to experience the very best puzzles the Minecraft community has to offer. Campers will work in teams to figure out these obstacles. Prove your worth and your team will have the opportunity to design and build your very own Minecraft puzzles for the other teams to play. Who are the masters of design and who can't be stumped? Only some well-placed blocks will decide. Minecraft with Ceramics $195 MTWRF, 9:00 a.m.-noon, July 17-21 Instructor: Kathy Brua How fun would it be to create your own Minecraft ceramics? We will be painting a square pencil holder, creeper mug, Steve face plate and TNT tile, as well as hand-sculpting a clay pig. We will also be painting a canvas Minecraft wall! Love Minecraft this camp is for you! Space Camp $135 MTWRF, 9:00 a.m.-noon, July 10-14 Instructor: Sarah Barr Get ready for all things space! In this camp, we will create, discover, experiment, and have fun learning about outer space.! Do you ever wonder what it would be like to live on another planet? Or why there are craters on the moon? Do you want to be an astronaut someday? If these questions spark your interest, then this is the camp for you. There are so many topics to cover and so much to do. Don t be afraid to get a little messy while learning. Pinterest Creations $160 MTWRF, 9:00 a.m.-noon, July 24-28 All the crafts made in this camp can be found on the popular website Pinterest. We will create, paint, duct tape, design, eat, and have lots of fun. So if you are ready to try something new and go home each day with an awesome new craft, then this is the camp for you! Universal Gaming $135 MTWRF, 1:00-4:00 p.m., June 26-30 Instructor: Justin Barr Whether we re button mashing our controllers, planning six moves ahead for checkmate, or playing tag outside with a group of neighborhood friends, we re still playing a game. Games have been around for centuries, and during this week of camp, we will delve into the history, strategies, and actual game play of a wide variety of games and game types. If you love to play games, then you will certainly want to come join this week of camp. Visit with Vikings: Faces of the Past $135 MTWRF, 1:00-4:00 p.m., July 10-14 Instructor: Veronica Berry Visit the Vikings by becoming one yourself! Learn how they lived, what they wore, what type of art they had, and what they ate. Create your own Viking shield and broach, play Viking games, learn the Viking alphabet, and maybe even try out some Viking war face paint. 4 Penn State Altoona Continuing Education
Entering Grades 6 9 Grades may vary per camp. See page 5 for more camps. Bring a lunch and stay all day by registering for two half-day camps. After Care Camp $25 MTWRF, 3:30-5:30 p.m. Wondering how you will get here to pick up your child at 3:30 p.m.? Don t worry, we have you covered! Counselors will escort your child to after care following their afternoon camp. Campers will be provided an afternoon snack and have the opportunity to participate in a daily craft project. Board games, books, and art supplies are available each day. Under counselor supervision, campers will spend some time outside each day (weather permitting) exploring the beautiful campus or playing games. Before Care Camp $25 MTWRF, 7:30-9:30 a.m. Having trouble dropping your child off at camp in the morning? Don t worry, we have you covered. Plan to attend before care camp. Campers will have the opportunity to participate in a daily craft project. Board games, books, and art supplies are available each day. Under counselor supervision, campers may spend some time outside each day (weather permitting) exploring the beautiful campus or playing games. Campers will be provided a snack and be escorted to their morning camp each day. The Great Outdoors with Ceramics $195 MTWRF, 9:00 a.m.-noon, July 24-28 Instructor: Kathy Brua Come explore a week filled with hands on activities! We will be painting a ceramic camper bank, dinner plate, cereal bowl, fish, and we will also hand-sculpt with air drying clay. The fun doesn t stop there! We will be going on a nature scavenger hunt, make fireflies, leaf rubbings, and make nature paint brushes. Don t miss out on the fun of the great outdoors! Lego EV3 Robotics, $135 MTWRD, 9 a.m.-noon, July 17-21 Instructor: Eric Kincaid Using the LEGO Mindstorms Robotics Invention System, teams of participants will learn to design their own robot inventions in this hands-on workshop. Lego builders and programmers of all levels will learn to combine Legos, motors, sensors, and computer software to create moving robots that react to light, avoid obstacles, and do amazing things. New Technologies $135 MTWRF, 9:00 a.m.-noon., June 26-30 Instructor: Adam Plucinski Come enjoy a week filled with cuttingedge technology. Work with drafting software to design gears and make these designs come alive using a laser-engraver. Campers will be introduced to 3D printing while using the software to make puzzles and a miniature lion statute to take home. Pinterest Creations $160 MTWRF, 1:00-4:00 p.m., July 24-28 All the crafts made in this camp can be found on the popular website Pinterest. We will create, paint, duct tape, design, eat, and just have lots of fun. So if you are ready to try something new and go home each day with an awesome new craft, then this is the camp for you! Railroad Engineering: From High-speed Rail to Heavy-haul Freight Transportation $135 MTWRF, 1:00-4:00 p.m., July 17-21 Instructor: Stephen Dillen and Brian Schlake Come learn the scientific design of railroad tracks, wheels, freight cars, and locomotives in this five-day camp. Explore how railroad track engineers design the grade and curvature to traverse a mountain, how mechanical engineers make the fastest and most energy efficient trains in the world, and how locomotives can pull heavy-haul freight trains weighing over 30 million pounds! Science of Star Wars $135 MTWRF, 1:00-4:00 p.m., June 26-30 Instructor: Veronica Berry A long, long time ago in a galaxy far away, people began to wonder if the things in the Star Wars movies were real or even possible. If you are one of these people, come discover for yourself, the science behind Star Wars. Find out what is real, or what isn't possible, all while creating your own replica light saber, conducting hands-on experiments and, of course, learning some trivia that will impress all of your friends. Science Makes Art $135 MTWRF, 1:00-4:00 p.m., July 10-14 Instructor: Jeff Barr The world is filled with beauty sometimes made by people and sometimes by nature. During this week of Kid s College, we ll be doing a little of both. Using physics, organic processes, and a few borrowed tricks from nature we will create art of all kinds. Are you ready to think differently, solve new problems, and make something special? If so, this class is for you. Girls Entering Grades 6-9 Girls Robot Invention $135 WRF, 9:00 a.m.-3:00 p.m., August 9-11 Instructors: Peggy Fisher Using the LEGO Mindstorms Robotics Invention System, teams of girls will learn to design their own robot inventions in this hands-on workshop. Learn to combine Legos, motors, sensors, and computer software to create moving robots that react to light, avoid obstacles, solve complex problems, and do amazing things. Test your creativity and critical thinking throughout the week while tackling several robot missions and challenges. This camp is designed to help students investigate and explore the field of Information Sciences and Technology. Bring a lunch each day. Call 814-949-5535 today to learn more about scholarship opportunities made possible in part by PS Solutions. Summer 2017 Kids College 5
Kids College Summer 2017 Registration Form Please print clearly. Penn State University Youth Program Health Services Medical Treatment Authorization This form must be completed and returned before youth camp/program/event enrollment dates in order for youth to be permitted to participate in any program activities. Personal Information Youth s Last Name First Name Birthdate M F Is your ethnicity Hispanic or Latino? Yes or No What is your race? Age Child s School Grade/Fall 17 SSN# or PSU ID Disclosure Statement The social security number you provide is for enrollment purposes. This number will be used by the university to verify your child s identity for official record keeping and reporting. Your SSN will be stored in a confidential repository, it will not be used as a primary source to identify your child within the Penn State system; the PSU ID will be used as the primary identifier. A PSU ID# will be assigned for the student and will be his/her ID# forever. It is your responsibility to retain that number for your records and safeguard its confidentiality. Any requests for childcare information for taxes or registrations for Kids College 2014 will need this PSU ID number, not the SSN. Address Home Phone Parent/Guardian Daytime Phone Place of Employment Health Insurance Carrier Plan Number Name of Family Physician In case of emergency, please notify: If neither parent nor guardian is available in an emergency, please contact: 1. Phone 2. Phone Drop-off and Pick-up Information: In the event that I cannot be reached or cannot pick up from camp, my child may be released to: 1. 2 I/we authorize Penn State Altoona personnel to photograph, videotape, and/or audiotape my/our child in promotion of Penn State s program and/or Investment Savings Bank Endowment fund. Yes No Health History [Please check and provide approximate dates that youth suffered from allergies and other conditions listed below] Allergies: Hay Fever Bee/Wasp Stings Insect Stings Penicillin Peanut Other Food/Drugs: Other: Asthma Diabetes Convulsions Concussion Behavioral/Emotional Other: Date of most recent tetanus immunization: Please list any major past illnesses (contagious and non-contagious): Please list any major operations or serious injuries (include dates): Has the youth ever been hospitalized? Does the youth have any chronic or recurring illness? Is there anything else in youth s health history that the program staff should know? Are there any activities from which the youth should be restricted? Are there any specific activities that should be encouraged? Does the youth have any special dietary restrictions? No Yes If YES, explain: Does the youth wear any medical appliances (glasses, contact lenses, orthodonture, etc.)? No Yes If YES, explain: Will the youth need to take any medication during the program? No Yes If YES, please list the specific prescription or over-the-counter medications below, reasons for medication, and daily dosage. If any medications change prior to arriving at the program, please provide an updated list upon arrival. Medication Reason(s) for Medication Daily Dosage/Time(s) Taken 1 2 3 4 City State Zip E-mail Address Parent/Guardian #2 Daytime Phone Place of Employment Policy Number Is physician authorization needed? Yes No Phone If at all possible, medication should be administered at home. Medications will be allowed at the Youth Program only when failure to take such medicine would jeopardize the health of a child and he/she would not be able to attend the Youth Program if the medicine were not made available. (Continuation to page 7) 6 Penn State Altoona Continuing Education
Penn State University Youth Program Health Services Medical Treatment Authorization Page 2 Youth s Last Name First Name Birthdate M F The parent(s)/legal guardian(s) of Youth Program participants are required to disclose their intention to bring medications to the Program, especially to treat potentially life-threatening conditions (i.e. inhalers, EPI-pens, insulin injections). Upon arrival to the Program, parent(s)/legal guardian(s) should plan to meet with a member of the Youth Program staff at registration to review medication issues for a Youth Program participant and complete additional required paperwork if not completed prior to arrival. For identification purposes, a current picture of the child is to be provided upon registration. All medications (prescription and over-the-counter) must be stored in the original product packaging and clearly labeled with the participant s name. Prescription medication(s) must also include a label with the medication s name and dosage instructions, as well as the prescribing physician s name and telephone number. All medications will be kept in a securely locked cabinet used exclusively for storage of medications. Medications that require refrigeration will be stored and locked in a refrigerator designated for medications ONLY. Access to all medications will be limited to approved personnel. The need for emergency medication may require that a Youth Program participant carry the medication on his/her person or that it be easily accessed (i.e. inhalers, EPI-pens, insulin injections). Penn State Youth Program staff will NOT purchase medications of any type (prescription or over-the-counter) for Youth Program participants of any age. If a Program has professional medical staff on-site, then the medical staff may administer over the counter medications (e.g., ibuprofen or Tylenol) supplied by the parent(s)/guardian(s) per package instructions. Medical staff may monitor the self-administration of medications, if necessary, upon written consent of the parent(s) and/or legal guardian(s) and/or physician orders. If there are no medical staff on-site, Penn State Youth Program staff will not dispense medications, but may monitor the self-administration of certain medications if necessary, ONLY upon written consent of the parent(s)/legal guardian(s) and /or physician s orders. It is NOT permissible for a participant to share any medications with any other participants. It is the responsibility of the parent(s)/legal guardian(s) to be sure that the participant s medications brought to the Youth Program are not left behind at the end of the Program. Failure to do so will result in the medications being destroyed within three working days after the participant s last day at the Program. Absolutely no medications will be returned via mail regardless of circumstance. I understand that all Youth Program participants are recommended to have a meningococcal vaccination prior to attending the program. I hereby authorize the clinical staff of University Health Services or other licensed practitioner of the healing arts, acting within the scope of his or her practice under State law, to provide medical care that includes routine diagnostic procedures (e.g., x-rays, blood and urine tests) and medical treatment as necessary to my minor daughter/ son/dependent. I understand that the consent and authorization herein granted does not include major surgical procedures and are valid only during the Youth Program/event. In the event that an illness or injury would require more extensive evaluation, I understand that every reasonable attempt will be made to contact me. However, in the event of an emergency and if I cannot be reached, I give my consent for physicians and staff at University Health Services or other licensed practitioners of the healing arts to perform any necessary emergency treatment. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes to the appropriate medical care provider. I understand that University Health Services does charge for services and that it is my responsibility to pay the bill if a claim can t be submitted by the University Health Services to my private insurance. As applicable, I may be responsible to submit any claims to my health insurance company for reimbursement. I authorize The Pennsylvania State University to receive medical/billing information and submit it to the University s insurance carrier. I understand that, unless specifically stated otherwise in the Penn State Youth Program/event literature, The Pennsylvania State University does not provide medical insurance to cover emergency care or medical treatment of my child. I understand that, in accordance with Youth Program policy, the medica on(s) should be given at home before and/or a er the Youth Program. However, when this is not possible, and medica ons will be brought to Youth Program camp, I agree to the provisions outlined above rela ng to the management of medica ons. HIPAA Penn State honors the privacy of the participants in its Programs and complies with the national regulations regarding health information. Follow this computer link to the University Health Services Notice of Privacy Practices. http://studentaffairs.psu.edu/health/welcome/confidentiality/noticeofprivacypractices.shtml Parent/ Legal Guardian Name (please print) Date: Parent/ Legal Guardian Signature * Terms and Conditions agreed to via electronic signature Revised January 21, 2015 (Continuation to page 8) Summer 2017 Kids College 7
Please register me for the camp(s) I have indicated with a checkmark: Camp Begin Date & Time Course# Fee Camp Begin Date & Time Sch # Fee After Care/Week 1 June 26, 3:30 5:30 p.m. EDUC 5084 $25 Lego EV3 Robotics 6-9 July 17, 1:00-4:00 p.m. CSE 5027 $135 After Care/Week 2 July 10, 3:30 5:30 p.m. EDUC 5084 $25 Minecraft with Ceramics 4-6 July 17, 9:00 a.m.-noon EDUC 5135 $195 After Care/Week 3 July 17, 3:30 5:30 p.m. EDUC 5084 $25 Minecraft: Mental Blocks 4-6 July 17, 1:00-4:00 p.m. CSE 5465 $135 After Care/Week 4 July 24, 3:30 5:30 p.m. EDUC 5084 $25 Minecraft: Mental Blocks 2-4 July 24, 1:00-4:00 p.m. CSE 5465 $135 Around the World K-1 July 10, 9:30a.m.-noon YTHPR5265 $125 New Technologies 6-9 June 26, 9:00 a.m.-noon YTHPR5260 $135 Around the World 2-4 July 10, 1:00-4:00 p.m. YTHPR5265 $135 Pinterest Creations 4-6 July 24, 9:00 a.m.-noon YTHPR5419 $160 Before Care/Week 1 June 26, 7:30 9:30 a.m. EDUC 5084 $25 Pinterest Creations 6-9 July 24, 1:00-4:00 p.m. YTHPR5419 $160 Before Care/Week 2 July 10, 7:30 9:30 a.m. EDUC 5084 $25 Railroad Engineering 6-9 July 17, 1:00-4:00 p.m. ENGR 9431 $135 Before Care/Week 3 July 17, 7:30 9:30 a.m. EDUC 5084 $25 Road Trip with Ceramics K-1 July 24, 1:00-3:30 p.m. EDUC 5135 $185 Before Care/Week 4 July 24, 7:30 9:30 a.m. EDUC 5084 $25 Science Makes Art 6-9 July 10, 1:00-4:00 p.m. EDUC 5041 $135 Cupcake Creations 2-4 July 10, 9:00 a.m.-noon H&SS 5320 $135 Science of Star Wars 6-9 June 26, 1:00-4:00 p.m. EDUC 7009 $135 Digging Into Dinosaurs K-1 July 24, 9:30 a.m.-noon EDUC 5033 $125 Sense-ational Endeavors Ages 4-7 July 17, 9:30 a.m.-noon YTHPR5331 $135 Dr. Seuss on the Loose K-1 July 17, 9:30 a.m.-noon YTHPR5373 $125 Sense-ational Endeavors Ages 8-12 July 17, 1:00-3:30 p.m. YTHPR5331 $135 Dr. Seuss on the Loose 2-4 July 17, 1:00-4:00 p.m. YTHPR5373 $135 Space Camp 2-4 June 26, 9:00 a.m.-noon SCIED 6045 $135 Everything Pokemon K-1 July 17, 1:00-3:30 p.m. C I 5802 $125 Space Camp 4-6 July 10, 9:00 a.m.-noon SCIED 6045 $135 Fun with S.T.E.A.M. 4-6 June 26, 9:00 a.m.-noon ENGR 5101 $135 Spectacular Science 2-4 July 24, 9:00 a.m.-noon CPHYS 7055 $135 Games Galore 2-4 July 17, 9:00 a.m.-noon YTHPR5390 $135 Strategies for Success Brain Power 2-4 June 26, 1:00-4:00 p.m. CWC 5027 $135 Girls Robot Invention 6-9 July 9, 9:00 am-3:00 pm CSE 5027 $135 Strategies for Success Brain Power 4-6 July 24, 1:00-4:00 p.m. CWC 5027 $135 Great Outdoors with Ceramics 6-9 July 24, 9:00 a.m.-noon EDUC 5135 $195 Universal Gaming 4-6 July 26, 1:00-4:00 p.m. YTHPR5417 $135 Junior Engineers 4-6 July 24, 9:00 a.m.-noon YTHPR5346 $135 Faces of the Past: Vikings 4-6 July 10, 1:00-4:00 p.m. HIST 5816 $135 LEGO Mindstorms Robotics 4-6 June 26, 9:00 a.m.-noon. CSE 5027 $135 You Be the Scientist K-1 July 24, 9:30 a.m.-noon SCIED5213 $125 LEGO Mindstorms Robotics 4-6 June 26, 1:00-4:00 p.m. CSE 5027 $135 M-Monday, T-Tuesday, W-Wednesday, R-Thursday, F-Friday Method of Payment Check enclosed made payable to Penn State Altoona Charge my ( ) MasterCard ( )VISA ( ) Discover ( ) American Express Account Number Exp. Date Print Cardholder s Name Cardholder s Signature Mail completed registration form with payment to Penn State University, Noncredit Registration Office, PO Box 410, State College, PA 16804 or fax your registration to 814-863-2765 if paying by credit card. Online registration is available at altoona.psu.edu/kids. Penn State encourages qualified persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Education and Training at 814-949-5535 in advance of your participation or visit. This publication is available in alternative media on request. Penn State is an equal opportunity, affirmative action employer, and is committed to providing employment opportunities to all qualified applicants without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. AAO 17-302 sra1 Scholarship Application (Complete the information below only if you are applying for a scholarship.) Scholarship money is limited and will be awarded on a first-come, first-served basis based on financial need. Each child in a family may attend one camp on a scholarship; camp fee not to exceed $200. Please select two choices for each child in order of preference. Deadline for applying is Friday, May 19 and applicants will be notified of scholarships by the week of May 22. Penn State Altoona s Office of Continuing Education offers sincere thanks to Investment Savings Bank and local donors who make these scholarships possible. 1st Choice Camp Title Date Time Fee 2nd Choice Camp Title Date Time Fee Number of adults in home Are you currently employed Are other adults in home employed Number of children in home Hours per week Hours per week Please check any of the situations below that apply to your family: Free School Lunches Reduced School Lunches Medical Assistance Other, please describe below Please indicate yearly family income below: 0 $5,000 $5,001 10,000 $10,001 15,000 $15,001 20,000 $20,001 25,000 Other (Please specify) 8 Penn State Altoona Continuing Education