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Get excited for

GEARS Summer Camp

Want to explore occupations in the skilled trades?


Or, are you interested in a STEM-related career?
Connect with other like-minded female students.
Experience the trades with hands-on learning.
Hands-on experience while you learn from trade professionals.
Skills are beneficial to learn and applicable to everyday life.
No cost to attend; lunch is provided every day.
Who: Girls (ages 1417)
Location: M-TEC, 60 Livingston Blvd., Gaylord
Dates: 6/20-6/23
Time: 9:00 AM-3:00 PM
Questions or to register TODAY: mtec@kirtland.edu, (989)705-3600
Limited seats available.

www.kirtland.edu

@kirtlandcc

2016 GEARS SUMMER CAMP


June 20 23, 2016
APPLICATION FORM
First Name: _______________________________ Last Name: ___________________________________
Date of Birth: ________________ Home Phone: ___________________ Cell Phone: ________________
Street: ________________________________ City: __________________ State: _____ Zip: __________
Grade Entering Fall 2016: _____ School Name: ________________________ Year of Graduation: ______
Parent/Guardian Email Address: __________________________________________________________
T-Shirt Size (Adult) ___Small ___Medium ___Large ___XL ___XXL ___XXXL
Lunch will be provided all week. (If there are any allergies, please let us know.)
Student Health Concerns: ________________________________________________________________
_____________________________________________________________________________________
NO Camp Registration fees
Return Registration form to:
Kirtland M-TEC, Attn: Luann Mabarak
60 Livingston Blvd.
Gaylord, MI 49735
Or email: mtec@kirtland.edu
Parent/Guardian Name: _________________________ Day Phone: _____________ Cell: _______________
Parent/Guardian Address if different that student: ________________________________________________
Emergency Contact Name: ___________________________________ Phone: ___________________
Participant Liability Agreement: By signing below, participant (or parent/guardian if participant is a minor)
acknowledges and accepts the risks of physical injury associated with participation in the activity described above.
Except for gross negligence on the part of sponsors, participant (or parent/guardian) accepts personal financial
responsibility for any injury sustained during the activity. Further, participant (or parent/guardian) promises to hold the
sponsoring organizations and their representatives harmless for any injury sustained during the time involved for the
activity. If a dispute over this agreement or any claim for damages arises, participant (or parent/guardian) agrees to
resolve the matter through final and binding arbitration.
___ I Agree ___I Disagree
Photo/Video Release: You have my permission to take pictures or video of me (or my child/ward) for future publicity
purposes related to the camp: ___Yes ____No
Medical Authorization: Is the participant covered by health insurance? ___Yes ___No
If yes, name of insurance provider: _________________________________ Policy/Group Number: _________________
Is Kirtland Community College authorized to approve medical treatment? ___Yes ___No

Parent/Guardian Signature: ____________________________________ Signature Date: __________