WISEST (Women in Scholarship, Engineering, Science and Technology) 295 Central Academic Building www.wisest.ualberta.ca Tel: 780.492.1842 Edmonton, Alberta, Canada T6G 2G1 wisest@ualberta.ca Fax: 780.492.2990 Dear Teachers and School Administrators: Thank you for your interest in registering your Grade 6 girls at our 2015 Choices Conference! Please find conference and registration details below: CHOICES CONFERENCE DETAILS: WHO: Maximum of 4 grade six girls per school accompanied by a Teacher or Principal. Registration is on a first-come, first-served basis. WHERE: Opening session: Engineering Teaching and Learning Complex (ETLC) Lecture Theatre (1-001) Closing session: To be determined Please see www.ualberta.ca for excellent maps of the building location and parking facilities. TIME: COST: Registration: 8:30 a.m. to 9:00 a.m. in the ETLC foyer Conference Sessions: 9:00 a.m. to 2:45 p.m. $40.00 per student. No registration costs for the supervising teacher. Please provide a school cheque (payable to University of Alberta). REGISTER FOR THE CHOICES CONFERENCE: Step 1 - School Information Reserve your students seats by completing the 2015 Choices School Registration online at www.wisest.ualberta.ca. We will hold your reserved seats until you complete Step 2. Step 2- Student Information Now we need information about your students. Print a 2015Choices Student Group Information Package (enclosed and on website) and send it with your payment (cheques only please) so that it is received by WISEST no later than 4pm, Jan. 16 th, 2015. Please send it to: WISEST/CHOICES 295 CAB University of Alberta, Edmonton, Alberta T6G 2G1 **IF WE DO NOT RECEIVE YOUR STUDENTS INFORMATION AND PAYMENT BY JANUARY 16 TH YOUR STUDENTS S SEATS MAY BE ALLOCATED TO WAITLISTED SCHOOLS*** REMEMBER THAT SEATS ARE OFFERED ON A FIRST-COME, FIRST-SERVED BASIS NOTE: NO FAXED OR EMAILED REGISTRATION FORMS WILL BE ACCEPTED and registration fees will not be refunded after January 30 th, 2015. CONFIRMATION: Registrations are finalized only after the Choices Student Group Information Package and payment have been received by WISEST. Schools that do not submit the Choices Student Group Information Package before 4pm, Jan. 16, 2015 may lose their seats to waitlisted schools. Seats are limited and available only to eligible school districts (visit WISEST website to see if your school district is eligible). Schools on the waitlist will be notified of their status within one week of Jan. 16 th, 2015, and be given two weeks to submit additional forms and payment.
SUMMARY OF THE FORMS THAT MUST BE RECEIVED BY WISEST NO LATER THAN 4 PM, JANUARY 16, 2015 (all forms Included in the Student Group Information Package in Step 2 above): The forms that we require to finalize your registration are to ensure the safety of all participants and the success of the Choices Conference. All registered schools and teachers need to be aware of their responsibilities and the University of Alberta s expectations as outlined in these forms: 1) School Administrator Agreement: School Administrators need to acknowledge and agree to their responsibilities that are outlined in this document. This ensures proper communication with parents and that all students will have the appropriate documentation and advance preparation needed to attend the Choices Conference. 2) Informed Consent Agreements: Parents and/or guardians of the participants must be made aware that there are potential risks associated with their daughters participation in the Choices Conference. Each parent/guardian must provide consent for their daughter s presence at the University and indicate their acceptance and full understanding of all health and safety risks that may be associated with her participation. Please make parents aware of which day their daughter will be attending Choices as they will need to indicate this on this form. 3) Authorization to Reproduce Physical Likeness Voice and Name: The University of Alberta/WISEST requires the consent of parents/guardians of the Choices participants to use their personal images/voices for educational materials, publications, websites and other consistent purposes. Please photocopy and ask each parent/guardian to complete. The parent/guardian has the option of accepting or declining the authorization. 4) Payment Information Form: Payment for all students must be received before WISEST will confirm registrations for your students. Please issue payment via a check (payable to the University of Alberta) and note that we will not be issuing receipts prior to the conference. **You must have all of these forms to WISEST by 4 PM, January 16 th For your registration to the Choices Conference to finalized All registration procedures and forms can be found on the WISEST website www.wisest.ualberta.ca Call 780-492-7774 or email wisest@ualberta.ca with any questions
School Administrator Agreement 2015 Choices Conference Preferred Date of Visit (dd/mm/yy): Name of School: School Board: School Street Address: City: Province: Postal Code: Phone Number: Fax Number: Class Information Name of Supervising Teacher: Number of Students: Activities: All activities that pertain to WISEST s 2015 Choices Conference (including group activities, labs, hands-on science, engineering or technology workshops and listening to guest speakers) Locations to be Visited (include Building and Room): ETLC 1-001 and various classrooms and labs at the U of A north campus Please ensure that the principal of the above school reads and agrees to the following acknowledgements by signing below: 1. The school has ensured that the parents and/or guardians of the participants have given written permission for their child/children to visit the University of Alberta for the purpose as stated above and have signed the University of Alberta Informed Consent Agreement for Choices, 2015. 2. The school will ensure that the students will be sufficiently instructed in lab safety and personal safety, and/or field trip safety prior to the above visit to the University of Alberta, as per the safety information that WISEST will provide to confirmed schools. 3. The school has informed students and their parents / guardians that they will be required to walk/travel between different sites on campus to a maximum of five blocks. In some instances students will be going outside, so they should dress appropriately for the weather. 4. The school has advised students and their parents / guardians that there is no place for students to leave their backpacks and outerwear. As a result, they should be advised not to bring valuables and be prepared to carry their belongings. 5. The school will ensure that the students have sufficient supervision at the ratio required by the school s policy and agrees that the University of Alberta is not responsible for providing supervision/discipline. The University's only intention is to provide information and instruction to the students as per the request of the supervising teacher. 6. The school will provide the signed Student Informed Consent and Authorization to Reproduce Physical Likeness/Voice and Name for Educational, Marketing and Advertising Purposes by the January 16 th deadline, as outlined in WISEST s 2015 Choices registration procedures. (http://www.wisest.ualberta.ca/en/programs/choicesconference/howtoattend.aspx) Signed this day of, 20 at EDMONTON, ALBERTA. Name of Principal Signature of Principal Protection of Privacy - The personal information requested on this form is collected under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. It will be used for the purpose of implementing this Agreement. Direct any questions about this collection to: Manager, Insurance & Risk Assessment, 780.492.8886. Office of Insurance & Risk Assessment Revised: June 2011
Authorization to Reproduce Physical Likeness / Voice and Name For Educational, Marketing and Advertising Purposes WISEST Choices Conference 2015 PRINT - First and Last Name of Student Parent / Guardian Address of Student Telephone Number of Student Address of Parent or Guardian Telephone Number of Parent or Guardian REPRODUCTION RIGHTS I HEREBY GRANT TO THE UNIVERSITY OF ALBERTA, including its employees, agents, assigns, or other third party as the University may authorize on its behalf, the nonexclusive right to: Photograph my daughter Make recordings of my daughter s voice Make combined audio-visual recordings of my daughter and her voice Photograph and make recordings of my daughter s (specify - e.g. hands only) I DO NOT grant the nonexclusive right for any of the above to the University of Alberta I CONSENT TO THE USE OF THESE RECORDINGS BY THE UNIVERSITY OF ALBERTA for educational materials, publications and websites and other consistent purposes. I hereby assign and transfer to the University of Alberta all rights to these audio and visual recordings and all benefits and advantages to be derived there from. Editing, publication, distribution, broadcast and use of this material shall be at the sole discretion of the University of Alberta, worldwide, in perpetuity. Intended uses: 1. Promotional and advertising purposes, including newsletters, information brochures, PowerPoint presentations, video clips and the WISEST website. 2. Media (including, newspaper, radio, television) I DO NOT CONSENT to the use of these recordings for educational materials, publications and websites and other consistent purposes the nonexclusive right for any of the above to the University of Alberta. CONSENT TO DISCLOSE IDENTITY Student s identity, as indicated below, MAY MAY NOT be included in the resources listed below as developed and published in print, electronic, or digital format, including any authorized University of Alberta website, such as www.ualberta.ca. Consent takes effect when this agreement is signed. FIRST AND LAST NAME FIRST NAME ONLY SCHOOL OR BUSINESS Signature of Guardian (If Model is Under 18 Years of Age) Date Protection of Privacy - The personal information requested on this form is collected and protected under the authority of the Alberta Freedom of Information and Protection of Privacy Act, for the purpose of managing the Authorization of the Disclosure of Personal Information process. Questions concerning the collection, use and disposal of this information should be directed to WISEST at (780) 492-1842. This form will be placed on file in the coordinating office and retained in accordance with approved records retention schedules.
WISEST (Women in Scholarship, Engineering, Science and Technology) 295 Central Academic Building www.wisest.ualberta.ca Tel: 780.492.1842 Edmonton, Alberta, Canada T6G 2G1 wisest@ualberta.ca Fax: 780.492.2990 I N F O R M E D C O N S E N T A G R E E M E N T, C H O I C E S 2 0 1 5 The University of Alberta provides on-campus educational, work and volunteer opportunities for students, such as the Choices Conference for grade 6 girls on Tuesday, February 17 h, 2015 or Wednesday, February 18 th, 2015. The Choices Conference engages students by providing handson, supervised scientific experiments, guest speaker presentations and a large group activity. Name of Minor: Print Name of Student Participant Name of School Student Participant Attends: Description of U of A Program: Choices Conference a science, engineering & technology experience for grade 6 girls Location of activities: Various classrooms and laboratories at the University of Alberta Student Participating In Choices Conference on (please check appropriate date): Tuesday, February 17 th, 2015 Wednesday, February 18 th, 2015 DISCLAIMER The Governors of the University of Alberta, Women in Scholarship, Engineering, Science and Technology, their officers, directors, employees, volunteers, members and representatives (hereafter referred to as The University ) are not responsible for any death, injury, loss or damage of any kind suffered by any person while participating the CHOICES Conference and all related activities, unless such death, injury or loss or damage was caused by the sole negligence of the University. ASSUMPTION OF RISKS The CHOICES Conference activities include but are not limited to: simple scientific experiments, guest speaker presentations, and small group discussions. The University of Alberta strives to provide a healthy and safe work environment. Although the minor will be supervised at all times, there are inherent hazards and risk in the workplace. These include the following: 1. Laboratory Setting: injury, incidents or property damage resulting from participating in simple science, engineering and technology hands-on experiments. 2. Other Settings: injury, incident or property damage resulting from the misuse of workplace equipment (mechanical, electrical, physical) located in any area of the University. ACCEPTANCE OF RESPONSIBILITIES CHOICES Conference participants will contribute to the health and safety of those participating by being aware of inherent risks associated with the activities and will avoid undue risks and dangers. My child will be instructed by me to follow the instructions given on safe participation in activities including but not limited to safe work procedures, emergency protocol and other policies and procedures to ensure their safety and the safety for their self and others. By signing this document the parent/guardian agrees that the minor will: 1. Follow all applicable University procedures, including those pertaining to health, safety, and the environment. 2. Participate in all required training, wear required personal protective equipment, report incidents, injuries and unsafe conditions, and follow all emergency procedures as necessary. The minor or his/her parent/guardian also agrees to inform the University of a Pre-existing Medical Condition if it may increase the risks normally associated with certain activities at the University. PARENT/LEGAL GUARDIAN I, the undersigned, declare that I am the parent or legal guardian of the minor identified herein. I agree to inform the minor of the guidelines and requirements pertaining to this University program. I CONSENT to this minor s presence at the University and I ACCEPT AND FULLY UNDERSTAND all health and safety risks that may be associated with his/her participation. Upon the University s request, I AGREE to remove the minor from campus should he/she refuse to follow the University s instructions or knowingly commit an environmental or health and safety infraction. Printed Name of Parent or Guardian Signature of Parent or Guardian Telephone Number at work Telephone Number at home or cell phone Protection of Privacy - The personal information requested on this form is collected under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. It will be used for the purpose of implementing this waiver. Direct any questions about this collection to: Grace Ennis, WISEST Coordinator, at 780.492.1842 OFFICE OF INSURANCE & RISK ASSESSMENT OCTOBER 2010
WISEST (Women in Scholarship, Engineering, Science and Technology) 295 Central Academic Building www.wisest.ualberta.ca Tel: 780.492.1842 Edmonton, Alberta, Canada T6G 2G1 wisest@ualberta.ca Fax: 780.492.2990 2015 Choices Payment Information Form School: School District: Teacher contact: Teacher Contact Phone: Teacher contact email: Registration Payment (No GST is required): Number of students x $40.00 per student = (Payment must be submitted with Student Group Registration Information Package) Cheque enclosed (payable to the University of Alberta) We will not be accepting credit cards this year due to limited capacity to process them. If you need to arrange for an alternate form of payment other than cheque, please call us at 780-492-1842. NOTE: RECEIPTS WILL BE ISSUED TO TEACHERS/PRINCIPALS WHO ATTEND THE CONFERENCE IN THEIR WELCOME PACKAGE. OFFICE OF INSURANCE & RISK ASSESSMENT OCTOBER 2010