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THE ATLANTA CENTER FOR CREATIVE INQUIRY SUMMER ACADEMY
Registration Application Kennesaw
Academy, June 1 - 5, 2020
PARTICIPANTS MUST SHOW PROOF OF MEDICAL INSURANCE TO PARTICIPATE
TO BE COMPLETED BY PARENT OR LEGAL GUARDIAN.
Please print in ink or type, and be careful not to skip any sections of this form, as all sections are required for registration. Prepayment, in full, is required to reserve your space. Return the completed application to [email protected] no later than Saturday, May 30, 2020.
STUDENT INFORMATION Male Female
Last name First name Middle initial
Birth date (month/day/year) Age
Home Mailing Address (No. and Street, or PO Box No.)
City State ZIP Code Country
Home Phone No.
Special dietary needs/accommodations - you may want to send your child's lunch:
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PARENT/LEGAL GUARDIAN INFORMATION
Parent’s/Legal Guardian’s last name First name
Email address of Parent/Legal Guardian
The Atlanta Center for Creative Inquiry Summer Academy will use this email address to communicate logistical information regarding the Summer Academy.
Daytime phone no. Home phone no. Cell phone no.
Academy Participant Pickup: Name of person who will be picking up the student.
Name Phone no. Relationship to participant
This Summer Academy is available to high school students only (entering 8th grader throughjust-graduated senior).
Student’s grade next fall (check one):
Entering 8th grade in fallEntering 9th grade in fallEntering 10th grade in fallEntering 11th grade in fallEntering 12th grade in fall2016 high school graduate
Each camp participant will have exposure to both architecture, engineering and landscapearchitecture. Please express the area of greatest interest to the participant:
ArchitectureLandscape ArchitectureEngineering
T-shirt size (T-shirt provided at on-site registration at no additional cost.):
S M L XL XXL
(If no size is indicated, the participant will receive a large T-shirt.)
Release I/We, the undersigned, individually and as parent(s) or legal guardian(s) of
, a minor, ask that he/she be admitted to participate in this Summer Academy sponsored by The Atlanta Center for Creative Inquiry. In consideration of such admission, I/we do hereby agree to release, discharge, and hold harmless The Atlanta Center for Creative Inquiry, its Officers, Agents, and employees of and from all causes, liabilities, damages, claims,
Registration Form - Continued
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or demands whatsoever on account of any injury or accident involving the said minor arising out of the minor’s attendance at the camp or residence in the course of activities held in connection with the camp.
Additionally, I authorize The Atlanta Center for Creative Inquiry Summer Academy to photograph, videotape, and/or audiotape my child in promotion of the Atlanta Center for Creative Inquiry Summer Academy.
I/We have reviewed the Standards of Conduct (attached) with my child, who agrees to follow this code.
Signature (At least one is required to complete registration.)
Parent’s/Legal Guardian’s signature Date
Field Trip Permission I/We give permission for my/our child to participate in the following field trips: construction site visits located on the Kennesaw State University campus and/or local vicinities. Note: Participants are towear long pants, hard-soled closed-toe shoes (no sneakers or sandals, for example) and shirts with 4-inch sleeves, minimum length, when visiting a construction site.
Yes No
Signature (At least one is required to complete registration.)
Parent’s/Legal Guardian’s signature Date
Registration Fee $150 fee per participant (on or before March 31, 2020)$200 fee per participant (on or after May 1, 2020)
Method of Payment To make your payment go to https://www.diversitycomplete.com/acci/summer-academy/ using Visa, MasterCard, Discover or American Express.
Health Form and other other Information
The next two pages contain the Health Form and must be completed and returned with the registration form.
Also attached is the Academy’s Standards of Conduct and Frequently Asked Questions (FAQ).
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THE ATLANTA CENTER FOR CREATIVE INQUIRY SUMMER ACADEMY Health Form
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 Participant’s Last Name First Name Birthdate ___ M F Specify program your child will be attending Address City State Zip Home Phone E-mail Address Parent/Guardian #1 Parent/Guardian #2Daytime Phone Daytime Phone Place of employment Place of employment Health Insurance Carrier Policy Number Plan Number Is physician authorization needed? Yes NoName of Family Physician Phone
In case of emergency, please notify If neither parent nor guardian is available in an emergency, please contact: 1. Phone
2. Phone
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 the Participant’s health history that the Academy’s staff should know? Are there any activities from which the Participant should be restricted? Are there any specific activities that should be encouraged? _ Does the Participant have any special dietary restrictions? NO Yes If YES, explain:
_ Does the Participant wear any medical appliances (glasses, contact lenses, orthodonture, etc.)? NO Yes If YES, explain:
Will the Participant 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
If at all possible, medication should be administered at home. Medications will be allowed at the Academy only when failure to take such medicine would jeopardize the health of a child and he/she would not be able to attend the Academy if the medicine were not made available.
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THE ATLANTA CENTER FOR CREATIVE INQUIRY SUMMER ACADEMY Health Form Page 2
Participant’s Last Name First Name Birthdate M F
The parent(s)/legal guardian(s) of participants are required to disclose their intention to bring medications to the Academy, especially to treat potentially life-threatening conditions (i.e. inhalers, EPI-pens, insulin injections). Upon arrival to the Academy, parent(s)/legal guardian(s) should plan to meet with a member of Academy staff at registration to review medication issues for the participant and complete additional required paperwork if not completed prior to arrival.
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 secure location and those that require refrigeration will be stored appropriately. Access to all medications will be limited to approved personnel. Academy staff will NOT purchase medications of any type (prescription or over-the-counter) for participants. With advance notice/permission, participants may carry emergency medication (i.e. inhalers, EPI-pens, insulin injections) on his/her person.
Academy 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 Academy 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 circumstances.
HIPAA The Atlanta Center for Creative Inquiry honors the privacy of the participants in its Programs and complies with the national regulations regarding health information.
Parent/ Legal Guardian Name (please print) Parent/ Legal Guardian Signature
Date: ____________________________ * Terms and Conditions agreed to via electronic signature
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THE ATLANTA CENTER FOR CREATIVE INQUIRY SUMMER ACADEMY Standards of Conduct
The following policies and guidelines have been developed to help you gain the maximum benefit from your summer experience at The Atlanta Center for Creative Inquiry Summer Academy. If you have questions about them, please talk to one of the program counselors. Failure to observe these standards may result in expulsion from the Academy. Any student dismissed from the Academy for disciplinary reasons will not receive a refund.
General Policies
If you are ill, see one of the program staff or counselors immediately.
Participants are to report on time to all scheduled activities.
Participants are required to participate in all scheduled activities. Only an Academy staffmember may grant permission to be excused.
Courteous and respectful behavior is expected at all times to all Academy staff andparticipants.
Participants are not permitted to leave the activity areas or go off the Academy campus unlessaccompanied or granted special permission by an Academy staff member.
Misuse or damage of Academy or university property is unacceptable. Charges will be assessedagainst participants responsible for damage or missing Academy or university property.
Cell phones and other electronic devices, including earbuds, may not be used/on during classor special sessions.
You must abide by the following regulations which prohibit the following:
Possession and use of alcohol or other drugs
Possession of fireworks, guns, and other weapons
Stealing
Violence of any kind (This includes sexual harassment.)
Tobacco products (Smoking is prohibited in all university buildings.)
Parking
If you drive a car to a summer the Academy, you must pay for parking and park in your assigned parking lot. Failure to do so may result in a parking fine.
Dismissal
Please keep in mind that during their classes at the university students are representing themselves, family, school, and community. While unacceptable conduct is not anticipated from participants, the Academy is prepared to deal with situations involving inappropriate behavior. The Atlanta Center for Creative Inquiry maintains the right to dismiss any student for improper conduct. Any student dismissed from the Academy will not receive a refund. A parent/guardian will be notified immediately and expected to pick up the participant.
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THE ATLANTA CENTER FOR CREATIVE INQUIRY SUMMER ACADEMY Frequently Asked Questions
QUICK REFERENCE EMERGENCY PHONE NUMBERS
EMERGENCY – CITY OF MARIETTA POLICE / FIRE / AMBULANCE ………………………………………………………………….……………………………911Kennesaw State Police – 24 Hour Emergency Contact………………………………………………………………………………………………….770-423-6666
Registered academy students and their parents will be given the Academy Director and staff’s work cell phone numbers during registration.
When does the camp begin and when should I register? The Academy is a one-week program that starts on June 4th and ends on June 8th. Registration is now open and is on a first-come, first-serve basis. Space is limited so return your application and make your payment today.
How do I register for the Academy? • Download a copy of the application at https://www.diversitycomplete.com/acci/summer-academy/• Complete the form and return to [email protected]• Pay your registration fees at https://www.diversitycomplete.com/acci/summer-academy/using Visa,
MasterCard, Discover or American Express
What happens after I register? Once you register and pay for the Academy, you will be sent a confirmation email to the address you entered with your registration. Additional Academy information will come to that same email address as the Academy dates get closer.
What does the cost of Academy include? Academy costs cover tuition, meals, healthy snacks and drinks, a t-shirt, and all Academy-specific project materials and supplies.
What insurance information do I need to provide? Each student is required to have proof of medical insurance on file. This information is requested on the registration form.
Can my child drive his/her personal vehicle to the Academy? Yes, students are allowed to drive to the Academy, but there is no free parking on campus. Students must park in a designated parking lot and pay the lot attendant.
When is Academy check-in?
Students are expected to be at the architecture building, Marietta and in his/her designated seat BEFORE 9am each morning.
Where is Academy check-in? The KSU Architecture and Construction Management building is located on the Stringer Loop off Polytechnic Lane (see map).
When is Academy check-out? Academy check-out is 5pm but staff will be in the building until 5:30pm to accommodate late pick-ups.
What clothing should my child wear? The temperature during the summer months is usually hot and humid. We urge students to bring cool cotton clothes. Shorts and comfortable shirts are acceptable attire. We expect students to dress as they would in their own school. During the day, we will move around the campus; comfortable walking shoes are must! Do not forget to include an umbrella or raincoat!! Also, on the last day (Friday) please wear a nice outfit (dress or shirt with nice pants, etc.) because we will have a final jury with outside jurors in attendance!
Does my child need to bring any spending money to Academy? All program expenses (except transportation to and from the Academy) are covered by the Academy fee, so there is no need for any student to bring large amounts of money to the Academy. Students may want to bring some cash, however, to purchase optional items such as snacks and/or souvenirs.
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Frequently Asked Questions - Continued
Will my child have access to internet? Depending on Academy academic programming, students may have limited internet access. Students will not have internet access during the classes.
Who supervises my child at Academy? Academy participants are supervised by a team of professional instructors and assistant instructors. There will be male and female counselors that reflect the Academy’s demographic composition. Members of our nationally recognized-faculty will lead academic programming and are joined in the classroom by our Academy counselors.
How do you select your counselors? Academy counselors are Kennesaw State undergraduate ar c h i te c t ur e students who were vetted through an extensive hiring process to include a series of interviews and a criminal background check.
Where will my child eat at the Academy? Academy participants will eat their lunches on campus. Lunch will be provided each day.
What if my child has a food allergy? The Academy cannot provide special meals for participants with food allergies. Should your child have food allergies, you are welcome to send any special food accommodations that may be necessary.
Where can I find an Academy schedule? Final schedules will be provided during registration/check-in.
What if a student needs to leave during the Academy? Academy participants are to remain with the group on campus for the duration of the program unless program activities require otherwise. If a student must leave the campus for some reason, we must receive prior written permission from the parent/guardian. Permission must be granted by the Academy Director in advance.
What is the Academy cell phone policy? Cell phones offer the best means for students and parents to keep in touch during Academy; therefore we do not prohibit cell phone use before and after classes at the Academy. However, cell phones should not be used during academic programming and should never be a source of disruption in the classroom. Parents should set clear guidelines and limitations for cell phone use during Academy. Participants will refrain from using electronic devices (i.e. cell phones, iPads, computers, etc.) during instructional periods unless otherwise authorized. If students are unable to adhere to this policy, the Academy Director may confiscate the device until the end of Academy.
TRAVELLING TO/FROM THE KENNESAW STATE UNIVERSITY MARIETTA CAMPUS
How do I get to Kennesaw State Marietta campus from Atlanta?
Transportation to and from your home will be the responsibility of the student and his/her family. The KSU Marietta campus is
easily accessible by car from I-75/85. A map of the KSU Marietta campus is available online: https://kennesaw.edu/maps/
(Attached) The Academy will be located in the main architecture building (N Bldg) located on Stringer Loop off Polytechnic Lane.Students may be dropped off in front of the College of Architecture's Hinman building between 8-8:30am and picked up at the
end of the day between 4:30pm and 5:00pm.
EVALUATIONS
How do we provide Academy feedback? We are constantly working to improve our Academy and request constructive feedback from students and parents alike. Students will complete an evaluation form prior to Academy graduation. Parents are also encouraged to provide feedback. If you have any additional questions, contact the ACCI Academy at [email protected].
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A B C D E F G H I J K L M N O P Q R S T U V W X Y
Marietta Campus
PARKING DECKSParking Deck.......................................... H,I,J-11
CAMPUS HOUSINGCommons 100 ............................................. S-11Commons 200 ............................................. S-12Commons 300 ............................................. T-13Commons 400 ............................................. T-13Commons 500 ............................................. S-13Commons 600 ............................................. S-12Community Center ..................................... R-10Courtyard 1000.............................................U-8Courtyard 2000............................................. T-9Courtyard 3000............................................. T-8Hornet Village 100.......................................J-13Hornet Village 200................................... K,L-14Housing Office ............................................ R-10Howell Hall .................................................. P-10SPORK............................................................ R-9University Columns 1 ................................. F-16University Columns 2 ................................. F-16University Columns 3 ................................. F-17University Columns 4 ................................. F-17University Columns 5 ................................. E-17University Columns 6 ................................. E-17University Columns 7 ................................. E-16University Columns 8 ................................. E-16University Columns 9 .................................D-16University Columns 10 ...............................D-17University Columns Activity Center..........D-11
ACADEMIC BUILDINGSAcademic Building (H)............................ M-9,10Architecture (N) .....................................P-14,15Atrium Building (J) ............................... N-11,12Civil Engineering Technology (L)...............N-16Crawford Lab Building (E) ............................ K-8Design 1 Building (I1) ................................. L-11Design 2 Building (I2) ................................. L-11Engineering Lab Building (G) .................... L-10Engineering Technology Center (Q) ........... I-10Lawrence V. Johnson Library (C) ..................N-8Mathematics Building (D) ........................... M-6Norton Hall (R2) ............................................ P-8W. Clair Harris Textile Center (M) ......... O-13,14Wilder Communications Center (T)........... L-18
ADMINISTRATIVE BUILDINGSFacilities - Administration (F1).................. W-14Facilities - Small Vehicle Storage (F3)........ X-15Facilities - Grounds and Vehicle Shop (F4) X-16Facilities - Large Vehicle Storage (F6) and Maintenance Shop (F7) ...................... Y-16 Facilities - Central Receiving (F8)............... Y-17Facilities - Grounds Storage Building........A-14Administration Building (B).........................O-7Norton Hall (R2) ............................................ P-8
STUDENT SERVICES/EVENTSField 1 .......................................................... B-15Field 2 ..........................................................A-15Field 3 .......................................................... C-13Gymnasium (S2) ................................... Q-15,16Joe Mack Wilson Student Center (A) .......... M-5Lawrence V. Johnson Library (C) ..................N-8Nuesoft Technologies Field........................A-13Recreation and Wellness Center (S1)........ S-3,4S. Walter Kelly Memorial Field ................... 0-18Stingers Dining Hall (X)...............................J-12Student Competition Team Building (O).. M-17University Stores ......................................... M-5
BUILDING NAME GRID
Kennesaw State University is aSmoke/Tobacco-Free University
visit the website atwww.kennesaw.edu/mobile
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Main Entrance1100 S. Marietta PkwyMarietta, GA 30060
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