Summer Indigenous STEM Camp

The mission of the Summer Indigenous STEM Camp is to increase the number of historically and currently underrepresented Native American, Pacific Islander, and Alaska Native students earning bachelor’s and graduate degrees in Science, Technology, Engineering, and Mathematics (STEM).

If you have any questions or need to contact us, please contact: Gracie RedShirt Tyon, 303-315-1882, grace.tyon@ucdenver.edu.

All camp activities will be supervised by adults. Activities will include:

Indigenous Health/Medicine

Sustainability/Wind Turbine

Indigenous Gardening

Native Lacrosse

Tipi Rising

Biology/Chemistry

Hand Games

Participant Information

First Name *

Middle Name

Last Name *

Birth Date * +

Class *

Ethnicity *

Gender *

Race (Choose one or more responses based on how you identify) *

Discipline you are interested in studying or plan to seek a degree in *

Food/Diet Information

Participants in the Summer INDIGENOUS STEM CAMP will receive breakfast, lunch and snacks during the camp. Please check the boxes below to indicate if you have any dietary restrictions: *

Primary Address and Contact Information

Address 1 *

Address 2

City *

State *

Zip *

Phone *

Alternate Phone

Email Address *

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Contact Phone Number *

Parent/Guardian First Name

Parent/Guardian Last Name

Contact Phone Number

COMMUTING PARTICIPANTS: Will the participant drive him or herself or will a parent/guardian drive the participant to and from the program each day? *

Drive Themselves

Parent/Guardian

If the participant will not be driving him or herself, who is allowed to drive the participant to and from the program each day? (Name/Relationship/Phone Number) *

If there is anyone who is not allowed to pick up the participant, please list below: (Name/Relationship) *

Health Information

Does the participant currently have any of the following? *

If yes, please describe.

PARTICIPANT EXPECTATIONS & CONDUCT AGREEMENT

The following requirements must be read and agreed upon by the camp participant and his or her parent(s)/guardian(s). During the time the Participant is in the care of the AISS (American Indian Student Services) Indigenous STEM Camp as part of the above-referenced program, the Participant agrees to:

Commit to successfully complete the program;
Adapt to and learn from the environment and comply with all rules;
Be respectful of other participants, team leaders and staff;
We require participants to participate in all events and activities. Exceptions may be made for religious reasons and certain arts events. We ask that you notify us in advance to request an exception;
Meet with team leaders, counselorsand other educators when scheduled;
Pay for any repairs or replacements of property damaged;
The AISS Indigenous STEM Camphas a zero-tolerance policy for use and/or possession of alcohol, tobacco, marijuana, weapons, and other controlled substances and items. Possession and/or use of these substances and/or items will result in immediate expulsion from the program;
Commuting participants must check in with Camp Coordinators at each morning meeting.
Not engage in sexual misconduct while enrolled in the program; and,
Not infringe upon the rights of the others participating in the program.
Participants are not to leave the scheduled activities on their own. When in transit, Participants and staff will travel as a group. This includes walking to meals,and other buildings and rooms on the CU-Denver campus. Participants and parents/guardians should understand that CU Denver is an open urban tri-university campus environment and not a K-12 environment.
Cell phones must be put away during classes, events, lectures, activities and workshops unless they are being used to facilitate the assigned activity
The AISS Indigenous STEM Camppromotesequality and respect among all faculty, staff, and participants, and do not tolerate harassment or bullying of any kind. In the case of reported harassment or bullying, participants involved will be interviewed, which may result in parents being contacted and expulsion from the program if necessary. In the case of such events, participants may first consult with their Teaching Assistantsand/or Camp Leaderswho will then take the issue to the correct authority.

I have read the above and understand that failure to comply with any of these expectations will result in disciplinary action and possibly early program termination. I understand that all participants must be in compliance with and abide by all the rules, regulations, and policies established by the University of Colorado/Colorado AHEC.

Participant Authorized Signer (Full Name as AUTHORIZED SIGNATURE) *

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RISK ASSUMPTION FORM (Signed by Parent/Guardian)

The University of Colorado welcomes you as a participant in this activity. Please read through the following important information.

I exercise my own free and voluntary choice to participate in the designated activity, including use of facilities and equipment provided by the University of Colorado. I understand and assume all associated risks of the designated activity. These risks include, but are not limited to: Cuts from handling sharp objects or lab equipment/tools, minor chemical burns to unprotected skin, including eyes, illness if hazardous supplies are consumed and other risks if laboratory safety precautions are not taken. Lab protection equipment will be provided, along with instructions on how to properly handle lab equipment and supplies. No other known risks, except ones related to inclement weather, other/outside visitors, pedestrian accidents (i.e. struck by vehicle), The University personal accompanying/escorting group will have an emergency contingency plan if situations should occur during visit.

I agree to assume all risk of personal injury or loss, bodily injury (including death), damage to or loss of, or destruction of any personal property resulting from or arising out of participation in the designated activity. I also release, waive, indemnify, hold harmless, and discharge the University of Colorado from all claims, damages, and injuries arising out of my activities, including, if applicable, my use of equipment and facilities provided by the University of Colorado.

The University of Colorado does not provide health insurance for individuals participating in activities made available or sponsored by the University of Colorado. As such, you or your personal health insurance will be responsible for payment of medical services and care for any injuries sustained during the designated activity.

Use of a privately owned vehicle, including the operation of or as a passenger, may be an option. The university does not provide liability or physical damage insurance coverage on privately owned vehicles. The vehicle owner must provide the liability and physical damage insurance coverage for the privately owned vehicle. Operation of a privately owned vehicle is at the driver’s own risk and any damage or injury will be paid by the owners insurance.

Participants in university activities are sometimes photographed and videotaped for use in University of Colorado promotional, educational and research programs. Such audio, video, film and/or print images may be edited, duplicated, distributed, reproduced, broadcast, and/or reformatted any form and manner without payment of fees.

I hereby certify that I have read and understand the provisions above. For participants under 18 years of age, the parent or guardian accepts the above terms and grants permissions for the student’s participation on behalf of said minor, as permitted by C.R.S. § 13-22-107.

Parent/Guardian Authorized Signer (Full Name as AUTHORIZED SIGNATURE)

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