College For Kids

College For Kids Application

* = required

Student Information

Student First Name *

Student Middle Initial

Student Last Name *

Student Preferred Name/Nickname (optional)

Student Birth Date *

Student Address *

Apt. No/Unit

City *

State *

Zip Code *

School Attending *

Grade Level *

Legal Sex *

Race *

Ethnicity *

Health/Medical History

Any allergy information we should know about (food/environment)? *

Any medical information we should know about? *

Parent/Guardian Information

Parent/Guardian Name *

Parent/Guardian Primary Phone Number *

Parent/Guardian Alternate Phone Number (optional)

Parent/Guardian Primary Email *

Select Major

Select 1st, 2nd, and 3rd choice for Major

** Please Note **
Students are required to select a major study. Each class has limited seating. Students will be placed in selected courses on a first come, first served basis. Thank you for your patience and understanding during the enrollment period.

Select Major - 1st Choice * Architecture Biology and Chemistry Culinary Engineering Video Communication Visual Communication

Select Major - 2nd Choice * Architecture Biology and Chemistry Culinary Engineering Video Communication Visual Communication

Select Major - 3rd Choice * Architecture Biology and Chemistry Culinary Engineering Video Communication Visual Communication

Select Minor - 1st Choice * Fine Arts Math Radio Broadcasting

Select Minor - 2nd Choice * Fine Arts Math Radio Broadcasting

Select Minor - 3rd Choice * Fine Arts Math Radio Broadcasting

Questions/Comments?

Pick Up/Release Authorization Form

In the case that your child needs to be picked up from the camp please provide the name of the authorized pick up/release person(s).

*Please note: 1st authorized person information is required. This can be a parent/guardian.

Name of 1st Authorized Individual *

Phone Number *

Email Address *

Name of 2nd Authorized Individual (optional)

Phone Number

Email Address

As legal, custodial parent/guardian of the participant I give the above individual(s) permission to pick up my child.

Individual(s) is/are Authorized for Pickup * Yes

Emergency Contact Information

1st Contact Name *

Relationship to Student *

1st Contact Phone Number *

1st Contact Email *

2nd Contact Name (Optional)

Relationship to Student

2nd Contact Phone Number

2nd Contact Email

Hold Harmless and Indemnity Agreement

The undersigned further expressly agree(s) that consideration of the foregoing and for other good and valuable consideration the receipt and sufficiency of which are hereby acknowledged, to indemnify, save, and hold harmless and defend, COMMUNITY COLLEGE DISTRICT NO. 504. COUNTY OF COOK AND STATE OF ILLINOIS (TRITON COLLEGE), and it’s Board Members, and the officers, employees therof, against all damages, losses, costs and expenses and attorneys fees in any manner caused by, arising from, incidental to and/or connected with or growing out of such participation.

I, the undersigned, hereby expressly consents and agrees that my child may participate in Summer 2024 College for Kids Program at Triton College.

Consent and Agree * I Agree

Participant Name: *

Parent/Guardian Signature: *

Date of Signature: *

Participation Agreement

Agreement with Parent or Legal Guardian of Student under the age of 18 for Participation in An Activity

The undersigned affirmatively states that participant is in good health and is under no medical restrictions which would inhibit participation in said activity.

The undersigned agrees to forever waive and relinquish all claims participant or the undersigned might have as a result of the participants participation in the activity. The undersigned further agrees to forever release and discharge the college, its officers, agents, trustees, and employees against any and all claims for losses, damages, judgements, claims, expenses, costs and liabilities with the undersigned or participants may have as a result of participation in the activity.

The undersigned recognizes and acknowledges that there are inherent risks in the participation in the above referenced activity which may result in serious bodily injury or death. In consideration of said participants, the undersigned agrees to hold harmless and indemnify Triton College, it’s officers, agents, trustees, and employees including reasonable attorney fees and expenses, cause by, arising from, incidental to, connected with or growing out of such participation.

During the course of the activity, in case of medical emergency, the undersigned hereby authorizes any local hospital, doctor, or other licensed medical practitioner, as well as emergency treatment personnel, to take whatever action necessary to address the medical emergency. If the undersigned is present during the activity, the undersigned shall retail the right to make all medically related decisions regarding the participant.

The undersigned certifies that the participant has health insurance coverage and the undersigned agrees that in the event medical treatment is rendered, said insurance shall be considered primary.

If any provision of the agreement or part thereof is ruled unenforceable by a court of competent jurisdiction, the remainder of the agreement shall be in full force and effect.

I have read the above and understand it. I enter into this agreement as my free and voluntary act.

Read and Agree * I Agree

I, as a parent or legal guardian of the participant do hereby express the participant to participate in the Summer 2024 College For Kids Program at Triton College.

Consent for Participation * I Agree

Participant Name: *

Parent/Guardian Signature: *

Date of Signature: *

Consent and Release

I hereby authorize and give my consent to Triton College, Cook County, Illinois, to film or videotape my child’s image or voice, in connection with the Summer 2024 College For Kids Program at Triton College.

I also authorize Triton College to distribute, exhibit, or cause to be distributed or exhibited, including by not limited to distribution to or exhibition on any broadcast medium, including but not limited to: cable TV, broadcast TV, satellite, broadcast radio, digital transmission and internet transmission, the above presentation at any time or place, without limitation and without my prior inspection or approval.

I waive all rights that I may have to any claims for payment, residualised payments or royalties in connection with any exhibition, distribution, broadcast, or any other showings of any kind of the above presentation at any time or place regardless of whether such exhibition distribution, broadcast or other showing is under educational, commercial, institutional, or private sponsorship, and regardless of whether a fee for admission or other rental is charged.

I have read this Consent and Release in its entirety and understand all of its terms. I have executed this instrument voluntarily and with full knowledge of its significance. * I Give Authorization I Do Not Give Authorization

Participant Name *

Parent/Guardian Signature *

Date of Signature *

Refund Policy

By checking this box, you indicate your enrollment and financial responsibility for the tuition and associated fees associated with this camp. Please note that you have three business days prior to your first class (example: before 8 a.m. Monday for a Thursday class) to cancel your registration by informing the CE team of your intent to disenroll via email written request. For any questions or further assistance, please feel free to contact us at askce@triton.edu or (708) 456-0300 ext. 3500.

I accept financial responsibility for the tuition and associated fees associated with this camp and agree to adhere to the refund policy.

I Acknowledge My Responsibility Yes

Parent/Guardian Signature *

Date of Signature *

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In This Section

Descriptions for Majors and Minors

Majors

Minors