Form : Great Lakes Aquarium

Goals & Participation Requirements*

Great Lakes Aquarium youth programs and camps aim to:
- Ensure the safety and well-being of all participants
- Offer the opportunity for each participant to feel successful
- Offer the opportunity to experience social development, authentic learning and leadership skills

In order to participate in this program, participants must be able to:
- Take care of their own personal needs (snacks, bathroom, etc.)
- Interact safely and respectfully with fellow participants, volunteers and Aquarium guests
- Work independently, cooperate safely with peers and follow verbal directions, especially with regard to: using scissors and other tools and interacting with aquarium animals
- Identify and advocate for their own allergies/medical needs, especially regarding seafood
- Conduct themselves appropriately and responsibly on off-site field trips

Please note: While Aquarium staff is trained in group management, activity facilitation and considerations for students with special needs, they are not necessarily certified in special education and cannot provide exclusive one-on-one support. If your camper needs individualized support at school or home, they are welcome at camp and programs but must be accompanied by an aide, caregiver or respite provider (at no extra cost to the accompanying adult).

If you have concerns that your child may have difficulty or require assistance with any of these requirements, contact Alexis Berke at aberke@glaquarium.org or (218) 740 - 2013 to discuss options for your camper.

I have read and understand the camp participation requirements.

I am filling this form out for:*

Myself
A child that I am the parent/guardian of

Participant Name*

First Last

Participant Name*

First Last

This form should be filled out by the above named child's parent or guardian.*

I am the parent/guardian of the child named above.

Participant's Gender Pronoun*

He
She
They

Participant's Gender Pronoun*

He
She
They

Participant's Birthdate*

Participant's must be 13 on or before February 12, 2023 in order to participate.

Contact Information

Parent/Guardian Name*

First Last

Parent/Guardian Phone Number*

Parent/Guardian Email Address*

Participant Email Address*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Alternate Contact Name*

First Last

Alternate Contact Phone*

Besides myself, I authorize the following individuals to pick up my child from Art at the Aquarium:*

Health Form

Great Lakes Aquarium is committed to creating an welcoming and inclusive environment for all participants. Please provide as many details about your child and their needs as possible so that we can provide a fun, safe and educational experience.

Allergies*

Does this camper experience an allergic reaction to any of the following? Select all that apply.

Foods
Medications
Environmental factors (insect stings, pollen, etc)
Other
None of the above

Please describe the specific allergen, symptoms, severity of reaction and usual treatment steps:*

Please share any relevant information from your child's medical history, along with usual treatment steps (i.e. takes inhaler for asthma). You may choose to include any medications the camper is currently taking.

Sensory Triggers*

Does this camper experience any sensitivities to sounds, lights, smells, textures or other unique needs that camp staff should be made aware of?

Yes
No

Please describe this camper's sensitivities/triggers and any accommodations camp staff can provide to give your camper the best experience possible. (It may be helpful to share parts of your school's Individualized Education Plan (IEP), school behavior plan, or home routines that support a successful day):*

Great Lakes Aquarium - Waiver and Release

Great Lakes Aquarium maintains high standards for safety. Please read thoroughly to help us maintain safe and informed programming.

Parent/Guardian Acknowledgment*

I am the parent or guardian of the participant. I understand, answer, and agree to each of the questions in this application on behalf of the participant.

Participant Acknowledgment*

I understand, answer, and agree to each of the questions in this application on behalf of the participant.

Participant Waiver*

I understand that I (or my child) am participating in the above program at our own risk. I will not hold Great Lakes Aquarium or its officers, directors, employees or volunteers liable for any negligence or alleged negligence or other fault (not including intentional acts) that results in personal injury, death, or property damage during or in connection with the above program. The undersigned, for myself and for my heirs, executors, administrators and assigns, hereby release and forever discharges Great Lakes Aquarium and its officers, directors, employees, and volunteers from all such claims. The waiver will be construed according to the law of the State of Minnesota.

I have read and agree to the participant waiver on behalf of my child.

Participant Waiver*

I understand that I am participating in the above program at our own risk. I will not hold Great Lakes Aquarium or its officers, directors, employees or volunteers liable for any negligence or alleged negligence or other fault (not including intentional acts) that results in personal injury, death, or property damage during or in connection with the above program. The undersigned, for myself and for my heirs, executors, administrators and assigns, hereby release and forever discharges Great Lakes Aquarium and its officers, directors, employees, and volunteers from all such claims. The waiver will be construed according to the law of the State of Minnesota.

I have read and agree to the participant waiver.

Disruptive Behavior Remediation Steps*

A "disruptive behavior" is any action by a camper that disrupts the learning situation, damages the camp environment, disrupts the social interaction of the group, or endangers the camper or others. Aquarium staff will take the following steps in response to disruptive behavior:

Step One: The camper will be asked to change their behavior and reminded that they will be asked to take a break if the behavior continues.

Step Two: If the disruptive behavior continues, the camper will be asked to take a break.

Step Three: If the behavior continues, the camper will take another break, during which they will meet with camp staff. A verbal behavior contract may be agreed upon.

Step Four: If the behavior continues, the participant will leave the activity and be supervised separately by another Aquarium staff member.

Step Five: The camper's parent/guardian will be called to remove the camper from the program for the day.

Great Lakes Aquarium reserves the right to skip action steps in response to severe behavior, including the right to ask parents or guardians make immediate arrangements for the camper to leave the program.

I agree to the disruptive behavior policy.

Medical Release*

I hereby give my permission for Great Lakes Aquarium to procure all necessary medical help for myself, my child or ward while said person is under the direct supervision of Great Lakes Aquarium, and grant permission to its representatives to authorize any competent medical professional to do all things reasonably necessary to take care of any injury or sickness.

There is no health insurance or medical coverage provided. Checking the box below acknowledges that the participant/guardian accepts responsibility for payment of any medical treatment which may be required while they are in this program.

I have read and agree to the medical release on behalf of my child.

Medical Release*

I hereby give my permission for Great Lakes Aquarium to procure all necessary medical help for myself, my child or ward while said person is under the direct supervision of Great Lakes Aquarium, and grant permission to its representatives to authorize any competent medical professional to do all things reasonably necessary to take care of any injury or sickness.

There is no health insurance or medical coverage provided. Checking the box below acknowledges that the participant/guardian accepts responsibility for payment of any medical treatment which may be required while they are in this program.

I have read and agree to the medical release.

COVID-19 Policy*

Great Lakes Aquarium programs are subject to the current organizational policies regarding mask-wearing and other safety measures at the time of the program.

Great Lakes Aquarium follows the current MN Health Department SCHOOLS AND CHILD CARE COVID-19 Best Practice Recommendations and Case Reporting.

MN Health Department School and Child Care COVID-19 Best Practice Recommendations.

I agree to the COVID-19 policy.

COVID-19 Policy*

Great Lakes Aquarium programs are subject to the current organizational policies regarding mask-wearing and other safety measures at the time of the program.

Great Lakes Aquarium follows the current MN Health Department SCHOOLS AND CHILD CARE COVID-19 Best Practice Recommendations and Case Reporting.

MN Health Department School and Child Care COVID-19 Best Practice Recommendations.

I agree to the COVID-19 policy.

Photo Release*

I grant permission for Great Lakes Aquarium to use photos and/or video of this child in: (Check all that apply)

Electronic correspondence with parents of other camp participants
Print and digital publications and Aquarium promotional materials
The Aquarium's social media pages
Local news media (newspaper, television, web content, etc.) in the event the program is featured in local news
None of the above

Photo Release*

I grant permission for Great Lakes Aquarium to use photos and/or video of me in: (Check all that apply)

Electronic correspondence with parents of other camp participants
Print and digital publications and Aquarium promotional materials
The Aquarium's social media pages
Local news media (newspaper, television, web content, etc.) in the event the program is featured in local news
None of the above

Payment

This payment secures your participants place in the April 1,2023 Mixed Media Paint Along program.

Refund/Cancellation Policy*

I understand that the Aquarium will refund 50% of the program fee for cancellations made at least two weeks before the program start date.

I understand that the Aquarium reserves the right to cancel this program in case of an insufficient number of participants or other unforeseeable circumstance. If this occurs, I will be notified at least one week in advance and a full refund will be issued for all registered participants.

I have read and agree to the refund/cancellation policy.

Are you the recipient of an Art at the Aquarium scholarship?*

Yes
No

Payment - Scholarship Recipient*

Please enter the amount you will pay for camp (This is the amount indicated in your scholarship award letter).

Program Fee*

Price:

Total

$0.00

Credit Card

American Express

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MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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Art at the Aquarium - May 3, 2023 5:00-8:00 p.m.

Contact Information

Health Form

Great Lakes Aquarium - Waiver and Release

Payment