CATEC KidsCollege@ - Piedmont Virginia Community … · Times: A.M. Academies: 9 a.m.–12:15 p.m....

www.pvcc.edu/kidscollege 1 Learn today...Lead tomorrowKIDSCollege@CATEC

at CATEC For Rising 7th-10th Graders

June 18-29, 2018

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• For Rising 7th-10th Graders

• Morning and/or Afternoon Academies

• STEM & Technical Academies

• Located at CATEC on Rio Road.

• NEW! CATEC Foundation Scholarships

www.pvcc.edu/kidscollege

Early Bird DiscountRegister by April 2 to receive a $10 discount per academy

Wide range of new hands-on, skill-based, fun STEM and technical academies. KidsCollege@CATEC is a collaboration between PVCC and CATEC. Visit www.pvcc.edu/kidscollege for more information.

Ages: Rising 7th–10th graders

Times: A.M. Academies: 9 a.m.–12:15 p.m.

Early Drop-Off: 8-9 a.m.

P.M. Academies: 1:15–4:30 p.m.

After-Academy Care: 4:30-5:30 p.m.

Location: Charlottesville Albemarle Technical Education Center, 1000 East Rio Road, Charlottesville.

KidsCollege & CATEC Foundation Scholarships are available. See page 10 for more information.

2 KidsCollege@CATEC Summer Academies 2018

KidsCollege@CATEC Academy ScheduleJune 18–22 Week Class No. ACADEMY Instructor FEE

8-9 a.m. 11729 CT Early Drop-Off CATEC Staff $5

9 a.m.–12:15 p.m. 11652 CT Firefighting Extreme Scenarios: What Would YOU do? NEW Captain Bobby Elliott $139

9 a.m.–12:15 p.m. 11626 CT Electronic Design Prototyping with Arduino NEW Wayne Zink $139

9 a.m.–12:15 p.m. 11643 CT Make and Decorate Amazing Cupcakes Chef Bob Bressan $144

9 a.m.–12:15 p.m. 11646CT Manipulating Life Itself (Homo evolutis: Next Stage in Human Evolution) NEW

Open Bio Labs $155

12:15–1:15 p.m. 11650 LUNCH SUPERVISION (bring your lunch) $20*

1:15–4:30 p.m. 11655 CT Delicious Dinners Around the World NEW Chef Tom Goss $144

1:15–4:30 p.m. 11627 CT Latest Hair Styles, Extensions, Make-Up & Nail Art NEWKaren Brown & Jackie Waller $139

1:15–4:30 p.m. 11656 CT The Human Cyborg NEW Open Bio Labs $155

4:30–5:30 p.m. 11731 CT After-Academy Care CATEC Staff $5

June 25–29 Week Class No. ACADEMY Instructor FEE 8-9 a.m. 11730 CT Early Drop-Off CATEC Staff $5

9 a.m.–12:15 p.m. 11630 CT Catapult into Engineering NEW Wayne Zink $139

9 a.m.–12:15 p.m. 11631 CT The Incredible, Edible Egg NEW Chef Bob Bressan $144

9 a.m.–12:15 p.m. 11632CT Auto Tech & Maintenance: Everything You Should Know NEW

Ron Moore $139


1:15–4:30 p.m. 11635 CT Get a Step Ahead with First Aid & CPR Certifications NEW Catherine Gardner $139

1:15–4:30 p.m. 11633 CT Awesome Desserts Around the World NEW Chef Tom Goss $144

1:15 – 4:30 p.m. 11634CT Auto Tech & Maintenance: Just Like the Auto Shop Pros NEW

Ron Moore $139

4:30-5 p.m. 11732 CT After-Academy Care CATEC Staff $5

*No lunch fee if registered for an A.M. and P.M. academy during the same week.

CT Make & Decorate Amazing CupcakesWin the cupcake decorating war! You will learn the basic skills of: how to make cupcakes from scratch and bake properly; how to make basic icing; and how to decorate cupcakes using basic techniques. A friendly cupcake decorating “war” will show off your creative design abilities. This academy will cover basic sanitation principles, knife usage and safety in the kitchen, as well as the basics of food preparation. You will learn about the culinary industry and food service occupations. Chef Bob Bressan taught for 14 years as CATEC’s culinary instructor. He was owner of the Bob Bressan Catering company in Charlottesville

for over 25 years and studied at the globally recognized culinary arts program at Johnson and Wales University in Colorado.

NEW! CT Firefighting Extreme Scenarios: What Would You do?Take the challenge! Experience the world of a firefighter through exciting hands-on activities and scenarios. You will learn the skills, training, and knowledge used by successful firefighters. You’ll also learn how the fire service started and about firefighting in our local community.Captain Bobby Elliott is a retired Fire Captain with the City of Charlottesville Fire Department and was with the Fluvanna County Volunteer Fire Department for 20 years. He has been the lead instructor for the Fire Service Academy at CATEC for 14 years.

www.pvcc.edu/kidscollege 3

WEEK 1: Jun. 18-22A.M. Academies 9 a.m.–12:15 p.m.

NEW! CT Electronic Design Prototyping with ArduinoInvestigate electronic design using the fun and flexible Arduino platform. You will be part of a small team that will create devices with digital and analog parts and program those devices on laptops with easy-to-learn code. Arduino is a popular, open-source platform used for building electronic projects. No electronics or coding experience is necessary; you will learn while you’re having fun building!Wayne Zink has over 20 years of elementary through high school classroom experience working with students in Virginia and California. He is a lifelong tinkerer, artist and maker who loves helping students make connections between art, technology and science.

KidsCollege@CATEC Academy ScheduleJune 18–22 Week Class No. ACADEMY Instructor FEE

8-9 a.m. 11729 CT Early Drop-Off CATEC Staff $5

9 a.m.–12:15 p.m. 11652 CT Firefighting Extreme Scenarios: What Would YOU do? NEW Captain Bobby Elliott $139

9 a.m.–12:15 p.m. 11626 CT Electronic Design Prototyping with Arduino NEW Wayne Zink $139

9 a.m.–12:15 p.m. 11643 CT Make and Decorate Amazing Cupcakes Chef Bob Bressan $144

9 a.m.–12:15 p.m. 11646CT Manipulating Life Itself (Homo evolutis: Next Stage in Human Evolution) NEW

Open Bio Labs $155


1:15–4:30 p.m. 11655 CT Delicious Dinners Around the World NEW Chef Tom Goss $144

1:15–4:30 p.m. 11627 CT Latest Hair Styles, Extensions, Make-Up & Nail Art NEWKaren Brown & Jackie Waller $139

1:15–4:30 p.m. 11656 CT The Human Cyborg NEW Open Bio Labs $155

4:30–5:30 p.m. 11731 CT After-Academy Care CATEC Staff $5

June 25–29 Week Class No. ACADEMY Instructor FEE 8-9 a.m. 11730 CT Early Drop-Off CATEC Staff $5

9 a.m.–12:15 p.m. 11630 CT Catapult into Engineering NEW Wayne Zink $139

9 a.m.–12:15 p.m. 11631 CT The Incredible, Edible Egg NEW Chef Bob Bressan $144

9 a.m.–12:15 p.m. 11632CT Auto Tech & Maintenance: Everything You Should Know NEW

Ron Moore $139


1:15–4:30 p.m. 11635 CT Get a Step Ahead with First Aid & CPR Certifications NEW Catherine Gardner $139

1:15–4:30 p.m. 11633 CT Awesome Desserts Around the World NEW Chef Tom Goss $144

1:15 – 4:30 p.m. 11634CT Auto Tech & Maintenance: Just Like the Auto Shop Pros NEW

Ron Moore $139

4:30-5 p.m. 11732 CT After-Academy Care CATEC Staff $5

*No lunch fee if registered for an A.M. and P.M. academy during the same week.

NEW! CT Manipulating Life Itself (Homo evolutis: Next Stage in Human EvolutionSplice DNA together and create your own glowing bacteria! We are entering the era of biotechnology where designer organisms are being created to solve the world’s biggest problems like hunger, clean water, and pollution. Unfortunately, not everything always goes as planned. What happens when we must decide to wipe out an entire species to save our own? Dive into the world of synthetic biology by learning not only microbiology and genetic engineering but the ethics needed to make sure we use this technology for good and not evil. All experiments are conducted safely with experienced scientists.Open Bio Labs, Charlottesville’s Synthetic Biology Education Center, makes the biosciences accessible to everyone, and provides the hands-on education and training students need to pursue their ideas in biotechnology and synthetic biology. Open Bio Labs hands-on experiences increases students love for science and prepares youth to become the emerging leaders of our transforming world.

P.M. Academies 1:15–4:30 p.m.

NEW! CT Latest Hair Styles, Extensions, Make-up & Nail ArtDive into the latest fashion hairstyles, make-up, and nail art manicures! Learn how to temporarily color hair, how to do hair chalking, how to use colored hair wax, and how to create your own hair extension. You’ll learn about general skin care and maintenance, correct make-up applications, and basic techniques using all safe and natural products.Jackie Waller and Karen Brown will co-teach the academy. Jackie Waller has taught Cosmetology at CATEC for three years and is owner of Finally Salon in Charlottesville. Karen Brown has been a licensed cosmetologist since 1984 and taught youth and adults cosmetology for 17 years. She is a current cosmetology instructor at CATEC.


Early Bird DiscountRegister by April 2 to receive a $10 discount per academy

NEW! CT The Human CyborgYou, me, and everyone—we’re all just mammals! Is a mammal more than just a biological machine? Come explore with us. You will make a working model of an arm and design your own circulatory system in this exploration of the human animal. Do you know which pieces of us can be replaced by machines? Have fun while we explore biology, anatomy, biomechanics, prosthetics, and the physics of the human body.Open Bio Labs, Charlottesville’s Synthetic Biology Education Center, makes the biosciences accessible to everyone, and provides the hands-on education and training students need to pursue their ideas in biotechnology and synthetic biology. Open Bio Labs hands-on experiences increases students love for science and prepares youth to become the emerging leaders of our transforming world.

Delicious Dinners Around the World NEW!Surprise your family with a delicious dinner! You will learn how to cook dinners with Italian, Latino, and Asian influences. Learn to make an incredible chicken parmigiana, pasta dishes, tacos, enchiladas, stir fry, lo mein, and more. This academy will cover basic sanitation principles, knife usage, and safety in the kitchen, as well as the basics of food preparation. You will learn about the culinary industry and food service occupations.Chef Tom Goss has been in the hospitality/restaurant business for 45 years. He has a master’s degree from the prestigious Cornell Hotel School, is a certified club manager and sanitation instructor, and has owned and operated seven restaurants. He has taught students from elementary through high school and currently teaches culinary arts at CATEC.

WEEK 2: Jun. 25-29A.M. Academies 9 a.m.–12:15 p.m.

NEW! CT Catapult into EngineeringExplore a variety of engineering and design processes as you build small machines, catapults, and trebuchets. Collaborate with partners and learn about design, prototyping, and testing your project. You will also learn about basic hand tools and power tools. The opportunities of what you can create are endless.Wayne Zink has over 20 years of elementary through high school classroom experience working with students in Virginia and California. He is a lifelong tinkerer, artist and maker who loves helping students make connections between art, technology and science.

NEW! CT The Incredible, Edible EggSurprise everyone with your amazing cooking skills! This academy will explore the many ways to prepare the incredible, edible egg and understand its usage and physiology. Eggs may be commonplace, but they have numerous, inventive cooking applications. This academy will cover basic sanitation principles, knife usage, and safety in the kitchen, as well as the basics of food preparation. You will learn about the culinary industry and food service occupations.Chef Bob Bressan taught for 14 years as CATEC’s culinary instructor. He was owner of the Bob Bressan Catering company in Charlottesville for over 25 years and studied at the globally recognized culinary arts program at Johnson and Wales University in Colorado.


NEW! CT Auto Tech & Maintenance: Everything You Should KnowImpress your friends and family! Learn all the hands-on basics of how take care of and maintain your car. In this academy, you’ll learn how to check and change a tire, check fluids, change the oil, and change wipers, headlights, and bulbs. You’ll also learn about auto detailing and how to clean, wash, and wax your car, as well as how to restore or maintain a vehicle’s value and shine—while having fun all at the same time. Don’t waste your money on simple repairs and maintenance that you can do yourself. Through hands-on instruction, students will learn how to care for a vehicle utilizing industry standards, tools, and materials.Ron Moore is the Auto Body Repair Instructor for CATEC and has taught college and high school students for 14 years. He is a graduate of Nashville Auto Diesel College and has worked in the auto body repair industry for the past 22 years, including positions with dealerships and as a paint and body fabricator for the Ford Motor Company.

P.M. Academies 1:15–4:30 p.m.

NEW! CT Awesome Desserts Around the WorldEnjoy making (and eating) delicious, unbelievable desserts! You will learn how to cook desserts with French, Italian, and German influences. Learn to make exquisite crème brulee, crêpes, tiramisu, chocolate cake, and kuchens. Getting hungry? This academy will cover basic sanitation principles, knife usage, and safety in the kitchen, as well as the basics of food preparation. You will learn about the culinary industry and food service occupations.Chef Tom Goss has been in the hospitality/restaurant business for 45 years. He has a master’s degree from the prestigious Cornell Hotel School, is a certified club manager and sanitation instructor, and has owned and operated seven restaurants. He has taught students from elementary through high school and currently teaches culinary arts at CATEC.

Online RegistrationLearn about newly added academies & program updates.

Check online for the latest information on NEW summer KidsCollege Academies and program developments at: www.pvcc.edu/kidscollege.


NEW! CT Auto Tech & Maintenance: Just Like the Auto Shop ProsShow off your auto tech and maintenance skills just like the pros! Utilizing professional industry equipment, learn how to repair flats and mount and balance tires. You’ll also learn the auto tech and detailing skills typically done in a shop including the art of paint-finish restoration. Utilizing industry standards, students will be taught the art of removing paint scratches in addition to bringing back the shine and beauty of the paint finish. Through hands-on instruction, students will learn how to care for a vehicle utilizing industry standards, tools, and materials.Ron Moore is the Auto Body Repair Instructor for CATEC and has taught college and high school students for 14 years. He is a graduate of Nashville Auto Diesel College and has worked in the auto body repair industry for the past 22 years, including positions with dealerships and as a paint and body fabricator for the Ford Motor Company.

NEW! CT Get a Step Ahead with First Aid & CPR CertificationsSave a life! These certifications are essential for many health care jobs as well as for life guards, child care, babysitting, and more. This academy covers both the American Heart Association HeartSaver First Aid and HeartSaver CPR certification courses. Each certification course requires that students participate in skills practice and demonstrate competency in the skills included with each certification (there is no written test for either). Upon completion, students will earn both First Aid and CPR certifications, which are good for two years. Students must be present for ALL components of each course in order to receive certification.Catherine Gardner began working in Fire and Rescue in 1999 and currently teaches the Emergency Medical Technician course at CATEC. Gardner has a degree in biology/pre-med from UVA, and holds several certifications including Paramedic, EMS Education Coordinator, and American Heart Association CPR/First Aid Instructor.


KidsCollege@PVCC Summer STEM & Arts AcademiesAges: Rising 3rd-9th graders

Times: A.M. Academies 8:45–noon P.M. Academies 1–4:15 p.m. Early Drop-Off 8–8:45 a.m. After-Academy Care 4:15–5:15 pm

Location: PVCC, 501 College Drive, Charlottesville.

Academies for rising 6th-9th gradersTo view the rising 3rd-6th grade academy schedule, please visit: www.pvcc.edu/kidscollege

WES COURSE Instructor FEE

June 11-1510868 Game Labs NEW Black Rocket $199

11001 How Stuff Works: Small Engines Gary Becker $139

10871 Code Your Own Adventure! NEW Black Rocket $199

10979 The Human Cyborg NEW Open Bio Labs $155

June 18-2210873 Advanced Robotics Challenge NEW Black Rocket $199

10958 Mix It Up: Glasslike Art Creations with Resin NEW Polly Breckenridge $139

10878 Video Game Animation Black Rocket $199

10974 What’s a Three-Dimensional Book? Imagine, Design, & Create Your Own! NEW L. Michelle Geiger $139

June 25-2910874 Virtual Reality: The Future is Now NEW Black Rocket $219

10961 EV3 Robotics Space Mission NEW Shelby Bowen $144

10875 Python Programmers: Make Your Own Game! NEW Black Rocket $199

11017 Vamonos! Let’s Travel to Spain Amanda Evans $139

Invent Your World with 3D Printers John Haverkamp $144

July 9-1310877 Advanced Robotics Challenge NEW Black Rocket $199

10981 Awesome Sculpture Designs from Real Life or Imagination NEW John Haverkamp $139

11006 Photography: Eyes on Your World Gwen Sherwood $139

11019 Intro to Engineering & Design NEW Wayne Zink $139

11002 iPad Movie John Haverkamp $139

11007 Fun with Photography Gwen Sherwood $139

10968 Blast Off! Build and Fly Rocketry NEWPiedmont Student Launch Team

$144

July 16-2010899 Virtual Reality: The Future is Now NEW Black Rocket $219

10970 Electronic Design Prototyping with Arduino NEW Wayne Zink $144

10983 Digital Comic and Manga NEW John Haverkamp $144

10901 ROBLOX® Makers-Coders-Entrepreneurs! NEW Black Rocket $199


After KidsCollege@CATEC

Please join us at KidsCollege@PVCC’s Summer STEM & Arts academies and ACE (Assistant Counselor Education) programs from June 11-Aug. 10.For more information visit, www.pvcc.edu/kidscollege, or contact us at [email protected] or 434.961.5354.

ACE (Assistant Counselor Education) • ACE program for rising 10th-12th graders• Application required. • Four-week, half-day program for rising 10th-12th graders interested in assisting with Summer

STEM and Arts Academies and gaining leadership and job readiness skills. • Students will receive training and support from summer staff. • Students will not be supervising younger students on their own. • Students will receive a certificate of completion at the end.

Program # ACE Program Dates Time Fee

ACE June 11–July 13 (no program July 2-6) 8 a.m.–1 p.m. $300

ACE June 11–July 13 (no program July 2-6) 12:15–5:15 p.m. $300

ACE July 16–Aug. 10 8 a.m.–1 p.m. $300

ACE July 16–Aug. 10 12:15–5:15 p.m. $300

10987 Real Life (or not) Drawing John Haverkamp $139

10937 Fly, Race & Pilot: Drone Obstacle Course Challenge NEW Drobots Company $199

10989 Be in a Rock Band NEW Stuart Gunter $139

July 23-2910902 Python Programmers: Make Your Own Game! NEW Black Rocket $199

10973 Catapult into Engineering NEW Wayne Zink $139

11011 Act, Create, and Experiment! Voice Through Theatre NEW Jessica Harris $139

10888 Code Breakers Black Rocket $199

10890 Minecraft Modders Black Rocket $199

10992 Original Electronic Designs with Arduino NEW Wayne Zink $144

10940 Drone Coding Wizards NEW Drobots Company $199

11012 You can be an Actor! Create a Show NEW Jessica Harris $139

10991 Digital Comic and Manga NEW John Haverkamp $144

July 30-Aug. 310994 Awesome Sculpture Designs from Real Life or Imagination NEW John Haverkamp $139

10996 CSI: In the Dining Room with a Candlestick? NEW Open Bio Lab $155

10934 ROBLOX® Makers-Coders-Entrepreneurs! NEW Black Rocket $199

10997 The Human Cyborg NEW Open Bio Lab $155

Aug. 6-1010935 Advanced 3D Video Game with Unity NEW Black Rocket $199

11014 New Inventions with 3D Printers John Haverkamp $144

10943 Code Your Own Adventure NEW Black Rocket $199


ScholarshipsKidsCollege@PVCC is committed to increasing access to our educational programs.

To apply for a financial need-based scholarship:

• The four-part scholarship application must be fully completed before it will be reviewed.

• Scholarships are available on a first-come, first-served basis.

• Academies are open on a space available basis.

• No academy spots are reserved until the scholarship has been approved and the partial fee

payment received.

Partial Scholarships:

Partial scholarships are provided for students that qualify and provide verification for the free/reduced school lunch income eligibility guidelines. After your completed application has been received, you will be notified of the scholarship decision and the remaining tuition fee amount due.

The partial tuition fee must be paid BEFORE a student is registered for an academy.

KidsCollege Scholarships

The reduced tuition fee for scholarship students is $30 per academy.

NEW! CATEC Foundation Scholarships for rising 10th graders

The reduced tuition fee for CATEC Foundation scholarship students is $25 per academy.

Early Drop-Off and After-Academy Care are provided at no cost to scholarship students. (Prior registration is needed.)

Scholarship Application:

Scholarship application form available at www.pvcc.edu/kidscollege/scholarships or from PVCC Workforce Services.

PVCC Workforce Services - KidsCollege@PVCC 501 College Dr.Charlottesville, VA 22902Call: 434.961.5354 or email [email protected]

Special Thanks:Scholarships are provided thanks to the generous support of the Albemarle County Rotary Club, Rotary Club of Charlottesville, Fluvanna County Public Schools, National Science Foundation (grant #1202181), State Farm, Wal-Mart, CATEC Foundation, and individual contributions.


How to RegisterPlease complete a separate online account or print registration form for each student. All previous students have an online account in their name. Registration is available online, in person, by mail, fax or email.

Online Registration Steps Please review carefully

Each student needs a separate account. All previous KidsCollege students already have an online account. The online registration system has a time limit, gather all necessary information to create your students’ profile account in advance. You will be able to return to your student’s online account to modify information.

Scholarships: To apply for scholarships, please see page 10 for registration details.

Early Registration Discount: Register for PVCC academies by April 2 and receive a $10 discount per academy.

To register go to: www.pvcc.edu/kidscollege Select >Browse our courses>KidsCollege>KidsCollege@CATEC

1. Create or Update Student Profile Account Previous KidsCollege Student? All previous students have an online account with student user name and password which is needed to register online. Don’t have it? Call or email 434.961.5354 or [email protected]. IMPORTANT: Carefully review and update all student profile information: emails, phone numbers and addresses. New KidsCollege Students: Create a separate online student profile for each student under the student’s name. Save your user name and password. Create each account using the student’s name. However, enter the email address for the primary parent/guardian.

2. Select Academies or Programs Choose all academies or programs. Additional selections may be added later. Lunch Supervision. Students bring their own lunch. If enrolling in an A.M. and P.M. academy during the same week, there is no charge for lunch supervision. Apply class code: “FREE” at checkout.

3. Checkout Process

At check-out, complete this information.

1. Assumption of risk/photo release/student conduct form. Please sign and read to your student(s).

2. Sign in/out information. Include your own name, if applicable. Students can only be signed out by names listed and the adult must present a photo ID. You can add more names later.

3. Emergency contacts. Include your own name, if applicable. Who should be contacted first in an emergency? Additional names may be added later.

4. Health needs/special considerations. Please list all health, learning issues, behavior issues, medical conditions and medications.

5. School attending and grade level in the fall of 2018.

6. Checkout and payment. Enter payment information. Online payments may be made by credit card or check.

You will receive a confirmation email and reminders before the academy starts.

For additional questions: Contact [email protected] or 434.961.5354 or

visit PVCC Workforce Services, Stultz Center, 501 College Drive, Charlottesville, VA 22902.

Cancellations: Workforce Services reserves the right to cancel any class.

Refund Policy: Participants must withdraw from an academy at least (5) business days before that academy is scheduled to begin to receive a full refund. No refunds will be provided after this time. Refund requests must be made in writing be mail, fax (434. 961.5270) or email ([email protected]). Include your name, student ID number, course title and reason for refund. Please note: If a student is registered by a staff nember or pays by check, your Social Security number. will be required in order to provide a refund check from the State of Virginia. Refund checks from the State of Virginia take 3-5 weeks to process.If a class is cancelled due to low enrollment, we will notify you within 7-10 days in advance and offer other programs. Otherwise, the note above regarding Social Security No.’s is applicable if a refund check is needed.NOTICE: In compliance with the sex offender and crimes against minors’ registry, a portion of this information will be submitted to the Virginia State Police.

Disability Statement: If you are a student with a disability who needs classroom accommodations under the Americans with Disabilities Act, you are required to meet with the Disability Services Counselor, Susan Hannifan to request accommodations. Her office is located in the Main Building, room M125, Phone: 434.961.5281, Email: [email protected]. To receive academic accommodations for this class, please obtain the proper forms and meet with me at the beginning of the semester.

Nondiscrimination Policy: Piedmont Virginia Community College is an equal opportunity institution providing educational and employment opportunities, programs, services, and activities. PVCC does not discriminate on the basis of age, color, disability, family medical history or genetic information, military service, national origin, parental status, political affiliation, race, religion, sex (including pregnancy and gender identity), sexual orientation, or any other non-merit base factor. The College also prohibits sexual harassment including sexual violence or misconduct. The following person has been designated to handle inquiries regarding any of these policies: Human Resources Manager, 501 College Dr., Main Building, Room M810, Charlottesville, VA 22902; 434.961.6567.


Learn today...Lead tomorrowKIDSCollege@CATEC

2018 Registration for qSummer qOther

Online registration available at www.pvcc.edu/kidscollege. To register by in-person, phone or by mail: Complete all forms (Registration Form, Assumption of Risk) and make a payment. Mail/bring to PVCC Workforce Services, 501 College Drive, Charlottesville, VA 22902. Questions and/or to register: 434.961.5354 or [email protected]. Payment must be received at time of registration. Scholarships available based on financial need. All scholarship and registration forms at: www.pvcc.edu/kidscollege.

Student’s (Child’s) Name

School Grade level in fall 2018/2019

Circle: Male Female Date of Birth: ____/____/____ Social Security #:

Student previously enrolled in a PVCC KidsCollege Academy or class? q YES qNO

Parent or Legal Guardian Name

Phone (Home) (Cell) E-mail Address:

Address:

City: State: Zip:

(optional) Additional Parent or Legal Guardian Name:

Phone (Home) (Cell) E-mail Address

Address:

City: State: Zip:

Student’s Ethnicity: qHispanic/Latino q AsianqAmerican Indian/Alaska Native q Black/African-American qWhite/Caucasian qNative Hawaiian/Other qPacific Islander qChoose Not To Specify

Is the student a U.S. citizen? qYes qNo If no, country of citizenship: Permanent Status: qResident alien Asylee Refugee #: What is the student’s current immigration status with the U.S.? qNot in U.S. I am requesting visa status qCurrently in U.S. qStudent is a dependent of someone who served in the military.How did you learn about KidsCollege@PVCC Summer Academies? qBrochure from school qReturning student qOther:

ACADEMIES Include early care drop-off, lunch & after-academy care, if applicable.

#Number Date Academy Title or Program Title Fee

TOTAL $

Please make payment to Piedmont Virginia Community College.

DO NOT FAX OR EMAIL CREDIT CARD INFORMATION. Call 434.961.5354 to pay with credit card. Method of payment: Check Money Order Visa • MasterCard • AMEX

Card No.: – – –

Exp. Date: / Billing Zip Code: Name on Card:

Signature: Total Amount Enclosed:

(for office use: Empl.ID )


Information about the KidsCollege Academies is distributed to students through mailings, at community events and through area schools. Albemarle County Public Schools does not discriminate on the basis of race, color, religion, age, sex, disability, national origin, pregnancy, or marital status. Questions or concerns regarding compliance with the School division’s nondiscrimination policies may be directed to: Director of Human Resources, 401 McIntire Road, Charlottesville, VA 22902; Phone: 434.296.5827.

Student Name (for office use: Empl.ID )

2018 KidsCollege@PVCC STUDENT INFORMATIONSIGN-IN/SIGN-OUT INFORMATION (additional names can be added later by parent/guardian. Please include your own name, if applicable)

Please list the names of the parent(s) and/or other adults who have permission to pick the student up, including parent signing below.

By signing this form, the parent gives permission for the adults listed below to pick his or her child up from the Academies:

1. Name Relation to student: Phone number:



Adults listed above may be asked to show photo I.D. at pick-up. Please have I.D. ready.

EMERGENCY CONTACTS

In case an emergency situation arises who should we contact first? Include your own name, if applicable, contact:


(OPT. Additional Phone number: )


(OPT. Additional Phone number: )

HEALTH NEEDS/SPECIAL CONSIDERATIONS1. Does the student have any allergies, or other health issues or conditions? qNo qYes

Please explain:

2. Does the student take any medications? qNo qYes Please list:

3. Will your student need to take any of these medications during the program? qNo qYes

4. Does the student carry a respirator, EpiPen, or other medical device? qNo qYes Please explain:

5. Does the student have any special learning or behavioral needs? qNo qYes Please explain:

Additional Comments:

Send payment and registration forms to PVCC Workforce Services, 501 College Drive, Charlottesville, VA 22902.

For more information or to register by phone with a credit card, please call 434.961.5354 or [email protected].


ASSUMPTION OF RISK/PHOTO RELEASE /STUDENT CONDUCT FORM

PIEDMONT VIRGINIA COMMUNITY COLLEGE - 2018 KIDSCOLLEGE@CATEC

I (the student) agree, that as a participant in the 2018 KidsCollege@CATEC Programs at CATEC, including Spring and Summer Academies, and Workshops, scheduled between January 1, 2018, and Dec. 30, 2018, I am responsible for my own behavior and well-being. I accept this condition of participation, and I acknowledge that I have been informed of the general nature of the risks involved in this activity.I understand that in the event of accident or injury, personal judgment may be required by College personnel regarding what actions should be taken on my behalf. Nevertheless, I acknowledge that the College personnel may not legally owe me a duty to take any action on my behalf. I also understand that it is my responsibility to secure personal health insurance in advance, if desired, and to take into account my personal health and physical condition.I further agree to abide by any and all specific requests by the College for my safety or the safety of others, as well as any and all of the College’s rules and policies applicable to all activities related to this program.In consideration for being permitted to participate in this program, and because I have agreed to assume the risks involved, I hereby agree that I am responsible for any resulting personal injury, damage to or loss of my property which may occur as a result of my participation or arising out of my participation in this program, unless any such personal injury, damage to or loss of my property is directly due to the negligence of the College. I understand that this Assumption of Risk form will remain in effect during any of my subsequent visits and program-related activities, unless a specific revocation of this document is filed in writing with the program coordinator, at which time my visits to or participation in the program will cease.

STUDENT CODE OF CONDUCT (Parent/guardian and student to review) I will treat fellow students, PVCC faculty and staff with respect at all times, including: respectful listening, participation during hands-on activities, avoid distracting behavior and follow directions from PVCC staff as necessary to ensure a safe and enjoyable experience by all. I understand that the College reserves the right to exclude my participation in this program if my participation or behavior is deemed detrimental to the safety or welfare of others. I agree to the expectations for behavior, which includes not smoking, chewing gum, rough-housing or using inappropriate language. I understand that cell phones and electronic games are allowed for limited use as permitted during breaks.I understand that the consequences for breaking these rules may include (1) a warning from the Instructor (2) meeting with Program Manager and/or staff (3) a phone call and/or meeting with the parent/guardian (4) being asked to leave the program without a refund.

PHOTO/VIDEO RELEASE I hereby grant to PVCC, and to the press and media, the right to photograph, videotape, or otherwise digitally collect my likeness, voice and sounds (as “Works”) during my participation in the KidsCollege@CATEC programs. I further acknowledge that these cooperating entities have the right to use or sublicense these Works in all forms and for all purposes, including without limitation, advertising and other promotions for the KidsCollege@CATEC programs, including on the KidsCollege@PVCC Facebook page. It is a PVCC policy not to print a minor’s name with his/her picture without specific permission from his/her parent or guardian.

My child/ward is under 18 years of age and I am hereby providing permission for him/her to participate in this program, and I agree to be responsible for his/her behavior and safety during KidsCollege@CATEC programs.

I acknowledge that I (student or parent/guardian) has read and fully understand this document. I further acknowledge that I agree to the terms and conditions of this form, and I am accepting these personal risks and conditions of my own free will.

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Parent/Guardian Signature (Type Name)

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CATEC KidsCollege@ - Piedmont Virginia Community … · Times: A.M. Academies: 9 a.m.–12:15 p.m....

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Transcript of CATEC KidsCollege@ - Piedmont Virginia Community … · Times: A.M. Academies: 9 a.m.–12:15 p.m....