Please read, complete, and sign all sections below.  

First Name *

Last Name *

Student Cell Phone

Email *

First Name *

Last Name *

Parent/Guardian Phone Number *

Email *

Full Name *

Relationship to Student *

Phone Number *

Full Name *

Relationship to Student *

Phone Number *

Is the student being treated by a physician for an injury, illness, or other medical condition that could impact participation in a field trip or event? *
- Select Option Yes No

Please list any medical condition(s) we should be aware of, that could impact your child's participation in trips and events. (If not applicable, enter "NA.") *

If there are any steps that need to be taken to accommodate the student's medical condition(s), please list them here. (If not applicable, enter "NA.") *

Please list any medication the student will need to have with them during trips and events. (If not applicable, enter "NA.") *

If you need to have a dose of your medication during the trip, please bring it with you to self-administer in the presence of TRIO Talent Search staff.

Please list any food allergies or dietary restrictions the student has. (If not applicable, enter "NA.") *

Please read the following statements and sign below to give your consent.

As the parent, legal guardian, or foster parent of the minor child listed above, I hereby certify that the above information is the most up-to-date and correct to the best of my knowledge that I agree to the following as a condition of my child’s participation in the GVSU program or visit and related activities.

I give my permission to GVSU, St. Mary’s Hospital, Spectrum Health Care System, or any other health care providers close to the field trip site to provide, seek, obtain, or approve any routine, necessary, or emergency health care during the minor child’s involvement in the GVSU programs.  I understand that this authorization is given in advance of any specific diagnosis, or treatment or medical care being required and is to serve as specific consent to any and all such diagnosis, treatment or hospital care which  may be deemed advisable.  I understand my rights under the Health Insurance Portability and Accountability Acts (HIPPA) and authorize GVSU to release information as necessary for managing program health care.

I acknowledge that participation in the visit and related activities involves assumed and inherent risk of personal injury.  I assume such risk on behalf of the minor child and give my permission to the minor child to participate in all program activities.  I release and agree to hold harmless GVSU, its Board of Trustees, students, and employees from all claims, actions, damages and liabilities for personal injury or damage relating to or arising out of any activity except where the injury or damage is caused by the gross negligence of the University’s employees.  I understand that the minor child will be subject to the rules and regulations of the GVSU visit and related activity.  I understand that any person who repeatedly disobeys University policies or procedures, or those of the TRIO Talent Search program, will be immediately expelled from the program. 

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A parent or guardian is expected to provide transportation for their son/daughter if possible.  Limited transportation may be available for students who have no other means of transportation to and from camp, but we are still awaiting confirmation on whether we are able to offer it, and for how many students.

Alternatively, we can provide you with a list of parents who would like to coordinate ride sharing amongst themselves, if you are interested in carpooling.  You will have the option to indicate below whether this option is of interest to you.

The drop-off location for each day will be the GVSU DeVos Center in downtown Grand Rapids.  Further details about drop-off and pick-up will be announced at a later date.  We will notify parents and students of the full details via the email address(es) you provided on this form.

If a parent/guardian does not pick their son/daughter up at the end of the camp day, and the student doesn’t have another way to get home, we will attempt to contact you via the phone number(s) you provided.  If we are not able to reach you, we will try to reach the emergency contacts you list above.  If we exhaust all other options and still cannot reach you, as a last resort we will contact GVSU Campus Safety Department and the police will assist us with trying to locate you.  

I understand and agree to the transportation policy above. *
- Select Option Yes No

Would you like us to connect you with other parents who are interested in carpooling? *
- Select Option Yes No

If interested in carpooling, are you willing to transport other students in addition to your own child?
- Select Option Yes No

If interested in carpooling, what contact information of yours do you permit us to share with the other parents?
Your phone number
Your email address

This summer camp is being offered free of charge.

Each student will receive 2 camp T-shirts.  We will enforce the camp uniform policy, so please make sure your child is wearing the proper uniform T-shirt each day.

Please select the student's shirt size below.  Shirts are unisex adult sizing.  If you are unsure of your size, please guess a size up, as we only order the size you indicate and cannot exchange it for another size the day of the camp.  

We cannot guarantee the correct size will be available, but we will do our best to accommodate your request.

Please select the student's T-shirt size: *
- Select Option Small Medium Large Extra-Large 2X-Large

Do you agree to make sure your child wears the proper uniform shirt each day of camp? *
- Select Option Yes

This camp is offered as a reward for students who have been participating in TRIO and striving for academic excellence. 

Students who have good attendance at school and at TRIO meetings, who have had few or no disciplinary issues (as verified by the school counselor), and have maintained satisfactory grades (2.0 and above) will have first priority for selection.  We will reach out to your school counselor to verify that your child's grades, attendance, and behavior meet our requirements for participation in the camp.

(Optional) If your child does not meet the above requirements, you may provide an explanation below of why he or she may not meet the above criteria and why you feel he/she is nevertheless a good candidate to participate in this opportunity.

Do you, the parent, feel confident that your child has the social skills to get along with students they may not know and participate fully in camp activities for three days? *
- Select Option Yes No Unsure

Our program incurs costs for every student who signs up, even if they do not actually attend.  In light of this, the last day to cancel your registration is Friday, June 7th. 

If you register your child for this camp and then cancel after that date, your child will lose field trip privileges for the next school year, unless the cancelation is for medical reasons.

There will be a mandatory orientation for parents on June 5^th from 6-7 PM, via Zoom.

All parents of summer campers must attend.  If you can’t make it, we will send you a video recording of the orientation and you will have to respond back to us before that Friday letting us know that you have watched it.

Please read each of these statements and then sign below to give your consent.

I hereby grant permission for my child/dependent, the above named student, to participate in a visit to the Allendale and Pew campuses of Grand Valley State University, as well as other sites in the area.  I understand that some of those external sites may require an additional waiver.

I understand that students will be participating in recreational games and sports. 

I, as well as my child/dependent, understand that all students participating in this event will be responsible in conduct to adult chaperones at all times.

I will not hold any school district, Grand Valley State University, the TRIO Educational Talent Search Program, or their employees, volunteers or agents responsible for any injury to my child that occurs during any trip taken in good faith.  

I understand that GVSU is not responsible for lost or stolen property.

I have read this entire minor child program release form. I fully understand it and I agree to be legally bound by it.

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Please read the following statements.  If you agree to these terms (which are optional and not required for participation) please sign below.

I, the Parent/Guardian of the above named student, hereby authorize GVSU TRIO Educational Talent Search to:

1. Take photographs, video, and/or electronic images of my child during the event or trip and use the student’s name in connection with these images/recordings.
2. Use, reproduce, exhibit or distribute in any medium these recordings for any purpose that the University, and those acting pursuant to its authority, deem appropriate, including promotional or advertising efforts.

I give permission to GVSU, to use, without charge and without reservation, my child’s likeness in any medium and for any lawful purpose, including promoting the University, its programs and services.  I waive any rights of action I may have and release GVSU and its licensees from any and all claims I may have arising from my child’s likeness, including the rights to sue for defamation or violation of my rights of privacy and publicity.

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If you do not want your child's photo taken, please contact our office at (616) 331-7110 or [email protected].

Refusal to sign the photo & video release portion of the permission slip does not impact the student's right to participate.