Congratulations! You have been selected to attend Pearls of Perfection’s 2015 Girls Rock S.T.E.A.M Experience.The Girls Rock S.T.E.A.M Experience (GRSE) will be held at Keiser University. The dates and times for this summer event are June 11th and 12thfrom 9:00AM to 3:30PM. The nominal fee of $30 will contribute to the purchase of your daughter’s Wild Adventure theme park ticket. The two day event will be open to girls from various Duval County Middle Schools. However, only 100 applications will be accepted. Transportation will be provided from designated schools to Keiser University and lunch will be provided. The goals of the Girls Rock S.T.E.A.M Experience (GRSE) are:

  • Provide Hands-on exploration in Science, Math, Engineering the Arts and Technology
  • Produce engaging and enriching experiences for all girls
  • Promote activities that will help students learn critical skills for theirfutures

For questions or concerns, please email or call Ta’Vianna Billingslea–, call 904.418.1227or Dr. Sandra Jackson - 904-477-4444

Please fill out one form per student. This form is to be completed by the Parent/Guardian. Please print your information.

Student Information

Name: ______

Address: ______

City/State/Zip: ______Phone:______

School Name: ______Grade Level Entering: ______

T-Shirt Size (adult): ______Facebook Name: ______

Parent/Guardian InformationCheck if same as Student’s

Name: ______

Address: ______

City/State/Zip: ______Phone: ______

Email: ______

Please provide at least two contact numbers with names and relationship:

  1. Name:______Relationship: ______Phone: ______
  2. Name:______Relationship: ______Phone: ______

Pearls of Perfection

Field Trip Form

School Name: ______

I consent to ______(Student’s Name) going to Keiser University and Wild Adventureson June 11th and 12th the year of 2015 for supervised activities, and agree to release and discharge the Pearls of Perfection, its officers, agent and employees, exercising reasonable care within their scope of employment, from liability growing out of personal injuries and property damage resulting or occurring during the afore mentioned activities, or in transit to and from said activity.

Please submit camp payments to a POP Advisor or online with the link below.

***REFUNDS CANNOT BE ISSUED FOR ANY REASON. ***

Departure Time: 8:00 AMCost/fee: $30.00

Return Time: 7:00 PM

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Parent/Guardian Legal Signature

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Date Signed

Are there any special instructions? ______

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Student Media Release

Pearls of Perfection or outside organizations including news media

I, ______, hereby authorize the videotaping/filming/photography of my child, ______, and/or the release of his/her name and achievement(s) for publishing (print, World Wide Web) and/or broadcasting purposes. I also consent to the showing of the video/film/photographs to any person. I understand that Pearls of Perfection is not a party to outside organizations’ photography/filming/video production and will hold Pearls of Perfection and its employees harmless from any liability in connection with a production not produced internally by Pearls of Perfection.

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Signature

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Print Name

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Date

STEAM CAMP Bus Schedule June 11th Only

School / Pick-up Time / Drop-off Time
Brookview / 8:15am / 4:00pm
Eugene Butler Middle / 8:00am / 4:15pm
Gilbert Middle / 8:15am / 4:00pm
Highlands Middle / 8:10am / 4:00pm
Jefferson Davis Middle / 7:30am / 4:00pm
Mandarin Middle / 8:00am / 4:00pm
Mayport Middle / 7:45am / 4:15pm
Northwestern Middle / 7:45am / 4:30pm
Oceanway Middle / 7:45am / 4:15pm