Department of Early Childhood, Elementary and Literacy Education

2016 epiSTEMic Camp

College of Education and Human Service

Department of Early Childhood, Elementary and Literacy Education

Looking for a fun and educational science, technology, engineering, and math (STEM) program for your rising preK-8th grader? The epiSTEMic summer program aims to develop campers’ knowledge and understanding of STEM through hands-on, inquiry-based, thematic projects for the early childhood and elementary-middle school learner.

epiSTEMic was developed by faculty in the department of Early Childhood, Elementary, and Literacy Education (ECELE) in the College of Education and Human Services. Nationally recognized for teacher preparation, the ECELE faculty delivers a camp designed with the child and teacher in mind. The camp aims to foster learning in children, while supporting our outstanding teacher development program. In addition to supporting STEM understandings for campers and MSU teacher education students, the program benefits our partner teachers who receive STEM training and professional development, and parents of campers are invited to be engaged members of the epiSTEMic community of learners.

epiSTEMic maintains a small camp size. Space is limited.

Specific goals:

·  Apply critical thinking skills to solve STEM problems

·  Foster positive attitudes towards STEM

·  Develop an awareness of STEM careers

·  Develop an engineering habits-of-mind

·  Apply digital technology skills

·  Develop communication and presentation skills

·  Ask questions, seek answers, and persevere

·  Create video and art projects

·  Have fun, play games, and more!

Program Dates: July 5 – 29, 2016, Monday – Thursday from 1 p.m. – 5:30 p.m.

Tuition: $1,325

Sample daily program:

1:00 Camper check-in

1:10-1:30 Whole group activity (for example: project introduction, team building)

1:30-2:30 Engineering challenge activities (past projects include: solar oven, marble run, Rube Goldberg, go-carts)

2:30-3:00 Snack

3:00-4:00 Small group activities (for example: math practice/enrichment, Minecraftedu, Scratch, Makeymakey)

4:00-5:00 Outdoor fun/fitness/choice

5:00-5:30 Group share/debrief/decompress

5:30 Parent/caregiver pick up

For more information contact: 973-655-5407 or

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2016 epiSTEMic Camp

ENROLLMENT APPLICATION (pages 2-6)

Step 1: PLEASE PRINT CLEARLY. COMPLETE PAGES 2 – 6. One form per child.

Step 2: Please send the completed Enrollment Application via email to:

Step 3: Please pay on-line. Go to http://msuecelesummer.eventbrite.com Use code: MSUsummer

Tuition: $1,325 (includes processing fee)

For special discounts. One discount per child. Discounts cannot be combined.

Early Bird $100 off if paid in full by May 1st

$50 off for 1 sibling, enter code sibling

$50 off for referral of new student, enter code referral

10% off for Summer Literacy and epiSTEMic at full-fee, enter code combo

Step 4: You will receive a confirmation email approximately 7-10 days from receipt of the date of completed application and enrollment fee.

CONTACT INFORMATION * MUST COMPLETE IN BOLD

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2016 epiSTEMic Camp

CHILD’S NAME GRADE FALL 2016 DOB
PARENT/GUARDIAN 1 / CELL PHONE / PARENT/GUARDIAN 2 / CELL PHONE
EMAIL / EMAIL
FIRST SUMMER WITH US? (CIRCLE)
NO IF NO AND MAILING ADDRESS IS THE SAME AS LAST YEAR, SKIP TO EMERGENCY CONTACT BELOW
YES HOW DID YOU HEAR ABOUT US?
MAILING ADDRESS

EMERGENCY CONTACTS AND PICKUP AUTHORIZATIONS

In addition to parents, ONLY those on the list below will be allowed to pick-up a camper from camp. (Photo ID will be required at pick up.) Please list all additional persons authorized to pick up your child. Parent/guardian may give written permission for an individual, who is not on this list, to pick up child. No child will be released without written permission. Please make sure that the individuals on this list are aware that they may be called in an emergency to pick up your child. You are welcome to add or to delete from this list at any time. Please indicate if a non-custodial parent has limits on visitation or pick up. If a non-custodial parent has been denied visitation or has limited visitation by court order, a copy of the order must be given to the epiSTEMic Camp at Montclair State University and kept on file at program.

ADDITIONAL AUTHORIZED PICK UP (Guardian, Friends, Nanny, Babysitter, Relatives, etc.)

NAME / CELL / HOME/WORK #
NAME / CELL / HOME/WORK #
NAME / CELL / HOME/WORK #

PARTICIPATION & PERMISSION AGREEMENT

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2016 epiSTEMic Camp

I hereby enroll my child in the 2016 epiSTEMic Camp at Montclair State University and I:

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2016 epiSTEMic Camp

______grant permission for my child to participate in all scheduled camp activities, including the bus transportation to and from camp and field trips.

______understand I must complete and return medical forms by law prior to the start of camp.

______give permission to use any pictures taken of my child during participation at camp for promotional purposes. This photograph may be placed on the epiSTEMic Camp at Montclair State University’s Web Page, brochure, or camp flyers to promote information about the program.

______understand the camp fees do not include health and accident insurance and I will be responsible for any and all charges incurred for prompt medical treatment.

______understand that each camper and parent must cooperate and accept camp rules and guidelines. Inappropriate behavior may result in disciplinary action by the camp directors and/or dismissal from camp. If a camper is dismissed for inappropriate behavior, camp fees are non-refundable.

______agree to pay the balance of camp fees.

______indemnify and hold harmless Montclair State University and its employees from liability for any harm that befalls my child as a result of participation in the camp.

______give permission for staff to apply or reapply as necessary sun lotion/bug spray that I provide for my child.

Reservation not valid without signature and will be returned to sender.

By signing below I acknowledge and accept the above stated release and the epiSTEMic Camp at Montclair State University’s camp policies that I have initialed.

Signature______

Printed Name______Date______

Camper’s Name______Age______DOB______

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2016 epiSTEMic Camp

BACKGROUND INFORMATION

1)  a) IF YOUR ARE NEW TO EPISTEMIC, what interested you in this program? ______

b) IF YOU ARE A RETURNING FAMILY, why did you decide to return to the program?

______

2)  What inspires your child’s curiosity/desire to learn?

______

3)  Please list priority skills in STEM you would like your child to develop.*

______

*We will do our best to address the skills listed.

4)  How does your child spend his/her free time?

______

5)  What is your child’s favorite subject(s) at school?

______

6)  What is your child’s least favorite subject(s) at school?

______

7)  What are your child’s socialization strengths and areas to develop?

Strengths:

______

To develop:

______

______

8)  Does your child have learning an Individualized Education Plan (IEP) or 504? □YES □NO

If YES, please provide a copy of your child’s IEP or 504 report, so that we may integrate appropriate instruction for your child. We will maintain confidentiality of the document.

9)  Any particular strategies or adaptations that you use at home that can help us support your child’s participation in the program?

______

10)  Does your child have any allergies or medical concerns we should be prepared to address? Please describe below.

______

11)  Do you give permission to videotape, audiotape, and photograph your child for:

a) camp activities? □YES □NO

b) newsletters? □YES □ NO

c) promotional materials? □YES □ NO

In order to learn how your child is benefitting from this program and to improve how to support teacher development through the epiSTEMic program, you and your child will be asked to complete a separate consent and assent form on the first day of the program.

By signing this form, I verify the authenticity of all responses in this document.

______

Signature Date

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MEDICAL INFORMATION

Family Doctor: ______

Phone Number: ______

Health Insurance Carrier: ______

Policy Number: ______

Emergency Contact: ______

Emergency Phone/Cell: ______

PLEASE CHECK:

1) Allergies ☐No Known allergies Camper is allergic to ☐food ☐medicine ☐things in nature ☐other

Please describe: ______

______

My child carries an EPI-Pen? ☐ YES ☐ NO

2) Any medical concerns we should be made aware? ☐ YES ☐ NO

If yes, please explain: ______

3) Any restrictions for physical? ☐ YES ☐ NO

______

In the event of a medical emergency, I (we) give permission to the university healthcare provider to hospitalize and/or secure proper treatment for my (our) child. Every attempt will be made to contact you prior to such decision.

______

Parent(s)/Guardian Signature

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