Waivers, Permissions and Agreements
Complete and sign every section, then scan or photograph all pages and email them to Registration@stemyea.com. This must reach us within two weeks of submitting the online registration form.
Permission to attend STEM YEA
I, the parent or guardian, give permission for my child to attend the STEM Youth Explorer Academy at Kutztown University. I understand that the Academy begins on Thursday, June 24, 2027 at 8:45 a.m. and concludes on Sunday, June 27, 2027 at 7:00 p.m. I understand that my child will be staying overnight in the Kutztown University dormitories under the supervision of Rotary Club volunteers who have received all background clearances required by the Pennsylvania Department of Education for volunteers who supervise school students. The Rotary volunteers will also have the Rotary Youth Protection Clearances.
Permission for use of images
STEM YEA will be using the following to make a record of, and to promote, STEM YEA:
I, the parent or guardian, hereby give consent to Rotary, STEM YEA, and Kutztown University to use the name and image of my child in the media listed above, for an indefinite period of time.
Medical consent
In the event of any medical emergency, I
… and consent to any X-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care that Kutztown University / Rotary STEM YEA personnel deem necessary for my child’s safety and protection. I understand and agree that Kutztown University / Rotary STEM YEA assumes no responsibility for any injury or damage arising out of or in connection with such authorized emergency medical treatment. I further understand that if my child experiences any condition requiring emergency medical treatment, Kutztown University / Rotary STEM YEA may direct that my child be transported to the hospital for such care.
Core STEM YEA participant expectations
The student named below agrees to the following for the duration of the Academy. Since this is a group-learning experience, we cannot accommodate students with behavioral issues that would disrupt learning and require extra staff time. Students exhibiting such behavior will be dismissed from the program.
Signatures
Scan or photograph both pages and email them to Registration@stemyea.com within two weeks of submitting the online registration form. Questions? Write to the same address and a Rotarian will call you back.