SummerYouth

CollegeJuly 13-16, 2015

WEEKLY SCHEDULE

Parent Orientation Monday only 8:00 am – 8:30 amClasses Monday – Thursday 8:30 am – 12:00 pm

Plan your summer fun now! Join our talentedinstructors for four days of classes thatchallenge your mind and stretch your

imagination! This academic summer camp isfor students entering the 1st through 6th

grades in the Fall.

General Information:

Summer Youth College will be held Monday through Thursday, July 13-16, 2015, on the MCC NorthCampus in the Brown Badgett Center(BBC). All students will attend three classes that meet one hour eachday from 8:30 am to 12 pm. Students will be grouped into classes customized for their grade level (Grades1 & 2; Grades 3 & 4; and Grades 5 & 6). Family and friends are encouraged to come to a 30-minuteOrientation on Monday at 8:00 am held at the BBC so that they can be introduced to their children’sinstructors and hear pertinent information about the week’s activities. This format will allow students toselect three action-packed classes for one low fee of $88. Daily snacks, classroom supplies and 2015 SYCT-Shirts are included in the cost.

Register Early!Enrollment is limited to the first 20 paid registrants in each class.

Class Selection

Choose one class from each pair of classes listed below. You will attend the same three classeseach day. Class enrollment is limited. If a class you choose is full or does not make, you will be

placed in the other class in the pair.

SUMMER YOUTH COLLEGE 2015CLASSES

Choice One

OR

Choice Two

OR

Choice Three

OR

Grossology with Bethany Crouch Koolinary Kreations with AmandaCrabtree

Totally Tribal with Sharon &Steve Mathias

Cartoon Classics with Glenn Riggs

Crazy for Coal with James McClain

*Content Key:

AR=Art DA=Dance LA=Language MA=Math MU=Music SC=Science SS=Social Studies TC=Technology TH=Theater O=Other

Everyday Art with Ashley Jackson

Do you like gross, sticky, slimy,exploding, andtasty science experiments? In Grossology we willhave 4 days packed with science fun that justmay blow you your socks off or simply make youhungry for more! *SC

Test your "KOOL-inary" skills! Use your mathand reading skills to create edible fun. Learnhow to create snacks without an oven! *LA *MA *SC

Do YOU know the Native Americans? Join us fora day in the life of the Native Americans-experience food, clothing, and family fun just likethe Indians. Don't miss out on our totally "tee-peed" display! *AR *DA *LA *SS

What do Minnie Mouse, Batman, and The Hulk have in common? They're all tasty ascookies! Learn how to decorate cookies withyour favorite cartoon characters: Mickey,Minnie, TMNT, Captain America, The Hulk,Spiderman, Batman, and Superman. Whichwill be your favorite to decorate? *AR

Can you dig it? Learn the facts about coal andparticipate in a mock fire rescue tounderstand more about this main source ofenergy used to power our homes . Grab yourhard hats and join us as we go crazy for coal! *SS *SC

Art is everywhere! Learn how to take itemsyou see, use, and even eat every day tocreate one-of-a-kind pieces. In this classyou'll explore painting and creating usingfood, recycled materials and more! *AR

Please print! Date:

Student: First ____________________ M.I. ____ Last_____________________Preferred on Nametag ________________ (Optional) SS# _____- _____- ____DOB:_____________________ Fall 2015 Grade ________ Please Circle One: Male Female School:____________________________________________________________Parent or Guardian: _________________________________________________Mailing Address:____________________________________________________City_____________________________ St _______ Zip _____________Day Phone: (______) _____ - ________ Email address: _____________________________________________________

Shirt Size (cirlce): Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large ____Other

Registration fee: $88.00 (Includes materials, snacks & SYC T-Shirt)Payment Method (circle): Check (Payable to MCC) Cash VISA MasterCard Discover

Credit Card #: ________-________-________-________ Expiration Date: _____/______

Name on Card___________________________________

Signature _______________________________________ PLEASE COMPLETE BACK PAGE

SYC Registration Form

Please select one class from each box for a total of three classes.

CHOICE ONE

CHOICE TWO

CHOICE THREE

Grossology

Crazy for Coal Everyday Art

Cartoon Classics

Koolinary Kreations

Totally Tribal

or

or

or

Register by Phone, Mail or Walk-in:

Madisonville Community College Workforce Solutions Office

Brown Badgett Center, Rm. 280Madisonville, KY 42431(270) 824-8658 or 8659

Register Early!Enrollment is limited to the first 20 paid registrants in each class.

Tuition refunds will be granted if requested in writing at least two weeks before your SYC begins.SYC Scholarships: A limited number of scholarships are available. Call 824-8689 for more information.

MCC reserves the right to cancel any class.

RELEASE OF CLAIMS FOR DAMAGES:

I, _____________________________________, parent of ______________________________ dohereby consent that said child may participate in Summer Youth College 2014 (July 13-16, 2015) and anySummer Youth College 2015 campus activities.

In consideration of time spent arranging and supervising of above activities, I do hereby personally, onbehalf of said child, absolve and release Madisonville Community College and Workforce Solutions Officefrom any claims of personal injuries which might be sustained by said child while at camp.

___________________________________ __________________________________Parent or Guardian Signature Student Social Security Number (Optional)

___________________________________ __________________________________Address Student Date of Birth

___________________________________ __________________________________City State Zip Phone Number

I hereby give Madisonville Community College permission to use the photograph of the student named onthis form for publicity and promotion. The photograph may appear in the local newspaper or MCC’swebsite or newsletter.

Student Name: ______________________Parent/Guardian Signature: ____________________

KENTUCKY COMMUNITY & TECHNICAL COLLEGE SYSTEMMedical Authorization

Authorization to Release InformationI authorize any Health Care Provider, Insurance Company, Employer, Person or Organization to releaseany information regarding medical, dental, mental, alcohol or drug abuse history, treatment or benefitspayable, including disability or employment-related information concerning the patient, to any CIGNAcompany, the Plan administrator or their employees and authorized agents for the purpose ofvalidating and determining benefits payable. This data may be extracted for use in audit or statisticalpurposes. I understand that I or my authorized representative will receive a copy of this authorization uponrequest. This authorization or a photo-static copy of the original shall be valid for the duration of the claim.

__________________________________ _____________ ___________________Signature (Parent or Guardian if claimant is a minor) Date Phone No.

Payment Authorization: I authorize all current and future medical benefits, for services rendered and billedas a result of this claim, to be made payable to the physicians and providers indicated on the invoices.

______________________________________________ _________________Signature (Parent or Guardian if claimant is minor) Date

MADISONVILLE COMMUNITY COLLEGEWorkforce Solutions Youth Series Event