Middle School Summer Application Form

Session

No classes on July 4

Student Last name

Student First name

Permanent home address

Apt. no.

City

State

ZIP code

School district

School name

Gender

Grade

Grade just completed

Has the student previously attended the JFKR AAA program?

Has the student previously attended an aviation/aeronautic program?

If yes, which one(s)

Parent/guardian last name

Parent/guardian first name

Parent/guardian Telephone no.

Parent/guardian e-mail address

Emergency contact full name

other than Parent/guardian

Emergency contact Relationship to student

Emergency contact Telephone no.

To determine which members of each ethnic/racial group are reached by this program, JFKR requests the information below. Submission of this information is VOLUNTARY and will not be used when considering this application.

Does the student qualify for free or reduced price lunch?

Does the student have any dietary restrictions?

Consent

I (Parent/Guardian), do hereby release and discharge the York College and all JFKR AAA Funding Entities, members, administrators, and agents from any and all claims, present and future, known and unknown, due to, or arising in any manner from, this child’s participation in the project or related activities sponsored by JFKR at York College. I have read or someone associated with JFKR AAA has read and explained the information contained in this form to me. I willingly agree and give my consent to let JFKR AAA enter data about my child and me into its computer information system. I hereby grant JFKR AAA and others acting on its behalf, the right to record my child and his/her voice using audio, photographic, video, or other such techniques; to include my child’s name, likeness, voice, and biographical material in connection with these recordings; to use, reproduce, distribute, and exhibit such recordings in any and all media throughout the world without limitation; and to authorize others to do so, for any purpose which JFKR AAA and those acting pursuant to its authority, deem appropriate. I hereby waive all rights of any nature in such recording(s) and the exhibition thereof. It is understood that this grant is provided at no cost and that no compensation of any kind shall be due or expected.

Parent/guardian Signature (Type your full name)

I have agreed to submit this application by electronic means. By signing this application electronically, I certify under penalty of perjury and false swearing that my answers are correct and complete to the best of my knowledge, including information provided about the student.

Aviation and Aeronautics Academy

Middle School Summer Application Form

Application Form