Virtual NASA Astro Camp - Choctaw Nation of Oklahoma

The first 50 Choctaw tribal members in grades 5-8 who sign up will be accepted to attend the camp. Participants must have sufficient internet connection and access to a computer/tablet with Zoom application. Email and home address for participant must be provided to receive Zoom link to join camp activities and a box of supplies (scissors, stapler, etc.) that will be mailed. This event is sponsored by the Choctaw Nation Youth Events & Activities Program and NASA.

Requirements

Participants must wear school appropriate attire during camp.
Virtual Camp

Participants must have sufficient internet connection and access to a computer/tablet with the Zoom application.
It is vital the email address provided on the Participant Information form is accurate and can be used to receive camp information (including the Zoom link).
Participants will be mailed a box of supplies to complete the camp activities. You may be asked to provide some common materials (ex. eggs, hair dryer, 2-liter plastic bottle, etc.)
Parents/Guardians please be aware that supply kits may contain materials that could require adult supervision (ex. scissors, stapler, etc.)
Lunch break from 11:00 a.m. - 12:00 p.m.

Registration

Child's Full Name(Required)

Date of Birth(Required)

Age(Required)

Grade(Required)

Tribal Member(Required)

Yes

Gender(Required)

Male

Female

T-Shirt Size(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian Name(Required)

By typing your legal full name into the box below you attest that you are the Legal Parent/Guardian authenticated into this application or an authorized user of this account, and the data you are entering/verifying is accurate and true to the best of your knowledge.

Parent/Guardian Phone Number(Required)

Parent/Guardian Email Address(Required)

Relationship to Child(Required)

Emergency Contact Name(Required)

Please make sure the emergency contact information is different than the guardian's contact information.

Emergency Contact Phone Number(Required)

Medical Notes(Required)

Do you have insurance?(Required)

Yes

If answered yes, please list insurance information

Parental Consent(Required)

By clicking the "I agree" button below, and/or by downloading, installing or otherwise using the software, you: (a) accept this agreement and agree that you are legally bound by its terms; and (b) represent and warrant that: (i) you are 18 years of age or older; and (ii) you have the right, power and authority to enter into this agreement for and on behalf of any minor children that participate in the activities. If you do not agree to the terms of this agreement, the nation will not and does not license the software to you and you must not download, install or use the software or documentation.

Participants Release and Waiver of Liability Agreement

Read Completely and Carefully Before Agreeing

This Waiver and Release of Liability and Indemnity Agreement (this "Release") is given by the Parent or Legal Guardian of the minor child(ren) (the "Participant(s)") in favor of the Choctaw Nation of Oklahoma (the "Nation"), a federally recognized sovereign Indian tribe.

I, the undersigned, as the parent or legal guardian of the Participant, and do hereby give my full consent and approval for the Participant to participate in the Choctaw Nation Youth Activities Program (the "Activities").

I understand that there are certain risks of damages and injuries, including death, inherent in the Activities, and in other related activities incidental to participation in the Activities, and I am willing to assume these risks on behalf of myself and Participant. These risks include, but are not limited to, those hazards associated with weather conditions, playing conditions, equipment, and other participants.
Further, I understand that there is inherent risk in the Activities and that inherent risk means those dangers or conditions, known or unknown, which are characteristic of, intrinsic to, or an integral part of the Activities and which are not eliminated even if the activity providers (the "Providers") acts with due care and includes failure by the Providers to warn me or Participant of an inherent risk or the risk that the Participant or another Participant in the Activity may act in a negligent or intentional manner and contribute to the injury or death of Participant.
I understand that Activities may actually be organized, directed, and presented by an individual(s) performing those duties as an independent contractor or specialist using Nation property. I further understand that this agreement applies to all Activities that my Participant is permitted to participate in, including, but not limited to: Sport Participant Instruction and Team Sports Activities (baseball, softball, soccer, basketball, football, etc.)
I understand and acknowledge that, I, as the parent or legal guardian of the Participant, am fully responsible for obtaining medical treatment for Participant.
In consideration for participation in the Activities, and on behalf of myself, Participant, my personal representative, heirs, next of kin, successors and assigns, I forever:
1. waive, release, discharge, and covenant not to sue the Nation and its elected officials, subsidiaries, affiliates, directors, officers, employees, independent contractors, consultants, and agents (the "Nation Parties"); and
2. agree to defend, indemnify, and hold harmless the Nation Parties from and against any and all claims, demands, causes of action and damages, including attorneys' fees, resulting from any accident, incident or occurrence arising out of, incidental to, or in any way resulting from Participant's involvement in the Activities.
I further affirm that by clicking the "I Agree" button, I am agreeing to all terms and conditions of this Release, and I recognize and agree to all terms and conditions of this Release on behalf of myself and on behalf of any Participants that are in my care. I have read this Release and fully understand that by agreeing to this Release I am giving up legal rights and/or remedies which may otherwise be available to me regarding any losses that I or Participant may sustain as a result of my participation in the Activities. I agree that if any portion of this Release is held invalid, the remainder will continue in full legal force and effect.
I acknowledge that I have read (or have had read to me) each and every one of the provisions in this waiver, release of liability and indemnification agreement, and that I understand each of the provisions in this agreement and that I agree to abide by them.

I also agree that the Choctaw Nation of Oklahoma may photograph or capture video of me and/or my child or ward. The Choctaw Nation of Oklahoma may use the images or video footage captured for any purpose, commercial or non-commercial, and in any form desired by Choctaw, in perpetuity and without the obligation to make any payment whatsoever. On behalf of myself and my child or ward and our heirs, successor and assigns, I forever waive all claims based on the Choctaw Nation of Oklahoma's use of the images, footage, or other likeness. I also agree that the Choctaw Nation of Oklahoma may contact me to obtain follow-up feedback after conclusion of the Event.

NASA Media Release for Parent and Minor

I do hereby give permission for the above-named minor child (hereinafter "Minor") to be photographed and/or videotaped by NASA or its representatives. I understand and agree that the photographs and/or videotapes containing the image and/or voice of the Minor may be used in the production of instructional and/or promotional materials produced by or on behalf of NASA (hereinafter the "Program") and that such
materials may be distributed or broadcast to the public and displayed publicly. I also understand that my permission to use the photographs and videotapes is for an unlimited duration and that neither I nor the Minor will receive any compensation for granting this permission or for the use, if any, by NASA of the
Minor's image and/or voice.

I acknowledge that NASA has no obligation to use the Minor's image or voice in connection with the Program.

I hereby unconditionally release NASA and its representatives from any and all claims and demands arising out of the activities authorized under the terms of this agreement.

By signing below, I represent that I am at least 18 years of age and am the parent/guardian/legal representative of the above-named Minor. I have read the foregoing agreement and am familiar with all of the terms and conditions thereof and I consent to its execution by the Minor. I agree that neither I nor the Minor will revoke or disaffirm the this agreement at any time.

I agree

Guardian Signature(Required)

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