PLEASE ENTER INFORMATION IN BLOCK CAPITALS

Student Name ______

Male: Female:

Address______

______

Home No. ______

Student Mobile No. ______

Parent Mobile No.______

Parent Email______

Student Email______

(Please provide at least one email address as confirmation of place & all further correspondence will be sent to this address)

Date of Birth______

School______

What year at school are you going into in September 2017?

4th Year5th Year 6th Year

How did you hear about the Summer Camp? ______

Summer Camp Fee:

The fee for the two day Science + Engineering Summer Camp is as follows:

PLEASE PICK ONE OPTION:

Option 1: €60 – Includes lunch on each day and teaching materials

Option 2: €55 – Includes teaching materials but does not include lunch

Fee Concessions:

  • Participants whose parents or guardians are employed by the University of Limerick are entitled to a 10% discount on fee.
  • Participants whose parents or guardians are in receipt of social welfare/unemployment benefit are entitled to a 20% discount on fee. See note below with regard to same.
  • If you are sending two children from the one family, you are entitled to a 20% discount on fee.

Please include proof of social welfare/unemployment benefit with application form

PLEASE READ CAREFULLY:

HEALTH:

Please list participant details of any special medical or dietary requirements:

______

The Science & Engineering Summer Camp will not be held responsible

for non-disclosure of any medical condition.

CONTACT IN CASE OF EMERGENCY:

Name: ______

Home Phone No:______

Mobile No______

Address: ______

PERMISSION FOR PHOTOGRAPH USE:

Please note that photographs may be taken during the sessions for the purpose of recording the event and for promotion. Permission will be taken as granted on receipt of application form unless otherwise stated in writing below by Parent/Guardian.

SUMMARY OF RULES AND PROCEDURES:

  • All students attending the Science & Engineering Summer Camp at the University of Limerick shall maintain acceptable standards of behaviour and shall act in a law-abiding, mature and honest fashion.
  • Smoking, alcohol and other drugs are strictly forbidden, regardless of parents attitudes to such matters while the student is at home.
  • University Property must be respected and the directions of Programme Staff adhered to at all times.
  • Safety procedures as laid down by University Faculty (during Laboratory Sessions, for example), must be followed.
  • Students are supervised between 9am - 5pm.
  • The University will not be held liable for any property lost, damaged or stolen.
  • All applications must include a passport size photograph for security purposes

Failure to comply with these rules, which exist to ensure an enjoyable and beneficial programme for all participants, will warrant immediate expulsion, in which case no reimbursement of fees will be made.

We have completed all sections of this application form and have carefully read and agree to observe, the Rules and Procedures of the Faculty of Science & Engineering Summer Camp.

Please tick 

Signed:

Student______Date:______

Parent/Guardian______Date:______

Please return completed Application Form (by post only) and non-refundable payment of €60 or €55, made payable to University of Limerick(S+E)by Monday 12th June 2017to:-

Linda Flannery

Science + Engineering Summer Camp

Faculty of Science & Engineering

University of Limerick

Limerick

For further enquiries contact:Linda Flannery

Tel 061 202642

Email

Web

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