The following information is necessary for our records and to ensure the safety of campers and a positive experience for children, staff and volunteers. The information provided is confidential.
Registration for the camp is $125. We accept cash or cheque. Cheques can be made out to: UOIT Faculty of Education. Please include the registration fee with the below registration/consent form.
Forms & money can be mailed or dropped off to:
ATTN: Janette Hughes, STEAM3D Maker Lab (room 415)
11 Simcoe Street North, Oshawa, L1H7L7
Please Print Clearly:
Child’s Name: ______
First Middle Last
Address: ______
Street# and Name City Postal Code
Date of Birth:______/______/______Age:______
Month Day Year
Home Phone #: ______e-mail Address:______
School Name: ______Grade: ______
______
Confidential Medical History

Health Card # ______Physician:______Phone #:______
Parent/Guardian #1 Parent/Guardian #2
Name:______Name:______
Work Phone #:______Work Phone#:______
Cell Phone#:______Cell Phone#:______
Emergency Contact (Other than Parent/Guardian):
______
First Last Relationship to child Home Phone# Alternative # (worker
Name two (2) people who are authorized to pick up children. These individuals will be asked to provide photo ID:
1.______2.______
NAME AND RELATIONSHIP TO CHILD NAME AND RELATIONSHIP TO CHILD
Phone#: ______Phone #: ______
I hereby give The University of Ontario Institute of Technologypermission to use visual likeness of my child(ren) and project work that may be displayed for media promotion.
(Please check one) Yes  No 
______
Parent/Guardian Signature Date
11 Simcoe St. N., Oshawa
(905) 721-8668

“Rules for Conduct in the Camp”

Camp Conduct:
  1. The Camp has “Rules of Conduct” that all students, staff and volunteers follow so that everyone can have a fun and safe program experience. Campers who cannot consistently follow camp rules will be removed from camp.
  2. Always be polite. Abusive or profane language is not allowed. Bullying is not tolerated.
  3. Respect one another. Use positive words.
  4. Listen to all leaders and try as hard as possible to do what they ask.
  5. Put your coats, boots and other items where they belong.
  6. Always respect one another’s belongings. They are not yours to take or borrow.
  7. We need to know where you are, so please stay in your program area until your group moves to the next area. Always ask a leader if you may go to the washroom or get a drink.
  8. Always have fun! Help others have fun by participating with them.
  9. Please take care of Camp equipment; games and supplies so we can all enjoy using them.

RESEARCH CONSENT

Our faculty is committed to engaging in ongoing research related to education. To that end, we are asking for both your consent and that of your child to participate in research connected to the activities in this March Break Camp. Our goal is to measure the impact of the camp sessions on participants’ numeracy skills, their traditional and digital literacy skills and their awareness of identity/identity development. Participation in the research component of this camp is entirely optional and students will not be penalized in any way if they do not participate.

Data will be collected from students in the camp at various times during the week. All activities will be a part of the regular camp program; however, only data collected from students who have consent from parents/Guardians and who have consented themselves to participate in the research study will be used in the analysis and reporting of findings.

Participation in this research would involve the following commitments for your child(ren):

  1. Pre and post-study Surveys – Participants will be asked to complete a brief, anonymous 20-minute online survey at the beginning and at the end of the camp. Questions will be related to their past experience with digital technology, including coding and digital crafts, and traditional crafts.
  2. Focus group or open-ended interviews – In small focus groups of 3-4 students or one-on-one informal interviews, participants will be asked to reflect on their learning during the camp.
  1. In addition to using the above as data in our study, the research team will observe camp activities and interactions and collect data using observation notes, audiotaping and videotaping of selected session proceedings. These recordings will be transcribed and students will be assigned a pseudonym; they will not be identified by name or using any other identifiable information.

Please understand that this is a voluntary project aimed at improving students’ academic achievementand attentional skills. Your decision to allow your child(ren) to participate or not participate in this research has no effect on their ability to participate in any part of the program, nor will they be penalized in any way if they do not have consent to participate.

Your child(ren) may withdraw from the research without penalty, prejudice, or explanation at any time by informing one of the investigators or by closing the survey on their browser (during a survey). Should participants withdraw from the study after their online survey is completed, their survey data cannot be removed because the survey is anonymous.

Dissemination of research results will be through standard academic means such as journal articles, conference presentations, and books. No participants will be identified by name.

Any questions or concerns about the research can be directed to Dr. Janette Hughes (; 905-721-8668, ext. 2875). You may also contact the Ethics and Compliance Officer (; 905-721-8668, ext. 3693).

Confidentiality will be protected; interviews will be transcribed using pseudonyms. Data collected from interviews and questionnaires will be kept on password protected hard drives accessible only to the researchers. Hard copies of transcripts will be kept in locked filing cabinets in the researchers’ offices.

Thank you for your voluntary participation this important research initiative.

Sincerely,

Dr. Janette Hughes

Associate Professor and Canada Research Chair, Technology & Pedagogy

UOIT Faculty of Education

Coding & Digital Making Camp

Parent/Guardian/Student Consent to Participant in Research

Having read and understood this letter of information and consent form:

  • I freely consent to allow the results from my surveys to be used anonymously in the research project.
  • I freely consent to allow the results from any interviews to be used without my name attached in the research project.
  • I understand the risks, benefits, and procedures of this study.
  • I understand that my participation is voluntary and I am free to withdraw at any time without consequence.
  • I understand that my data will be kept confidential until such time as the ID key is destroyed, and my data will then become anonymous and part of a larger set of data for statistical analysis.
  • I understand that results from this study will be used for scholarly purposes, including but not limited to the creation of research articles and conference presentations.
  • I understand that I am not waiving any legal rights by signing this form.

Parent/Guardian Name (block capitals)
Parent/Guardian Signature
Date
Parent/Guardian
Email address
Student Name
Student Signature
Date