WAITLIST June 3-5 Chip Camp Registraton

WAITLIST Chip Camp Registration Form: June 3-5

Name of Student Registered for Chip Camp(Required)

First Middle Last

Preferred name, if applicable

First

Date of bith(Required)

Age of student(Required)

Parent/Guardian 1 Information

Name(Required)

Relation to student(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 2 Information

If this is not applicable, please simply write “NA” in each space

Name(Required)

Relation to student(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Emergency Contact 1 Information

Name(Required)

Relation to student(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Emergency Contact 2 Information

Name(Required)

Relation to student(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Are there any other adults your child is allowed to be released to?(Required)

If yes, name(Required)

Relation to student(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

My student will be a 7th or 8th grader:(Required)

Yes

Name of school your student attends(Required)

Does the student have any food allergies or sensitivities?(Required)

Yes

If yes, please list any food allergies or sensitivities

Will your student be taking any medications during program hours?(Required)

If so, please list in the space. If not, simply say “no”

Please state any other special health, accessibility, or behavioral needs that would help us care for your child(Required)

If none, please simply say “no”

Students will receive Chip Camp T-shirts to wear during program hours. Please specify your student's T-shirt size (offered in adult sizes):(Required)

Does your student have a family member who is employed at Micron?(Required)

Yes

Relation(Required)

As part of the camp activities, students will have the opportunity to participate in a Virtual Reality (VR) experience focused on semiconductor and fabrication processes. Do you consent to your student using a VR headset during this activity?(Required)

Yes

Chip Camp Requirements

Student and parent/guardian must complete the following questions in order for the students to participate in Chip Camp.

Camper Code of Conduct – Student must type their name below to confirm understanding of expectations(Required)

At all times the student will show respect for and follow the directions of the activity instructors. Students will also show respect to other students and speakers. No inappropriate or distracting behavior is allowed. Failure to meet these standards will result in the student missing out on camp activities, and potential for parents/guardians to be notified.

Transportation – type parent/guardian's name below to confirm consent(Required)

I, parent/guardian, give my consent for the student named above to be transported by bus on day 2 of Chip Camp from the Boise State campus to Micron and back. If parent/guardian does not give consent, please explain an alternate drop-off and pick-up plan. A team member will reach out to confirm at the phone number listed above.

Alternate transportation plan, if applicable

Medical Release – type parent/guardian's name below to confirm consent(Required)

I, parent/guardian give my consent that if my student is injured while attending Chip Camp, parents/guardians will be promptly notified with details about the incident. In the event of an injury requiring paramedics, emergency services will be notified prior to parents or guardians being notified. Once a call has been placed to 9-1-1, parents and guardians will then be contacted

Please select ALL options the student identifies as their ethnicity/race(Required)

Hispanic/Latinx

White/Caucasian

Asian – Far East/South East/Indian

Native American/Indigenous

Pacific Islander/Native Hawaiian

Black/African American

Prefer not to answer

This information will be used to help make Micron STEM programming better, and determine if our STEM programs help to close opportunity and access gaps. This information will not be shared with a third party.

Gender of student(Required)

Female

Male

Non-binary

Prefer not to say

Privacy Notifications – if student is under 18, parent must complete this section

Before completing your registration, please review Micron’s Privacy Notice http://www.micron.com/privacy. If you are a parent or guardian and believe that you or your child provided Personal Information (including Children’s Information) to Micron which you would like to access, correct or have deleted, or have questions about Micron’s process of Personal Information, please contact us via email at: privacy@micron.com or k-12programs@micron.com

Media Permission(Required)

Yes, media permission granted

Micron and Boise State programs and events may include photos and videos. These photos and videos may be used to promote both programs, including but not limited to social media and in marketing and communication materials with the student names removed. Please indicate YES or NO to acknowledge your permission to use the media captured of your student in our materials. Indicating “no” does not affect the student’s ability to attend; technical steps will be taken to ensure the student’s image is not shared.

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WAITLIST June 3-5 Chip Camp Registraton

WAITLIST Chip Camp Registration Form: June 3-5

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Emergency Contact 1 Information

Emergency Contact 2 Information

Chip Camp Requirements

Privacy Notifications – if student is under 18, parent must complete this section

Institute for Microelectronics Education and Research