CCIM+ 3-Day Workshop

Friday, June 20, 2025 until Sunday, June 22, 2025 Eastern Daylight Time UTC -04:00

Looking for a summer workshop experience that can help you develop new skills, make new friends and find new passions within a media, communications, technology, esports or storytelling field? Look no further! At Ball State, we offer a robust summer experience for middle and high school students and teachers looking to become better leaders, writers, storytellers, designers, editors, photographers, videographers and more! No prior experience necessary.

This form is to be submitted by a teacher or guardian.

* required

Please confirm the workshop to be attended:

3-Day

4-Day

5-Day

Available Workshops

On the Ball Media Retreat

Photographic Storytelling

Sports Media Production (Sports Link)

Visual Effects (VFX)

Yearbook 101

Digital Storytelling and Production

Media Design and Graphics

Social Media Video & Content Creation

Speech Camp

Sports Reporting

Student Media Leadership

Esports Virtual Bootcamp

Attendee Information

First Name

Preferred First

Last Name

Email Address

Confirm Email Address

Birthdate

Gender (needed for housing purposes)

Female

Male

X or another legal sex

Pronouns

Phone Type

Phone Number

Text Message Opt In

Yes

Mailing Address

Country

Street

City

Region

Postal Code

Parent/Guardian Information

Parent/Guardian Type

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone

School Information

Search by the full school name, if you do not see the name search again by city and state.

If you are home schooled enter "Home School Clearing House".

High School Name

(hidden) CEEB

Expected High School Graduation Year

MS/HS Media Teacher Name (if applicable)

MS/HS Media Teacher Email (if applicable)

MS/HS Media Teacher Cell Phone (if applicable)

Additional Information

T-Shirt Size

Requested Roommate
You may request one roommate. Requested roommate must also request you as a roommate. All dorms are air-conditioned!

Special Concerns

Workshop Information

MS/HS Media Student Media or Communications Program
Check one box for the group you are representing at this workshop.

Yearbook

Newspaper

Magazine

Web

Radio

Speech

Other

N/A

How do you plan to get to/from workshops?

Parent/Relative drop off/pick-up

Ride share with other attendee parent

Attendee Self Drive*

Ride share with other attendee student driver

Air travel using workshops airport transportation**

Bus travel***

* If you are planning on driving yourself (or others) to workshops and keeping a car on campus, be aware that you will need to purchase a parking pass through the CCIM Outreach office.

** If you are traveling by air, you will need to fill out a Transportation Form (found on the Outreach website.) Be aware there are a few additional fees for airport pick-up and drop-off.

*** If you are planning to travel by bus, please call the CCIM Outreach office to make individual pick-up and drop-off arrangements at the Muncie bus station.

Payment

3-Day Commuter: $300 (includes $30 meal card)

3-Day Residential: $350 (includes $30 meal card)

Payment

4-Day Commuter: $350 (includes $50 meal card)

4-Day Residential: $425 (includes $50 meal card)

Payment

5-Day Esports Virtual Bootcamp: $300

Additional Add-Ons
Select all that apply.

School P.O. can be sent to ccimoutreach@bsu.edu

Personal checks be mailed to:

CCIM Outreach, LB 102
Ball State University
2000 W University Avenue
Muncie, IN 47306

Workshop Policies

All students and chaperons are to follow local, state, and federal laws while attending workshops.
Curfew is 11 p.m.
Students are not to enter the Village, other residence halls or surrounding neighborhood houses during workshops.
Opposite genders are not permitted to be on the same floor of the residence halls.
Students will not operate their motor vehicles while at the workshop or ride in or on anyone else's personal vehicle while at workshops. This includes the use of electric scooters and other mechanical modes of transportation.
This is a workshop and students are expected to complete assignments under given deadlines.
CCIM Outreach and its employees may take photos during workshops to post on social media. Photos inside dorm rooms, bathrooms, etc. where privacy is expected will not be taken or posted. Student names will not be used.
Smoking/vaping/tobacco use is prohibited during workshops.
The use of drugs and alcohol is strictly forbidden.
Students are expected to attend all sessions, unless sick. In such case, students must contact their RA or report directly to the CCIM Outreach office in LB 104 immediately.
State and federal law prohibits students from tampering with fire alarms, safety, or security equipment.
Horseplay, including excessive noise, removing window screens, and throwing items from windows, is strictly prohibited.
Parents are responsible for any financial restitution owed to the university for property damage or lost keys.
If students have/bring a smart phone to workshops, they will be asked to join a free "Group Me" messaging app that allows workshop leaders to send reminder messages to students about the daily schedule and events. This is a one-way communication -- students are not able to respond or send their own messages.
In case of an emergency, students may receive individual text messages from workshop leadership (e.g. if a student is late or absent from class).
Students are representatives of their schools and should act in accordance with all school rules and policies.
Students may be dismissed from the Workshop if they are found violating any of the workshop policies.
In the event of dismissal, parents will be notified to pick up their child immediately (regardless of the time of day or night).

I have read and agree with the Workshop Policies

Yes

Acknowledgement of Risk

I, the undersigned, desire that the applicant listed above, a minor of whom I am the parent having legal custody and/or the legal guardian of the estate and the person of the minor, be permitted to participate in the CCIM+ Summer Workshop (the “Program”), which will be held on the campus of Ball State University in Muncie, Indiana. I am fully aware that my child will be participating in various physical activities, some of which will take place at the Ball State Student Recreation and Wellness Center. I hereby authorize my child to fully participate in the Program, with the understanding that such participation shall include, but not be limited to, use of equipment, use of facilities, instruction. I understand that the University encourages me to have a physical examination or health screening of my minor child and to obtain adequate health and accident insurance prior to my child’s participation in the Program. I hereby certify based upon my own knowledge and such consultation with a physician (if I have consulted one) that my child has no health problems that would interfere with my child’s participation in the Program. I hereby certify that I understand and appreciate that participation in the Program may result in bodily injury or personal injury (whether physical, emotional, and/or psychiatric or any combination thereof) to my child, including but not limited to bruises, scrapes, disease, strains, bone fractures, concussion, partial and/or total paralysis, heat stroke, heart attack, stroke, and death and may result in loss, damage or destruction of my or my child’s personal property. I further understand and appreciate that such illness, injury, loss, or damage may be caused by the negligence of the University or any of its employees, agents, contractors, or volunteers. The participation of my child in the Program is purely voluntary, and I elect for my child to participate in the Program in spite of the risks. I am voluntarily assuming the risks and I understand that the University will not be responsible for any property loss or damage, or for any physical ailment or injury, including death, sustained by my child while participating in the Program.

I have read and agree with the Acknowledgement of Risk

Yes

Release of Claims

In consideration of my child’s participation in the Program, I, the undersigned parent or legal guardian, agree to release and on behalf of myself, my child, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE the University, its Board of Trustees, officers, employees, and agents from any liability, actions, causes of action, claims, or demands of any nature whatsoever, including, but not limited to, a claim of negligence on the part of the University, its Board of Trustees, officers, employees, contractors, agents, or volunteers, which I or my child may have as a result of any personal injury, property damage, permanent disability, or death my child may suffer in connection with my child’s participation in the Program.

I have read and agree with the Release of Claims

Yes

Medical Authorization

I understand and agree that neither the University nor any of its trustees, officers, employees, agents or volunteers accept any responsibility for providing medical care services for my child and that the cost of any medical care services that my child may need remain my responsibility. In the event of a medical emergency for my child, I request that the individual named immediately below be contacted, and I agree that the officers, employee, or agents of the University are hereby authorized to consent to emergency medical treatment for my child on my behalf. I understand and agree that all costs of any such treatment are my responsibility and not that of the University or any of its officers, employees, agents, or volunteers. I, for myself, my child, my heirs, representatives, executors, administrators, and assigns, hereby waive, release, discharge, and hold harmless the University, its Board of Trustees, officers, employees, agents, and volunteers from any liability, actions, causes of action, claims, or demands of any nature whatsoever, either in law or in equity, including based on the alleged negligence of any of them, in connection with any decision of any of the University’s officers, employees, agents, contractors, or volunteers to obtain emergency medical treatment for my child.

I have read and agree with the Medical Authorization

Yes

Emergency Contact Name (not parent or guardian)

Emergency Contact Phone (not parent or guardian)

Family Physician

Name

Address

Country

Street

City

Region

Postal Code

Phone

Medical History

Food Allergies

Insect Allergies

Medication Allergies

Medications

Chronic Conditions

Medical Responsibility

Students who have been prescribed medication from a licensed physician are responsible for their own administration per the prescription. Student will not sell or trade medications and if found doing so will be reported to University Police, their parents will be contacted, and they will be released from attending the remainder of the program.

I have read and agree with the Medication Responsibilities.

Yes - participating student agrees with the Medication Responsibilities.

Yes - participating parent/guardian agrees with the Medication Responsibilities.

Electronic Communication

Faculty and Staff have chosen to the GroupMe app to communicate with students during the program. Faculty and Staff are copied on all GroupMe correspondence. This is one-way communication only. Student participants cannot post messages to the GroupMe app. The summer workshop group is deleted after the program is over.

I have read the Electronic Communication policy.

Yes - My student is allowed to use the GroupMe app.

No - I prefer my student not use the GroupMe app.

Cancellations And Refunds

Both Student and Parent understand and agree that any cancellation and request for refund must be submitted in writing via email, or US Postal Service, or overnight delivery, and must be signed by the Parent, Legal Guardian or Personal Representative who signed the Registration Application. Student and Parent further understand and agree that in order to offset costs incurred by CCIM+ once it has received the Student’s Registration Application, a full refund for cancellation may be requested through May 25. Cancellation refund requests made between May 26-June 12 will receive 50% refund. Refunds will not be granted for cancellations made after June 12.

Students who are dismissed from the Program for disciplinary reasons or leave the Program early for any reason are not eligible for refund.

I have read and agree with the Cancellations and Refunds

Yes

Postponement Or Cancellation Of The Workshop

CCIM+ reserves the right to modify, postpone or cancel the Program because of low enrollment, health, safety or other issues including, but not limited to, acts of God, acts or omissions of government authority, compliance with government regulations or any other cause or event beyond the control of CCIM+ Summer Workshops.

In the event that CCIM+ postpones the forum, tuition payments received prior to the postponement will be applied to the new Program dates. If Student elects to cancel his/her enrollment in a postponed Program, tuition will be refunded. Any cancellation and/or request for refund must be submitted in writing and signed by the Student.

In the event that CCIM+ cancels the Program, all tuition will be refunded. CCIM+ shall not be responsible for any expenses incurred by Student outside of those listed in the Tuition section of this agreement, including, without limitation, all expenses for travel to the Program city and any other miscellaneous expenses incurred by Student.

I have read and agree with the Postponement Or Cancellation Of The Workshop

Yes

Equal Opportunity

CCIM+ complies with all applicable federal and state nondiscrimination laws and does not engage in prohibited discrimination in employment or the provision of services. The Program admits qualified students without regard to race, color, sex, religion, nationality or ethnic origin, disability, age, sexual orientation, place of residence or any other claim prohibited by law to all rights, privileges, programs and activities generally accorded or made available to students during the Program. It does not exclude any student from participation in the Program, discriminate against any student in providing the benefits associated with such program (including any scholarship or financial assistance, and use of any facility), or subject students to discrimination under such program, on the basis of race, color, sex, religion, nationality or ethnic origin, disability, age, sexual orientation, place of residence or any other claim prohibited by law.

I have read and agree with the Equal Opportunity

Yes

Photo and Video Release

Student and Parent both grant CCIM+ permission to use photographs, videotapes or movies taken in which Student may appear in connection with the Program, as well as permission to utilize any information obtained by the Program on both Student and Parent through Student’s registration in the Program for marketing and other purposes. Photographs and video will not be taken in areas where student privacy is expected, i.e. bathrooms, sleeping quarters, etc.”

I have read and agree with the Photo and Video Release

Yes

Student Code Of Conduct Statement

I understand that CCIM+ Summer Workshops is a professional setting and, as such, demands the highest standards of behavior. I will conduct myself in a manner that will contribute to a sense of community along all students and foster an atmosphere of mutual respect. I agree that I will not use tobacco, alcohol or non-prescription controlled substances during the Program. I will not engage in any threatening behavior while at the CCIM+ Summer Workshop. I will not leave campus unless pre-arranged with written notification from my parent/guardian to the Director of Student Support Services for CCIM+. I also agree to follow the instructions of the Program staff at all times and participate in all Program activities.

I have read and agree with the Student Code of Conduct Statement

Yes

Agreement to the Terms of this Release

I certify that I am at least 18 years old and have read and understand the terms of this Release. I understand that by signing this Release I am relinquishing substantial legal rights, including the possibility of recovery for injury, whether the injury results from the inherent risks of the Program or the ordinary negligence of the University, its Board of Trustees, officers, employees, agents, contractors, or volunteers. I am signing this Release, after having carefully read the same, of my own free will, and by doing so, fully intend to release the University, its Board of Trustees, officers, employees, agents, and volunteers from liability or loss due to the inherent risks of the Program or the negligence of the University, its Board of Trustees, officers, employees, agents, contractors, or volunteers.

Parent/Guardian Signature and Date

Student Signature and Date