Architecture + Planning Camp

* required

Applicant Information

First Name

Preferred First

Middle Name

Last Name

Email Address

Confirm Email Address

Birthdate

Sex

Female

Male

X or another legal sex

Pronouns

These are how you want to be addressed when someone is speaking with you. Again, with the recognition that these may be fluid, you will be able to change your pronouns at any time you choose.

Gender Identity

This is what you feel like and how you identify but may not outwardly demonstrate. This may not align with the sex that you were assigned at birth.

Phone Type

Phone Number

Text Message Opt In

Yes

No

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

High School GPA

Additional Information

Academic Area of Interest

T-Shirt Size

How did you hear about Architecture + Planning Camp?

**The Architecture + Planning Camp will need to meet its minimum enrollment in order to proceed. If it does not meet the minimum enrollment it may be canceled.

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 Architecture + Planning Camp (the “Program”), which will be held at the CAP Indy location of 25 North Pine Street, Indianapolis, Indiana from June 24, 2024, to June 28, 2024. 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 All 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 All 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

Emergency Contact Phone

Family Physician

Name

Address

Country

Street

City

Region

Postal Code

Phone

Medical History

Food Allergies

Insect Allergies

Medication Allergies

Medications

Chronic Conditions

Tuition

Student and Parent both understand and agree that Student’s registration and this Release and Agreement must be received by the R. Wayne Estopinal College of Architecture and Planning no later than the enrollment deadline of June 7, 2024. Final payments are due June 7, 2024.

Student and Parent further understand and agree that Student’s participation entitles Student to only the standard arrangements and activities offered and/or scheduled, including, but not limited to, meals, and educational materials. Generally, special arrangements and/or requirements desired or required for Student must be independently provided, and Student and Parent must bear the cost of any and all special arrangements and requirements. The R. Wayne Estopinal College of Architecture and Planning will comply with all federal, state and local laws in connection with this Release, including the Americans with Disabilities Act.

I have read and agree with the Tuition

Yes

Cancellations And Refunds

Both Student and Parent understand and agree that any cancellation and request for refund must be submitted in writing via email, FAX or US Postal Service, or overnight delivery, and must be signed by the Parent, Legal Guardian or Personal Representative who signed the Enrollment Application. Student and Parent further understand and agree that in order to offset costs incurred by the R. Wayne Estopinal College of Architecture and Planning once it has received the Student’s Enrollment Application, a full refund for cancellation may be requested 15 days prior to the start date.

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

The R. Wayne Estopinal College of Architecture and Planning 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 the R. Wayne Estopinal College of Architecture and Planning.

In the event that the R. Wayne Estopinal College of Architecture and Planning 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 the R. Wayne Estopinal College of Architecture and Planning cancels the Program, all tuition will be refunded. The R. Wayne Estopinal College of Architecture and Planning, 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

The R. Wayne Estopinal College of Architecture and Planning 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 the R. Wayne Estopinal College of Architecture and Planning 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.

I have read and agree with the Photo and Video Release

Yes

Student Code Of Conduct Statement

I understand that the R. Wayne Estopinal College of Architecture and Planning 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 understand that an infraction of these rules may result in my immediate dismissal, denial of my Certificate of Completion, and forfeiture of all Program tuition paid.

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