1. science
2. engineering

University of Toronto Engineering Outreach
How to Register for DEEP Saturday Workshops 2013-2014
Step 1: Complete the registration form and submit it by email, mail or in person.
• Fill out the attached registration form, ensuring that the information is accurate and legible.
• Please note that incomplete forms cannot be processed.
Step 2: Pay by cheque, money order or credit card.
Option 1 − Cheque or Money Order:
• Please make your cheque payable to “University of
Toronto – Engineering Outreach.”
• Write the student’s name in the memo field and
submit it to the Engineering Outreach Office.
• Cheques are deposited once an applicant is accepted
into the program.
Option 2 − Credit Card:
• If payment is made by American Express, Visa or MasterCard,
we will contact you via email with a link to our secure online
payment site. Please make your payment immediately, as the
link will expire in a few days.
• The charge will appear on your credit card statement as
“U of T Engineering.”
Important Information
Communication and email:
Program information and updates will be sent to the email address of Parent/Guardian #1. Please ensure that your email address is
accurate and set up to receive emails from [email protected].
Grade Policy:
Students must enrol in the program appropriate to their current grade level. Programs and curriculum are designed to be
challenging, socially engaging and age appropriate for the specified grades. Students enrolled in the incorrect level may be
removed at any time.
Cancellation Policy:
If you withdraw or cancel your registration two weeks prior to the start of the program, you will receive a full refund, minus a $25
administration fee. We prefer that you notify us of cancellations via email. After the cancellation date, no refunds will be issued.
Please note that courses may be combined or cancelled if registration is low.
Cancellation Dates:
Fall 2013
Workshop on November 23: Must cancel by November 8
Workshop on December 7: Must cancel by November 22
Winter 2014
Workshop on January 18: Must cancel by January 3
Workshop on February 22: Must cancel by February 7
Submit your completed registration form in one of three ways:
By email:
[email protected]
By mail:
Engineering Outreach Office
35 St. George Street, Room 173
Toronto ON M5S 1A4
In person:
Engineering Outreach Office
35 St. George Street, Room 173
Galbraith Building
University of Toronto
(Closest intersection: College Street and St. George Street)
University of Toronto Engineering Outreach
Student Registration Form 2013-2014 - Page 1
Personal Information
Student Information
First
Name of Student
Last
M/F
Gender
DD/MM/YYYY
Age
Date of Birth
Address
School Information
Address
Apartment Number
City
Province
School Name
School Board
Postal Code
Country
Current Grade
Parent/Guardian Information
Parent/Guardian 1
Information
(Required)
Last
First
Name of Parent/Guardian
Email Address of Parent/Guardian (Primary Contact)
(
Parent/Guardian 2
Information
(Optional)
)
–
(
)
(
–
)
–
Telephone Number (Home)
Telephone Number (Cell)
Telephone Number (Work)
Are you an alumnus of U of T?
If yes, what and when did you study?
Last
First
Name of Parent/Guardian
Email Address of Parent/Guardian
(
)
–
Telephone Number (Cell)
Are you an alumnus of U of T?
Emergency Contact
(Required)
First
(
)
(
–
)
Telephone Number (Home)
Telephone Number (Work)
If yes, what and when did you study?
Last
Name of Emergency Contact (other than parent)
(
Relationship to Participant
–
)
–
Telephone Number
University of Toronto Engineering Outreach
Student Registration Form 2013-2014 - Page 2
Health Information
Providing accurate and complete information will assist staff in an emergency and in preparing to ensure a
safe environment for all students. Please answer yes or no to the following questions. If the answer is yes,
use the space below to provide more information, or attach another sheet if required.
Does your child have any allergies*? Yes / No
* For severe allergies, please complete the Severe Allergy Form
Details:
Does your child have any medical or behavioural concerns? Yes / No
Details:
Does your child require any accommodations in the classroom to support their success? Yes / No
Details:
Will your child need to take any medication during the program? Yes / No
Details:
University of Toronto Notice of Collection (Privacy Policy)
The University of Toronto respects your privacy. Personal information that you provide to the University is collected pursuant to
section 2(14) of the University of Toronto Act, 1971. It is collected for the purpose of administering admissions, registration,
academic programs, university-related student activities, activities of student societies, safety, financial assistance and awards,
graduation and university advancement, and reporting to government agencies for statistical purposes. At all times it will be
protected in accordance with the Freedom of Information and Protection of Privacy Act. If you have questions, please refer to
www.utoronto.ca/privacy or contact the University Freedom of Information and Protection of Privacy Coordinator at 416-9467303, McMurrich Building, room 201, 12 Queen’s Park Crescent West, Toronto, ON, M5S 1A8.
University of Toronto Engineering Outreach
Student Registration Form 2013-2014 - Page 3
Program Selection | DEEP Saturday Workshops | 1:00 - 4:00 p.m. | $65 per workshop
Select your workshop date(s) and topic(s):
Workshop on November 23, 2013 >> Choose one of the following three options:
Junior (Grades 9 & 10 ) Biomedical Engineering: Artificial Organ Design...................................$65
Senior (Grades 11 & 12) Engineering Leadership: Changing the Future Through Innovation..$65
Robotics (Grades 9 to 12) From Motors to Robotic Arms...............................................................$65
Workshop on December 7, 2013 >> Choose one of the following three options:
Junior (Grades 9 & 10 ) Civil Engineering: Bridge Design & Construction...................................$65
Senior (Grades 11 & 12) Sustainable Solar Energy Solutions: Blueberry Solar Cell Lab.............$65
Robotics (Grades 9 to 12) Sensors & Their Role in Robot Communication..................................$65
Workshop on January 18, 2014 >> Choose one of the following three options:
Junior (Grades 9 & 10 ) Automotive Engineering: Torque, Traction and K’NEX..........................$65
Senior (Grades 11 & 12) MATLAB: Visualization Techniques.........................................................$65
Robotics (Grades 9 to 12) Controlling Robotic Prosthetics...........................................................$65
Workshop on February 22, 2014 >> Choose one of the following three options:
Junior (Grades 9 & 10 ) Biomedical Engineering: Designing Prosthetics....................................$65
Senior (Grades 11 & 12) Rehabilitation Engineering: Designing for Ability...............................$65
Robotics (Grades 9 to 12) Robotics 3D............................................................................................$65
Total payment owing: $
Payment
Indicate method of payment:
Option 1: Cheque or Money Order (please submit payment by mail or in person)
Option 2: Credit Card (we will send you a payment link via email)
Additional Information
What other programs have you or your family members participated in?
Saturday Science & Engineering Academy (SSEA)
Jr. DEEP
DEEP
Girls’ Science & Engineering Saturdays (GSES)
Girls’ Jr. DEEP
ENGage
Go ENG Girl
March Break Programs
Other
How did you hear about our programs?
University of Toronto Engineering Outreach
Student Registration Form 2013-2014 - Page 4
Permissions: Signature Grants Permission for all Sections
Photo Permission
I/We give permission for my/our child to be photographed or filmed for promotional purposes.
I/We do not give permission for my/our child to be photographed or filmed for promotional purposes.
Leave on Own Permission
My/Our child is at least twelve years old and I/we give permission for my/our child to leave on his/her own at the end of the session.
My/Our child will be picked up at the end of the session by a parent or guardian.
Informed Consent Agreement
I/We the UNDERSIGNED, hereby acknowledge that certain RISKS OF INJURY are inherent to participation in hands-on
science activities. These types of injuries may be minor or serious and may result from one’s own actions, or the actions of
others, or a combination of both. I/We understand that the RULES AND REGULATIONS are designed for the safety and
protection of participants and hereby undertake that my child will abide by these rules and regulations. I/We hereby
WARRANT that my/our child is physically fit to participate and understand that the CHOICE to participate brings with it the
ASSUMPTION OF THOSE RISKS AND RESULTS which are part of these activities. I/We agree that THE GOVERNING COUNCIL
OF THE UNIVERSITY OF TORONTO or THE FACULTY OF APPLIED SCIENCE AND ENGINEERING (FASE), their directors, officers,
employees, agents and volunteers, shall not be liable for any injury to my child or loss or damage to my child’s personal
property arising from, or in any way resulting from, his/her participation in those activities, UNLESS such injury, loss or
damage is caused by the SOLE NEGLIGENCE of the University, FASE, their directors, officers, employees, agents, and
volunteers, while acting within the scope of their duties. I/We agree to allow my child to receive basic first aid/medical care
from instructors certified in first aid or trained medical professionals if necessary. I/We declare having read and understood
the above INFORMED CONSENT AGREEMENT in its entirety and hereby consent to participate acknowledging all the
foregoing. I/We also certify that the information provided in this form is, to my/our knowledge true and complete.
Signature
Name of Parent/Guardian
Signature
Date