1. food and drink
2. food
3. grains and pasta

SUMMER
YOUTH
PROGRAMS
2015
AGES 11–18
CONTINUING
E D U C AT I O N
YOUTH PROGRAMS
SUMMER 2015
Get ready for a summer of learning, fun, and
activity! The youth summer program offers
classes for students ages 11- 18.
All classes take place on the Cranford campus.
For 11–13 year olds, classes take place in the
morning while classes for 14+ year olds take
place in the afternoon.
Schedule:
Classes take place Monday through Thursday.
Student Drop-off/Pick-up:
Duct Tape Divas II (12 hrs)
Attention all Duct Tape Divas graduates! You asked
for it, and here it is! Are you ready for part two of the
class that brought duct tape out of the toolbox and
onto the runway? Amp up your duct taping with cool
new crafts and activities that are sure to take your
summer from drab to fab! With cool new patterns
and outrageous new ideas, the possibilities are endless. Everything’s better with duct tape!
AEKE 020 Sec 190
Mon-Thu
8/03-8/06
AGES 11–13
Teaching 101 (12 hrs)
ART
New
Girls Rule! (12 hrs)
Girls rule in this stylin’ get-together where everyone
is sure to have a blast! Join us in this fun-filled class
of glitz and glamour where it’s great to be a girl.
Students can look forward to spending the day in
their pajamas at our “Slumber Party” or relaxing on
“Salon ’n’ Spa Day” with do-it-yourself beauty treatments and pedicures. The talented ladies from FYI
Creations will also offer a variety of very fancy projects to craft, including makeup bags, glitter body gel,
lip gloss, and more. So take a cue from us and make
every day a girly day!
AEKE 018 Sec 190
Mon-Thu
7/06-7/09
$125
9:00 a.m.-12:00 p.m.
Duct Tape Divas (12 hrs)
Duct Tape isn’t just for dad anymore! Join the latest
crafting craze that’s sweeping the nation! Be the envy
of your friends as you design creative fashions and
crafts that are sure to bring out your inner diva. From
hot pink zebra stripes to funky tie-dyes, there’s no
limit to what duct tape can do!
AEKE 019 Sec 190
Mon-Thu
7/27-7/30
$125
9:00 a.m.-12:00 p.m.
$125
9:00 a.m.-12:00 p.m.
New
Learn how to become a teacher in this fun and educational workshop designed to bring out the innerteachers in all students. Learn how to decorate a
classroom, develop exciting lesson plans, and maintain a grade book in this workshop where children
are the teachers! From creating graphic organizers to
grading papers, this course will provide children with
everything necessary to become highly qualified instructors. This course is a definite A+!
AEKE 021 Sec 190
Mon-Thu
7/13-7/16
$125
9:00 a.m.-12:00 p.m.
The Artist Within:
Drawing and Sketching (24 hrs)
Develop your drawing skills through a variety of assignments: wildlife, landscapes, and portraits. Explore different styles: abstract, realism and
impressionism. Materials to be purchased by student
prior to first day of class: 11"x 14" sketchpad, pencils
and 24-pack of pastels.
AEKE 002 Sec 190
Mon-Thu
6/29-7/09
New
Graffiti Art/Design Projects (24 hrs)
New
For all students enrolled in a class,
parents/guardians must go to the classroom to
drop off and pick up children at the assigned
classroom. Children must be picked up on time.
$235
9:00 a.m.-12:00 p.m.
Design Your Own Comic Book/
Graphic Novel (24 hrs)
Learn about developing characters, structuring a
story, designing the visual layout and eye-catching
covers. Materials needed: 11"x14" spiral sketchpad,
pencils: H, 2H, B, 2B, color pencils, erasers and 24pack of markers.
AEKE 505 Sec 190
Mon-Thu
7/13-7/23
…for a better life
Learn how to apply your Cartooning and Graphic Art
skills to canvas and simulated wall surfaces made
from Styrofoam and plaster to create beautiful and
displayable works of art. Students will be shown techniques for developing their characters and lettering
designs into original, colorful and finished compositions. Required materials: Ebony pencil, fine point
Sharpie marker, 9"x12" or 11"x14" sketch pad , three
artist paint brushes ( fine, medium and large ) and
five tubes of acrylic paint ( black, white, yellow, red
and blue ). All additional materials will be provided.
AEKD 726 Sec 190
Mon-Thu
6/29-7/09
$235
9:00 a.m.-12:00 p.m.
AEKD 726 Sec 19A
Mon-Thu
8/03-8/13
$235
9:00 a.m.-12:00 p.m.
MATH
Middle School Math Review (24 hrs)
This course is designed to review each of the New Jersey Core Curriculum Content math Standards for
middle school students. Students will review numerical operations, geometry and measurement, algebra,
data analysis, as well as mathematical processes.
AEKE 117 Sec 190
Mon-Thu
8/03-8/13
$235
9:00 a.m.-12:00 p.m.
MUSIC
Guitar: Beginning (24 hrs)
Learn to read music, chords, and scales, play songs and
picking and strumming patterns. Bring a six-string
guitar and picks (light, medium, and heavy) to class.
AEKE 608 Sec 190
Mon-Thu
7/06-7/16
$235
9:00 a.m.-12:00 p.m.
Guitar: Intermediate (24 hrs)
A continuation of the beginning course with more
advanced music reading, picking techniques and
songs. The beginning course is suggested prior to
taking this class.
AEKE 609 Sec 160
Mon-Thu
7/20-7/30
$235
9:00 a.m.-12:00 p.m.
$235
9:00 a.m.-12:00 p.m.
➟
908-709-7600 • WWW.UCC.EDU/NONCREDIT • TO REGISTER, USE THE FORM ON PAGE 7
YOUTH PROGRAMS • AGES 11–13/AGES 14+
SCIENCE
Start Wars project. Projects offered will depend on
availability from the Lego HQ, and students will not
build all projects listed.
Super Science!
We are pleased to partner with Super Science
to provide new, innovative and exciting classes!
Battle-Bot Build-a-Thon (12 hrs)
In our Sumo-style robot battles, you use the Robotix
building system to construct a robot that can push
your opponent out of a large Sumo-robot ring. In addition, have fun building a wide variety of other motorized Lego Technic and K’NEX contraptions. All
participants take home a Battle-Spider or Warrior
robot as a part of this program.
AEKE 950 Sec 190
Mon-Thu
7/13-7/16
$185
9:00 a.m.-12:00 p.m.
Lego Architecture (12 hrs)
In this architectural, art and science program, young
Lego builders construct and invent their own Lego
models based on famous architectural designs from
around the world. Students build Lego designer, Adam
Tucker Reed’s famous Brick structures including the
Empire State Building, John Hancock Tower, Seattle
Space needle, White House, Guggenheim Museum,
Falling Water and more. Then they research famous
structures and use the Lego Brick as a medium to design and build their own interpretation of the model.
Students also build bridges, towers, and other structures
using variety of other materials and learn about structural engineering principles. All students take home a
Lego Architecture model as a part of the program.
AEKE 949 Sec 190
Mon-Thu
7/20-7/23
$185
9:00 a.m.-12:00 p.m.
Lego Star Wars and
Motorized Machines (12 hrs)
Lego enthusiasts have fun building your favorite adventure from a Star Wars galaxy that is far, far away.
Star Wars projects will vary depending on availability
from the Lego Headquarters, but will probably include most of these NEW models which will vary by
age level: Trifighter Droid, AT-DP, Tie Advanced Prototype, AAT, Hailfire Droid, Wookie Gunship, BattleDroid Troopers, Droid Gunship, B-Wing, MTT, Star
Destroyer, and more. We will also continue to stock
the best of some of the older models. In addition, students will build a wide assortment of motorized Lego
machines with the Lego education motorized mechanisms curriculum that is designed to teach students
just how those complex machines work. Topics include simple machines, mechanical advantage, gear
rations, and a host of others. With the new machine
sets students can even create their own projects that
illustrate science concepts. This is a stimulating enrichment program and not geared as a teacher-driven
education class. All students will take home a Lego
4
AEKE 951 Sec 190
Mon-Thu
7/27-7/30
$185
9:00 a.m.-12:00 p.m.
Lego Friends and Crafts (12 hrs)
By popular demand, we are offering an exclusive
Lego Friends class for girls. In this program you will
have fun making friends as you build Lego Friends!
Projects include the pet Salon, Fawn Forest, Downtown Bakery, Olivia’s Beach Buggy, a Rehearsal Stage,
a Dolphin Cruiser, and many more. Additionally, we
will offer crafts, games, making jewelry, friendship
bracelets and more. Participants will take home a
sampling of products and crafts made in class.
AEKE 954 Sec 190
Mon-Thu
7/06-7/09
$185
9:00 a.m.-12:00 p.m.
New
The Writer Within: Short Stories (24 hrs)
Love to write? This course will focus on developing
your creative writing skills as you create strong characters, interesting plots, dialogue and writing that
will resonate. Create short stories that can be entered
in contests, or e-published. Come prepared to write
and read and share your work with other writers.
Course will be taught by a published author.
$235
9:00 a.m.-12:00 p.m.
New
Better Thinker–Better Writer–Better
Grades (12 hrs)
This course will help you improve your critical thinking and strengthen your writing skills when reading
literature and writing school essays. Learn strategies
that will help you get better grades, while also improving your ability to understand, discuss and write about
the literature you read throughout the school year.
AEKE 022 Sec 190
Mon-Thu
8/10-8/13
Order in the Court/Mock Trial
Workshop (24 hrs)
Bring law to life and practice your acting skills as you
enact a fictitious trial through active participation,
preparation and dramatic technique! Take on the
roles of lawyers and witnesses and learn the real life
procedures of the courtroom.
AEKE 014 Sec 190
Mon-Thu
7/06-7/16
$235
9:00 a.m.-12:00 p.m.
AGES 14+
TEST PREP SERIES:
Get a jump on test taking strategies and
fundamentals that will enhance your abilities and help improve test scores. All
courses are taught by NJ Certified Teachers.
WRITING
AEKD 240 Sec 191
Mon-Thu
7/27-8/06
OTHER
$235
9:00 a.m.-12:00 p.m.
SAT (24 hrs)
Learn important test-taking strategies and prepare to take the SAT in the Fall. Specific concepts
covered include math, verbal, and writing. Course
price includes the book and test-taking materials.
VERBAL/READING/WRITING
AEKD 211 Sec 191
Mon-Thu
6/29-7/23
$190
1:00-2:30 p.m.
AEKD 211 Sec 19A
Mon-Thu
7/20-8/13
$190
1:00-2:30 p.m.
MATH
AEKD 107 Sec 191
Mon-Thu
6/29-7/23
$190
2:40-4:10 p.m.
AEKD 107 Sec 19A
Mon-Thu
7/20-8/13
$190
2:40-4:10 p.m.
ART
Cartooning (24 hrs)
If you are a comic book fan and love to draw and
write, this class will give you the opportunity you
need to get started creating your own large format
graphic novel pages. Students will learn traditional
hands-on techniques for penciling, inking, lettering
and colorization that they will develop into a finished
product that may be displayed, printed or shared with
other comic book artists. Materials: No.2 pencils,
erasers, x-tra-fine point Sharpie markers, 9"x12" or
11"x14" (heavy weight) drawing pads, colored pencils.
AEKD 726 Sec 191
Mon-Thu
6/29-7/09
$235
1:00-4:00 p.m.
AEKD 726 Sec 19A
Mon-Thu
8/03-8/13
$235
1:00-4:00 p.m.
UNION COUNTY COLLEGE • CONTINUING EDUCATION • SUMMER 2015 CLASS OFFERINGS
YOUTH PROGRAMS • AGES 14+
The Artist Within:
Drawing and Sketching (24 hrs)
Develop your drawing skills through a variety of
assignments: wildlife, landscapes, and portraits.
Explore different styles: abstract, realism and impressionism. Materials to be purchased by student prior
to first day of class: 11"x14" sketchpad, pencils and
24-pack of pastels.
AEKE 002 Sec 191
Mon-Thu
6/29-7/09
$235
1:00-4:00 p.m.
Design Your Own Comic Book/
Graphic Novel (24 hrs)
Learn about developing characters, structuring a
story, designing the visual layout and eye-catching
covers. Materials needed: 11"x14" spiral sketchpad,
pencils: H, 2H, B, 2B, color pencils, erasers and 24pack of markers.
AEKE 505 Sec 19A
Mon-Thu
7/13-7/23
$235
1:00-4:00 p.m.
FILMMAKING
We are pleased to partner with IncrediFlix to
provide new, innovative
and exciting filmmaking
classes!
New
New
Advanced Lego Flix (12 hrs)
We know you love Legos and can create incredible
Lego worlds, now it’s time to bring those worlds to
life in Lego stop-motion animated flix! Students will
create a Lego set with Lego characters for a movie
they storyboard, write, shoot and voice-over in ageappropriate groups. In this advanced class, students
are given more instruction on how to create compelling stories, and more independence to try ideas
that may be more difficult. *Flix downloadable
within a month after camp ends.
AEKE 953 Sec 190
Mon-Thu
7/13-7/16
$125
1:00-4:00 p.m.
FINANCE
TEEN FINANCE WORKSHOPS
This series of workshops will cover the topics of
credit, banking, and budgeting. Students will
learn how bank accounts and credit cards work
and learn financial strategies for budgeting
and saving and even investing their own
money. Topics covered will include balancing a
check book, writing checks, applying for a
credit card, interest rates, good and bad credit,
budgets and savings.
Balancing a Budget and Basic Banking
Advanced Imagination Flix (12 hrs)
Take your characters underwater, to a volcano, or even
to outer space! In this exciting stop-motion animation
camp, there are no limits to where your imagination can
take you. You’ll brainstorm, create your very own clay
characters (that you keep), choose the backgrounds,
film your movies using a green screen, and add voiceovers, while working in age-appropriate groups. In this
advanced class, students are given more instruction on
how to create compelling stories, and more independence to try ideas that may be more difficult. *Flix downloadable within a month after camp ends
AEKE 916 Sec 190
Mon-Thu
7/06-7/09
$125
1:00-4:00 p.m.
AEKD 710 Sec 191
Tue
7/07
$29
1:00-3:00 p.m.
TEEN CERTIFICATE
PROGRAMS
Certified Pharmacy Technician (48 hrs)
Get prepared to work as a technician and to pass the
National Pharmacy Technician Certification Exam.
This program covers medical terminology, interpretation of prescriptions, dosage forms and routes of
administration, pharmaceutical calculations and
related computer usage. Cost includes books.
AEKD 705 Sec191
Mon-Thu
7/06-7/30
$600
1:00-4:00 p.m.
Servsafe for Teens (16 hrs)
The ServSafe Food Safety Program provides educational training for the restaurant and food service industry. The following topics are included: Basic Food
and Safety Concepts, Protection Against Foodborne
Illness Outbreaks, Reduction in Liability Risks, and
Minimization of Insurance Cost. After completion of
this course, there will be an exam and a grade of 75%
is required to pass and become ServSafe certified.
Cost includes books and exam fees.
AEKD 719 Sec 191
Mon-Thu
8/03-8/13
$200
1:00-3:00 p.m.
WRITING
New
The Writer Within: Novels (24 hrs)
MATH
Publishers, Hollywood and the e-book market are
eager to work with new talent. Learn how to develop
your creative ideas and shape them into a workable
novel. You will learn how to outline and structure a
novel, as well as make it marketable. Learn how to create characters and plots that have depth. Come prepared to write, read and share your work with other
writers. Course will be taught by a published author.
Algebra Review (24 hrs)
AEKD 236 Sec 191
Mon-Thu
7/27-8/06
Credit Cards and Credit Scores
AEKD 725 Sec 191
Wed
7/08
$29
1:00-3:00 p.m.
This course addresses the material covered in a
middle or high school Algebra course. Through interactive lessons and practice problems, students will
strengthen their Algebra knowledge. Students will be
pre-tested to determine their proper, level and need.
AEKD 115 Sec 191
Mon-Thu
8/03-8/13
$235
1:00-4:00 p.m.
$235
1:00-4:00 p.m.
New
Better Thinker–Better Writer–Better
Grades (12 hrs)
This course will help you improve your critical thinking and strengthen your writing skills when reading
literature and writing school essays. Learn strategies
that will help you get better grades, while also improving your ability to understand, discuss and write about
the literature you read throughout the school year.
AEKE 022A Sec 190
Mon-Thu
8/10-8/13
908-709-7600 • WWW.UCC.EDU/NONCREDIT • TO REGISTER, USE THE FORM ON PAGE 7
$235
1:00-4:00 p.m.
YOUTH PROGRAMS • BLACK ROCKET
App Attack! Make Your
First Game App (12 hrs)
Classes for ages 11–13 and 14+
We are pleased to partner with Black Rocket
Productions to deliver educational and fun
classes designed to mirror real life experiences
and the collaborative nature of the creative
process. Students will work in pairs or teams
for most of the programs.
Make Your First Video Game! (12 hrs)
If you love playing video games, this is the camp for
you! Make your first video game in this one-of-akind class that shows you the crucial keys to designing your first 2-D game. Conceptualization, play
experience, challenge levels, graphics and elements,
music and sound, software, and simple coding are
just some of the concepts that we’ll explore as you
learn how to really get into the game because you
made it yourself! No prior experience necessary just a
desire to have fun. Student created games will be
available on a password protected Black Rocket website to share with friends and family.
AGES 11–13
AEKE 914 Sec 190
Mon-Thu
6/29-7/02
$185
9:00 a.m.-12:00 p.m.
Make Your First 3D Video Game!
(12 hrs)
By popular demand, we are now offering a 3D game
design class. This experience allows you to develop a
game concept that goes well beyond the limitations of
the traditional 2D game design classes. Students will
learn the physics behind 3D games, explore beginner
event scripting, level design, controlling flow of
gameplay, and storytelling. Student created games
will be available on a password protected Black
Rocket website to share with friends and family.
AGES 11–13
AEKE 946 Sec 190
Mon-Thu
7/20-7/23
$185
9:00 a.m.-12:00 p.m.
AGES 14+
AEKE 946 Sec 191
Mon-Thu
7/20-7/23
$185
1:00-4:00 p.m.
6
Minecraft Designers (12 hrs)
Take the first steps into the world of mobile app design
and customize your own game app! Using a specialized
game development tool, students will explore the world
of phone-based and tablet applications. In addition to
learning the basics of mobile app design and game development, you will also see firsthand how the world of
App’s publishing functions. Student created apps will
be accessible on a private site and can be played on any
mobile device or computer. Parents may choose to
publish apps if certain criteria are met and final decisions are the sole discretion of Apple or Google. No
prior experience is necessary and students do not need
to own a smartphone or tablet to take the class.
AGES 11–13
AEKE 816 Sec 190
Mon-Thu
7/13-7/16
$185
9:00 a.m.-12:00 p.m.
AGES 14+
AEKE 816 Sec 191
Mon-Thu
7/13-7/16
$185
1:00-4:00 p.m.
Video Game Animation (12 hrs)
Take your game design to the next level by creating
and animating your own character sprites, objects,
and background. Start with a name, develop the character’s personality, signature moves, special powers,
and a story line. Finish with a fully animated character to be used in future games. Students do not need
any prior experience in game design, animation, or
sketching. Student created animations will be available on a password protected Black Rocket website to
share with friends and family. Games are only compatible on PC computers, Mac versions can be created
after the program for a $15.00 conversion fee.
AGES 14+
AEKE 514 Sec 191
Mon-Thu
6/29-7/02
$185
1:00-4:00 p.m.
App Adventures! The Next Level (12 hrs)
Continue your quest to make the next viral app!
Whether you want to move past the basic techniques
learned in App Attack or want to jump right in, we are
ready for you! All students will choose from a selection
of different mobile app types and explore more in
depth programming concepts. Student created apps
will be accessible on a private site and can be played
on any mobile device or computer. Parents may choose
to publish apps if certain criteria are met and final decisions are the sole discretion of Apple or Google. No
prior experience is necessary and students do not need
to own a smart phone or tablet to take the class.
AGES 11–13
AEKE 817 Sec 190
Mon-Thu
7/27-7/30
$185
9:00 a.m.-12:00 p.m.
AGES 14+
AEKE 817 Sec 191
Mon-Thu
7/27-7/30
$185
1:00-4:00 p.m.
If you love the game Minecraft, but always wanted to
design your own characters and buildings for your
games this class is for you. Learn the basics of creating
3D modeling using a new industry grade software to
design your very own characters and import them into
your favorite Minecraft games. Students must have
Minecraft at home to import characters and parent
email address is required to create student accounts.
AGES 11–13
AEKE 304 Sec 190
Mon-Thu
7/06-7/09
$185
9:00 a.m.-12:00 p.m.
AGES 14+
AEKE 304 Sec 191
Mon-Thu
7/06-7/09
$185
1:00-4:00 p.m.
Code Breakers (12 hrs)
Calling all future coders, programmers and designers! Learn the basics of coding languages like
HTML5, JavaScript, and CSS through a series of web
projects and design challenges each day and be on
your way to becoming the next tech star! Whether
you want to be the next Mark Zuckerberg or the 15
year old high school student who just made 1 million
dollars for programming in his bedroom, this course
has the essentials you need to begin your journey.
Student projects will be available on a Black Rocket
website to share with friends and family.
AGES 11–13
AEKE 305 Sec 190
Mon-Thu
8/10-8/13
$185
9:00 a.m.-12:00 p.m.
AGES 14+
AEKE 305 Sec 191
Mon–Thu
8/10-8/13
$185
1:00-4:00 p.m.
New
Minecraft Modders (12 hrs)
Use your favorite game to learn the basics of modding and foundations of programming. Learn scripting and logic statements as you create your first mod!
Introductory coding will also be taught through a
simulated environment inspired by Minecraft. Student projects will be available on a Black Rocket website to share with friends and family. To access their
project at home students must own a PC/MAC version of Minecraft. Tablet, phone, and game console
version of Minecraft are not compatible. Students will
work in teams for most of the program.
AGES 11–13
AEKE 306 Sec 190
Mon-Thu
8/03-8/06
$185
9:00 a.m.-12:00 p.m.
AGES 14+
AEKE 306 Sec 191
Mon-Thu
8/03-8/06
$185
1:00-4:00 p.m.
UNION COUNTY COLLEGE • CONTINUING EDUCATION • SUMMER 2015 CLASS OFFERINGS
CONTINUING
E D U C AT I O N
YOUTH PROGRAMS
REGISTRATION FORM
…for a better life
The Youth Programs Permission Slip must be completed and returned with this registration form.
Please print clearly and complete all sections
STUDENT DATA
Last Name
First Name
MI
Street Address (including apartment number)
City/Town
State
Gender: □ Male
Student ID Number
(
Zip
)
Home Telephone
□ Female
Date of Birth (MM/DD/YYYY)
PARENT/GUARDIAN DATA
Last Name
First Name
MI
Street Address (including apartment number)
City/Town
State
Zip
Telephone
□ Home
□ Work
□ Cell
E-mail Address
CAMPUS PARKING
□ I decline campus parking
License Plate Number
□ I wish to have a permit for campus parking (Complete the information below and add $10 parking fee)
State
Year, Make and Model of Car
You must pick up your parking permit at the Public Safety Office, at which time you will be required to show a current vehicle registration.
COURSE SELECTIONS AND FEES (Please enter your course selections)
Course Code-Number
OFFICE USE ONLY
Section Number
Course Title
Pay Code____________________________________ Amount ______________
Start Date (MM/DD/YY)
Course Fee
Parking Fee (if applicable)
Date ______________________________ Cashier ________________________
Total
Make checks payable to Union County College. Register in person or mail to:
Continuing Education, Union County College, 1033 Springfield Avenue, Cranford NJ 07016-1599
Phone (908) 709-7600 • Fax (908) 709-7070 • Email [email protected]
䡺
⻬ I am financially responsible for all program costs for
Student’s Name
Your Name
Address
Telephone
Note: Students are responsible for being aware of and following the Code of Conduct found in the Union County College Student Handbook, available at www.ucc.edu/go/handbook.
Have questions about Union County College Youth Programs? Email us at [email protected]
Union County College does not discriminate on the basis of race, color, national origin, sex, age or disability.
Youth Programs Permission Slip
C O N T I N U I N G E D U C AT I O N
All Youth Program participants
must have this form completed by parent or guardian.
This form must accompany Registration Form.
Summer 2015
Youths will not be admitted or allowed to participate in any program
without completing and submitting this form. Please provide
ONE permission form and ONE registration form per youth.
Register Early!
Student Information: PLEASE CLEARLY PRINT ALL INFORMATION
Full Name: __________________________________________________________________________________________________
First
Last
Middle Initial
Child’s Age: _______
Current Grade (for Summer students, grade entering in upcoming Fall) _______
Home Phone: (________) ________________________
Parent/Guardian Contact Information:
Name:________________________________________________
Preferred Phone: __________________________
Alternate Phone: ________________________
Emergency Contact Information:
If I am not available, I hereby designate the following person(s) to be contacted in an emergency:
Name ______________________________Relationship ______________________Phone # ______________________________
Name ______________________________Relationship ______________________Phone # ______________________________
Doctor’s Name ________________________________________________________Phone ________________________________
Medical Insurance Co __________________________________________________Policy # ________________________________
The above named child has the following food allergy(ies) and/or medical condition:
____________________________________________________________________________________________________________
It is the responsibility of the parent/guardian to notify program staff of any change in the above contact information.
I, ____________________________________________________, the legal
parent/guardian of the above named Youth Programs participant, will:
• I understand that the College is not responsible for lost, stolen or damaged
property.
CHOOSE ONLY ONE OF THE FOLLOWING THREE OPTIONS
• I understand that in an emergency I will be contacted as soon as possible at
the above phone number(s). If I am not available, I have provided an alternate contact above.
□ Pick up my child at the conclusion of his/her scheduled course(s) in the
designated location on the Union County College Cranford Campus
□ Permit the following individuals to pick up my child at the conclusion of
his/her scheduled course(s) in the designated location on the Union
County College Cranford Campus.
Name: __________________________________ Phone: ________________
Name: __________________________________ Phone: ________________
□ Permit my child to leave the campus unattended by Program or College
staff at the conclusion of his/her scheduled course(s) on a daily basis.
Check this option if you are permitting your child to walk home, ride his or her bike home, take the bus, etc.
No supervision is provided and no responsibility for your child is assumed once he or she is dismissed from his
or her last class. Your child will not be permitted to remain on College property or in any campus building if
this option is checked.
The Parent or Guardian acknowledges that he or she has read, understands
and approves the following statements:
• College personnel are not permitted to hold or be responsible for administering any medication.
• I understand the College may suspend or terminate my child from the program for any reason that is deemed harmful or disruptive to the other participants or for other just cause. Refunds will not be granted if a child is
suspended or terminated.
I have read, understand, and agree to the foregoing information. I also authorize the Union County College staff to take whatever measures are in their
estimation, deemed necessary, especially in the event of an emergency. I understand it is the responsibility of the parent or guardian to notify program
staff of any change in the above contact information. I also give permission
for my child to be given emergency treatment at a local hospital or on site.
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Parent/Guardian name (print)
• I give consent for photographs and/or videos of my child to be used solely
for UCC promotional and/or public information purposes.
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• I will not hold the College or the College personnel responsible in the event
of an accident or injury.
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Parent/Guardian Signature
Date