Imagine Architecture – Adjustment

Participant Information

Name(Required)

First Last

Date of Birth(Required)

Grade completed in June 2020(Required)

Any dietary restrictions or allergies?

What are your motivations for taking this program and/or what do you hope to gain from participating?(Required)

Any medical or behaviourial information that course instructors should be made aware of?

Expected year of entry to university(Required)

Parent Information

Primary Parent/Guardian Contact Name(Required)

First Last

Email(Required)

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Secondary Parent/Guardian Contact (optional)

First Last

Phone

Emergency Contact Information (optional)

The Emergency Contact is an alternative person we may try to contact should we be unable to reach the Parent(s)/Guardian(s) in the event of an emergency.

Full name

First Last

Phone

How did you hear about Imagine Architecture?(Required)

High School Guidance counselor

Word of mouth

Email from Carleton University

Carleton University website

Google search

Other

Program fee(Required)

LAB 101 - $600 plus HST

LAB 102 - $600 plus HST

LAB 103 - $600 plus HST

Please note: We are at capacity for LAB 101. A new session on a different week may be offered. The decision will be confirmed by Feb 14. Please join the waiting list to be contacted when a spot becomes available.

Parental Consent(Required)

Carleton University AND the Azrieli School of Architecture and Urbanism, their agents, officials, officers, directors, employees, volunteers, contractors, or representatives (hereinafter refer to as “THE RELEASEES”) are not responsible for any death, injury, loss or damage of any kind suffered by any person while participating in the Imagine Architecture program and all related activities, including injury, loss or damage which might be caused by the negligence of THE RELEASEES.

The Imagine Architecture program involves studio activities and may include an organized field trip to and from Carleton University to an Ottawa location by public transportation.

In consideration of my CHILD’S participation in Imagine Architecture program and all related activities, I acknowledge that I am aware of the possible RISKS, DANGERS AND HAZARDS associated with the Imagine Architecture program and all related activities including THE POSSIBLE RISK OF SEVERE OR FATAL INJURY TO MY CHILD OR OTHERS.

These risks include, but are not limited to:

• Risks associated with travel to and from all venues of the various components including transport by public or private motor vehicle which could include but are not limited to an accident resulting in severe physical injuries or death;

• Food related illness resulting from any meal arranged for my child by Imagine Architecture organizers;

• Muscular injuries and soft tissue injuries, broken bones, bruises, scrapes, cuts, sprains, dislocation, head, facial eye and/or dental injuries which might result from participation in Imagine Architecture activities

• Injuries resulting from malfunctioning of equipment or misuse of equipment whether owned, designed or operated by my child or the staff of THE RELEASEES;

• Death, injuries or illness resulting from failure to follow directions from those in charge of the program and all related activities; and

• The risks associated with my child returning to their residence after participating in the program and/or related activities;

In return for allowing my child to voluntarily participate in the program and all related activities, I agree:

1. TO ASSUME AND ACCEPT ALL RISKS arising out of, associated with or related to my child’s participation in the Imagine Architecture program and all related activities.
2. TO BE SOLELY RESPONSIBLE FOR ANY INJURY, LOSS OR DAMAGE which my child might sustain while participating in the Azrieli School of Architecture and Urbanism program and all related activities.

By checking the box below, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, executors, administrators and representatives.

I confirm that I have read and I agree to this

Photo Permission

By checking the box below, I agree to allow the Azrieli School of Architecture & Urbanism (ASAU) of Carleton University to photograph, audio record, video record, podcast and/or webcast my Child (digitally or otherwise) without charge; and to allow ASAU to copy, modify and distribute in print and online, those images that include my child in whatever appropriate way that ASAU sees fit without having to seek further approval. No names will be used in association with any images or recordings.

I confirm that I have read and I agree to this

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