Course Descriptions and Registration

Ocean S.T.E.A.M.™
Huntsman Marine Academy
Student Application/Medical Form
Aquatic Sciences Field Course

Cost: FREE ($100 deposit, will be reimbursed when student completes the course)

The Salty Sessions – Celebrating the Albums of Salty Towers” on January 28!

Huntsman Marine Academy Student Application/Medical Form

* fields are mandatory

Student's First Name

Indigenous

Student's Last Name

Age

Gender & Preferred Pronouns

Street Address

City

Region/State/Province

Postal / Zip code

Home Phone

Student Cell Phone

Birthday required

Student Email

Family Email

(Communication between the Huntsman and course participants will be through email)

School Name

School Contact Name

School Contact Email

Please provide the name of a teacher, school counsellor, or administrator that will be able to act as a reference for you and review your career journal. (Please check with the adult they are willing to be a reference and can review the career journal with you before you list them.)

EMERGENCY INFORMATION - Confidential

Give the name and contact information of a person who can be reached in an emergency, during the course dates.

First Name

Last Name

Relationship

Street Address

City

Region/State/Province

Home Phone

Cell Phone

MEDICAL INSURANCE

Health Insurance Number

Name of Insurance Company

Coverage Number

Family Physician

Telephone

HEALTH INFORMATION

Dietary Restrictions

Vegetarian Required

Yes

But will eat:

Allergies

Serious Health Conditions

Please give any drug sensitivities, regular medication and other information that might be of significance to a physician or hospital treating you in an emergency situation.

Do you have an accessibility requests?

What are your interests in Aquatic Sciences? What experiences have you had in Aquatic Sciences?

Photo Release

Yes

I consent that the Huntsman Marine Science Centre & Government of New Brunswick can photograph, record and use minor’s image for promotional purposes in any media, including print, broadcast or electronic and to use this material in whole or in part, now and in the future, in printed form and display form for the promotion of the Huntsman Marine Science Centre & Government of New Brunswick.

I do voluntarily consent to said minor's participation, and I do hereby assume all risks of loss and injury that may be incurred, directly or indirectly as a result to said minor's participation in all activities at the HUNTSMAN MARINE SCIENCE CENTRE. I also authorize the HUNTSMAN MARINE SCIENCE CENTRE to arrange for professional care and treatment in case of medical emergency.

I further agree to direct my son/daughter to comply with Huntsman policies and personnel. I realize that if my son/daughter does not comply with said policies, he/she may be sent home from the facility at my, the parent or legal guardian's, expense.

The HUNTSMAN MARINE SCIENCE CENTRE reserves the right to cancel the program and refund all monies in the event that enrolment is inadequate. Participants are responsible for all travel expenses to St. Andrews and will not be reimbursed for those expenses in the event that the program is cancelled.

Select a date required

Parent or Legal Guardian Signature

Ocean S.T.E.A.M.™ Huntsman Marine Academy Student Application/Medical Form Aquatic Sciences Field Course