Studentt Name: ________________________

Session: Twwo Week

Threee Week
Fouur Week
Scholars
Hooya-Spartan S
Institute Rules
R & Universiity Release Form
You are subbject to all of thee rules pertaining
g to the use of th
he MSU residencce halls and otheer facilities, as w
well as certain
special ruless of the Spartan Debate Institutes. The following is a partial listt which highlightts some of the m most important
rules:

1. USE OF CONTROLLE ED SUBSTANC CES IS PROHIB BITED: Campuss and Institute reegulations strictlly forbid any
possession or
o use of drugs or
o alcohol. This includes
i access to
t tobacco whilee in attendance aat the camp. Viollations will
result in imm
mediate expulsio
on from the cam
mp without refund d. Students invollved in such actiivities may also face legal
action.

UCTIVE BEHA
2. DESTRU AVIOR AND HA
ARASSMENT OF ANY TYPE
E WILL NOT B
BE TOLERATE
ED:

Destructive behavior such asa tampering with h or defacing firre equipment, eleevators, halls, roooms, equipmentt, etc. is
forbidden. Harassmentinc
H cluding but not limited
l to physiccal, verbal, sexuaal, or racial haraassmentof studdents or staff of
the SDI or MSU
M is forbiddeen. Violations wiill result in immeediate dismissal from the camp w without refund. Students
involved in such activities may
m also face leg gal action.

ONS OF ANY KIND

3. WEAPO K ARE NOT
T ALLOWED.

4. DAMAG GE FEES: You will w be financiallly responsible fo

or any lost keys, lost meal cards,, or damage that you do to your
room, suite, or other universsity property.

5. CURFEW W: The dormitorries lock at 10:00pm. Students must

m be in the buuilding at that tim
me. Bed checks w
will be used to
verify studeents presence.

6. HOUSIN NG AND RELA ATIONSHIPS: For F security, you

u will be issued a key to your rooom and we ask yyou not to be in oother
peoples roo
oms without theiir permission. Ev veryone should be
b in their own rrooms at bed cheeck. Sexual relaationships betweeen
students willl lead to studentts being sent hom
me.

7. DRIVING: Students are not allowed to drive

d themselvess to the institute or to have accesss to a vehicle duuring the
institute.

8. RESIDENCE LIFE ASS SISTANTS: In n addition to the SDI staff, MSU provides their oown trained residdence life staff
that is there to assist camperrs and to enforcee hall regulationss. Their instructiions are also to bbe followed.

9. PETS: Pets
P are not allow
wed. Please do not
n bring any to the institute.

MICHIIGAN STAT
TE UNIVERS
SITY CONSE
ENT FORM
M AND RELE
EASE
I wish to partiicipate in Michigaan State University
ys Spartan Debatee Institute. I undersstand that there aree risks inherent in any activity. I
assume these risks and accept th he consequences involved in my parrticipation in the pprogram.

I understand that
t participation in
i this program is voluntary
v and I maay withdraw at anyy point during the program. I undersstand that
participation may not benefit me
m directly in any way.
w I hereby releaase Michigan Statee University, its B oard of Trustees, eemployees and
students from
m any and all costs,, claims, injury or illness resulting frrom my participatiion in the program
m.

I acknowledg ge that I understand

d the program in which
w I will particiipate. I accept the rrules and regulatioons set forth and I consent to
participate in the program. I hav
ve been advised th
hat I should look to o my own insurancce policy in case oof injury.

All deposits are non-refunda able for accepted students. Any tuiition paid beyondd the deposit is reefundable before tthe start of the
program. Aftfter the start of thee program, all tuittion and paymentts are non-refund
dable. By makingg a payment to thhe Spartan
Debate Instittute, you are hereeby consenting to this refund policy and agree that ddecisions regardiing refunds are mmade at the sole
discretion off the Director of thhe Spartan Debatte Institutes and are
a final.

I have read an
nd fully understand
d this document. All
A blank spaces were
w filled in and/oor sections crossedd out prior to my siigning below.

___________
______ _______
_______________
________________ ___________________
Daate Parrticipant Signaturee (Student)

___________
______ _______
_______________
________________ ___________________
Daate Parrent/Guardian Sign
nature
 Studentt Name: ________________________
Session: Twwo Week
Threee Week
Fouur Week
Scholars
Hooya-Spartan S
Addition
nal Inform
mation
Do you haave any food allergies or unique
u dietary
y needs?

________
__________
___________
__________
_______________________________________________
________
__________
___________
__________
_______________________________________________

Do you neeed any speciial accommod

dations?

________
__________
___________
__________
_______________________________________________
________
__________
___________
__________
_______________________________________________

Are you planning

p on brringing a lapttop computer to camp? Yes Noo

Are you debating

d paperless (using a computer to read evidencce)? Yes No

Partner Reequest: _____

___________
____________
_______

Roommaate Request: __________

__________
_______________

These requests will only be honored if the students are the same sex and are attending the same
session of the SDI. Requests MUST be mutual. We need to have this information written in
advance and cannot honor requests received after the deadline.

Is the stu
udent planninng on leaving g the Institutte for any reeason duringg the camp? A
Are any
people au uthorized (orr explicitly not
n authorizeed) to check this studentt out from thhe camp?
Please noote that inforrmation heree.
________
__________
___________
__________
_______________________________________________
________
__________
___________
__________
_______________________________________________
 Studentt Name: ________________________
Session: Twwo Week
Threee Week
Fouur Week
Scholars
Hooya-Spartan S
Addition
A al Releasse Form

I authorizze Michigan n State Univeersity to use materials m my child deveelops during the Spartann
Debate In nstitute for use
u in debatee-related reseearch, educaational, and ppublic servicce programs. I
also authhorize Michig gan State Un niversity to audiotape,
a viideotape andd/or photogrraph my childs
image an nd/or voice for
fo use in deb bate-related research, edducational, annd public serrvice prograams. I
understan nd and agreee that these written
w materrials, audio, video, film and/or printt images mayy be
edited, duuplicated, diistributed, reeproduced, annd reformattted, in any mmanner withoout paymentt of
fees, in perpetuity.
p This
T includess use on sociial media (e..g. the Spartaan Debate Innstitute Faceebook
page and d Twitter). I understand
u that
t this auth horization is not a condittion of particcipation in thhe
Spartan Debate
D Instittute.

Child's name:

(please print)

Parent or Guardian Name:

(please print)

Parent or Guardian Signature:

Address:

Telephone:

Date:
 Studentt Name: ________________________
Session: Twwo Week
Threee Week
Fouur Week
Scholars
Hooya-Spartan S
Travel
T In
nformatioon Form
**Please note: Student check-out time on departure day (last day of camp) is 12:00 noon. Please plan
travel to depart by that time**

I will provide all of my own transportation to and from the SDI

I will be flying and am requesting shuttle arrangements for arrival and/or departure
($15 each way for Lansing; $25 each way for Flint; $10 each each for Amtrak/Michigan Flyer drop-off)

Oth
her (please contact
c the SDI
S office)

If you require the SDI to provide shuttle service, we MUST know your flight information by the
forms deadline. Please be sure to complete the entire following chart:

Date Airport Airline Flight Arrival Time Departure Time

Number from LAN/FNT from LAN/FNT

Arrival -----

Departure ----

Additiona
al Flight Info
ormation (su
uch as conneccting flights/iitinerary):

Are you planning

p on arriving latee or departing
g early from
m the camp?

________
__________
___________
__________
_______________________________________________
________
__________
___________
__________
_______________________________________________
 Studentt Name: ________________________
Session: Twwo Week
Threee Week
Fouur Week
Scholars
Hooya-Spartan S
Travel
T In
nformatioon Form

SHUTTL
LE CONSE
ENT FORM
M MUST BE
B RETURN
NED IF REQUESTING
G SHUTTL
LE
SERVIC
CE

___________
I, _______ ___________
_____, the parrent/guardian of

________ ____________ ___________ ___, am requeesting that thee Spartan Debbate Institutes (SDI) provvide my
student sh
huttle service to and/or from
m

____________
________ ___________
_____ (name of airport or ttravel station)).

I understaand that the SD

DI is only ressponsible for meeting my sstudent at the airport/statioon at the time
specified on the previoous form, and for providing g them with trransportation to the airportt/station by thhe
departure time specifieed. I understaand that the SD DI is not respponsible for mmaking sure thhat my studennt is on
their fligh
ht aside from providing
p theem with transp portation to thhe airport/stattion, nor is thhe SDI responnsible
for my stuudents behavvior/actions while
w at the airrport/station.

I further understand
u that the SDI meeets students at
a a designateed group pickk-up spot at thhe airport and drops
them off outside
o the terrminal, and th
hat staff mem
mbers do not aaccompany stuudents to the gate or checkk them
in to their flight.

The SDI can provide unaccompanied minor escort service for students who are 14 and 15 years old and attending
the program. Due to the size of the program, we cannot accept unaccompanied minors who are 16 years old or
older. To request this, email debate@msu.edu with the subject line Unaccompanied Minor and include the
students name in the body of the email.

____________
________ ___________
___________
___ _____________________
Parent Sign
nature D
Date
 Studentt Name: ________________________
Session: Twwo Week
Threee Week
Fouur Week
Scholars
Hooya-Spartan S
Medicall Releasee Form
Your soon/daughter willl be involved in a Michigan Statee University program on the aboove date(s). We are asking you tto complete this form to
nor injury or meddical problems. In the event of sserious injury orr illness,
give ann appropriate medical facility perrmission to treat him/her for min
you willl be contacted; treatment
t will prroceed before coontacting you on
nly if the situationn is urgent and ddoes not permit delay.

Childs N
Name _________
______________
______________
_______ Date of Birth _________________________________________________

Namee of Primary

Address _______________
______________
_____________
________ Care Physician
P ________________________________________________

______________________
______________
_____________
________ Addreess _____________________________________________________

Phone ________________
______________
______________
_______ Phonee ______________________________________________________

INFORM
MATION NEEDE
ED ABOUT CHILD: YES NO IF
I YES - INDIC
CATE OR LIST BELOW

Is there anny chronic probllem or illness? _______

______________
___________________________________________

Has the peerson been treateed recently for

some mediccal problem? ________

________________________________________________________

Are there any allergies to medications

or local anesthesia? ________

_________________________________________
________________

List any m
medications now
w being taken

for treatm
ment of any medical problem ___
______________
______________
____________________________________________________________

Date of laast Tetanus Shot:: ____________

______________
_

HEALTH
H INSURANCE INFORMATION
N:

Policyholders Name and Relationship to Patient ______

______________
________________________________________________________

Policyholders Address __
_____________
______________
______________
______________
____________________________________________

Policyholders Date of Biirth: __________

______________
_____________
_________________________________________________________

Name andd Address of Insu

urance Co. ____
______________
______________
________________________________________________________

If you havve HMO or PHP

P insurance - list the emergency treatment
t authorrization phone nuumber ____________________________________

Name andd Address of Em

mployer _______
______________
______________
______________
__________________________________________
___

All Policyy Numbers (pleaase identify) ____

_____________
______________
__________________________________________________________

I, ____________________
_____________
______________
___ , as parent/leegal guardian of __________________________________________

I do hereby authorize Spartan Debate Institute representatives to seek any medical and/or surgical treatment necessary for the care of my child.

The above-designated
e SDI representative isi hereby authoriized to incur med dical costs necesssary to provide medical treatmeent for said childd, for
which I sshall be fully ressponsible. I also
o authorize the medical
m facility to
o release any annd all informationn required to com
mplete insurancee claims
and also authorize insuraance payment directly to the med dical facility.

Signature _____________
_____________
______________
____ Relationsh
hip to Child _______________________________________________

Daytime/W
Work EMERGE
ENCY PHONE NUMBER
N ____
______________
___________________________________________

Address:_______________
______________
_____________
______________
_________________________________________________________
 Studentt Name: ________________________
Session: Twwo Week
Threee Week
Fouur Week
Scholars
Hooya-Spartan S
Medical
M Insurancce Card

On thiis page pleasee include a co

opy of the studdents medicaal insurance ccard:

(Front)

(Back)