Student Information - DO NOT USE apostrophes (') or special characters (ex.: #,/,`)
First Name:
MI:
Last Name:
Home Address:
City:
ZIP Code:
T-Shirt Size:
Ethnicity:
Gender:
DOB:
Grade Level:
School:
Parent/Guardian Contact Information
Full Name:
Phone:
Email:
Emergency Contact Information
Full Name:
Phone:
Email:
Media Waiver & Release
I hereby consent to and authorize the use and reproduction by Savannah State University (SSU), or anyone authorized by SSU, of any and all photographs/videos taken of my child during the GenCyber Summer Camp event. SSU has permission to use their names, likeness and/or images obtained from these activities may be reproduced by the university and/or public media to promote and advertise, publicly or educational events/activities. All media (print, digital, website, etc.) are owned by SSU. I have read and understand the above and attest that I am the parent or legal guardian of the child attending the summer camp. I hereby waive any claims I may have, and release the university and its employees from liability of claims arising out of such activities.
E-Signature:
Click Submit to finish this application; however, does not mean acceptance to the summer program. If the applicant is selected, you certify that all information provided is accurate and true, and that you are legally responsible for the camper named in this application.