INSPIRING FUTURE ENGINEERS: Youth Summer Program Summer 2016 What are we? Inspiring Future Engineers is a hands-on-project-based program that uses STEM education to involve your child in a world of exploration and creation! Basic concepts of Civil, Environmental, Mechanical, Industrial, Electrical, and Aerospace Engineering will be taught by Engineering students from the University at Buffalo. During this summer program, children will develop problem solving and critical thinking skills that channel their inner-engineer! Monday - Friday 9:00 AM – 1:00 PM $165 Check us out online! IFEWNY.COM/home.html Day 1: Design a Roller-Coaster/Build a Suspension Bridge Day 2: Design a Rube-Goldberg Machine/Peeps Catapult Competition Day 3: Egg Drop Challenge/Design a PVC Pipe Marshmallow Shooter Day 4: Design a Mentos-Soda Rocket Car/Solar Powered Oven S’mores Day 5: Building and Racing Sailboats/Bungee Action Figures & Barbies Boys and Girls ages 9 to 13! Prizes awarded every day! Sessions: Session 1: July 18th – July 22nd Session 2: July 25th – July 29th Session 3: August1st – August 5th Free T-Shirt!!! **sessions will fill up on a first-come-first-serve basis. Contact Info: Isabel Hall: imhall@buffalo.edu (512)786-0085 Luke Cook: lcook3@buffalo.edu (716)548-2661 Harlem Community Center 4255 Harlem Rd Amherst, NY

Student’s Name: ______________________________________ Inspiring Future Engineers Youth Summer Program 2016 Complete registration form by Thursday, June 30th. Forms received after June 30th will be charged a $20 late fee. Mail with check payment made payable to: Luke Cook to 8941 Galway Terrace Clarence Center, NY 14032 Pricing for each week per child: $165 Students will be provided snacks and water each day. Students may bring a lunch to eat during snack time. ***Program fee is 100% refundable if given at least 7 days notice*** ***Multiple weeks can be selected ___Week 1: July 18th to July 22nd Payment Method: ___ PayPal ___ Check Enclosed ___Week 2: July 25th to July 29th ___Week 3: August 1st to August 5th Student’s Name: ______________________________________ Sex: _________ Age: ______ Birth Date: __________________ Allergies:_____________________________________________ ____________________________________________________ Grade Level: ____________ School: _______________________ Parent/Guardian’s Name: ________________________________ Address: ______________________________________________ Phone: _______________________________________________ Email: ________________________________________________ Emergency Contact: ____________________________________ Emergency Phone: ______________________________________ Primary Care Physician: _________________ Phone: ___________ T-Shirt Size: Youth Sizes: __YS __YM __YL __YXL Adult Sizes: __S __M __L __XL Parent/Guardian Consent PERMISSION IS GIVEN to program leaders to bring my child to a hospital emergency room or doctor to obtain medical treatment if necessary. I UNDERSTAND that the highest priority of the leaders is the safety and well-being of the children and staff. Occasionally, there may be situations or circumstances, which, in the opinion of the program leaders, are not safe, nor are they suitable for surrounding individuals. Therefore, staff reserves the right to make decisions regarding enrollment and participation in activities and programs. If this were to happen, all fees are non-refundable. Parent/Guardian Signature: _________________________________ Date: ___________________________________________________