Dear Student,

Congratulations! You have the opportunity to attend the 2014 Atlanta Urban Debate League Institute (AUDI). By completing this form, you are asserting that you have the raw talent and skills necessary to succeed as a debater. Debate is no easy event in public speaking. It is an intense activity that requires fast thinking and the ability to defend your position for the ultimate win. The AUDI will provide you with the fundamental debate training necessary to participate and succeed with your school’s debate team and tournaments throughout the school year.

The AUDI will run from July 28-August 1 at Georgia State University in Atlanta, GA. The training will cover debate theory, research techniques, topic specific instruction, practice debates, and college bridge information. You will also attend lectures and participate in small lab groups. Breakfast, lunch and a snack will be provided.

In this form, you will find more details about the institute as well as the necessary forms to fill out and return. The forms are due no later than July 7, 2014. Please contact James Roland at (404) 727- 6189 or by e-mail at catalystatc@gmail.com or lauren.jacob@emory.edu at (404) 727-7178 if you or your guardian have any questions.

See you this summer!

Student Contact Information

Student First Name *

Student Last Name *

Grade (2014-2015) *

School Attend (2014-2015) *

Student ID #

Date of Birth (xx/xx/xxxx) *

Student Email

T-Shirt Size (Adult Sizes)

Home Address *

City & State *

Zip Code *

Parent/Guardian Contact Information

Parent/Guardian Name *

Parent Email *

Parent/Guardian Home Phone *

Parent/Guardian Cell Phone *

Please click here is you have the same home address as your child.

same address

Home Address

City & State

Zip Code

Transportation and Medical Information

Emergency Contact 1 NAME, PHONE, and RELATIONSHIP TO CHILD *

Emergency Contact 2 NAME, PHONE, and RELATIONSHIP TO CHILD *

In addition to parent/legal guardian, the following individuals have permission to pick up my child: (please list NAME, PHONE, RELATIONSHIP TO CHILD) *

Name & Phone of Physician: *

Child's Allergies and/or current medical conditions *

GENERAL CONSENT AND RELEASE AGREEMENT

I understand that participation in the program is entirely voluntary. I agree that in consideration of the National Debate Project sponsoring the program and permitting me to participate in this program, I, on behalf of myself and my representatives, will indemnify, defend, and hold harmless the National Debate Project, its officers, agents, employees, successors, and assigns form liability for any and all claims, demands, rights or causes of action, present or future, resulting from or arising out of any travel or activity related to the program. *

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SOCIAL CONTRACT

In order to afford all AUDI Program participants the most beneficial and enjoyable experience, we require that certain minimum standards of conduct be observed. Our experience has shown that a prior understanding of these standards by students and their parents will help contribute to a more effective learning experience.
1. I will conduct myself in a safe and sensible manner while participating in this program. I will attempt to uphold the five P’s: Be Positive, Be Prepared, Be Punctual, Be Proactive, and Be Patient. I understand that I need to be respectful and a good community member.
2. Attendance at all program classes and functions (including field trips) is required and verified. Tardiness and other infractions of rules will result in disciplinary action to encourage maximum learning from the program.
3. Students are not permitted to leave the Georgia State University campus unless it is for an event sponsored by the program or unless they have received written parental permission verified by the workshop director. Failure to abide by this regulation can result in removal from the program.
4. I authorize the program to secure necessary emergency medical treatment in the event of injury or illness while participating in the program.
5. Alcoholic beverages and narcotics or other controlled substances, weapons, or threatening behaviors are not permitted; any student found in possession thereof or engaging there in will be required to leave the program.

These regulations are not all-inclusive. Additional rules regarding individual conduct may be given to each student (e.g., library rules, etc.) Violation of any of these rules or the additional rules provided to the students may result in subsequent termination from the program.

STUDENT AND PARENT: please sign below to indicate your understanding and acceptance of these regulations. *

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Medical Release Form

Should my child suffer an injury or illness while in the care of the AUDI Summer Program, and the staff is unable to contact parent/guardian immediately, they (AUDI Summer Program) shall be authorized to secure medical attention and care for above mentioned child as deemed necessary. The below signed parent/guardian shall assume full responsibility for payment of all medical cost as related to the care of above mentioned child. *

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Student Interest and Debate Information

Have you ever been to a debate institute/workshop before? *

yes

not sure

How many years of debate experience do you have? (including middle school) *

Student: Do you have any diagnosed learning disabilities or any other special needs that require accommodation?

Student:Name 3 of your favorite music groups

Student: What are some topics you would like to debate about? Remember, it can be about anything. *

Payment and Scholarships

The registration fee for each debater is $500 for the week. This includes all materials, breakfast, and lunch.

If you would like to be considered for a scholarship, please check the box below.

I would like to be considered for a FULL scholarship.

Please choose from the following payment options:

a. Online payment

b. Mail check to:

Atlanta Urban Debate League
c/o Glenn Pelham Foundation
P.O. Box 15087
Atlanta, GA 30333

For parents/guardians and student: Anything else that you would like to add to ensure that we deliver a great workshop experience for you?

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