CE Summer Workshops Pre-Registration

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The Office of Continuing & Professional Development
Kingston Center of SUNY Ulster
94 Mary's Avenue
Kingston, NY 12401
cereg@sunyulster.edu | 845-339-2025

SUNY Ulster Summer Workshops - Pre-Registration Form

Child's First Name:

Child's Last Name:

Gender

Date of Birth

Current Age

Parental Consent for Account Creation

Because the student is under the age of 13 SUNY Ulster requires students to have an electronic account in order to:

Register for courses
Access instructional materials and online learning systems
Use the college’s email, library, and academic resources

Information collected is subject to the terms of the SUNY Privacy Policy. Use of a SUNY Ulster account is subject to the terms of the SUNY Ulster Computer and Network Security and Acceptable Use Policy. This policy is section 3.11.5 of the SUNY Ulster Policy Manual.

Because your child is under the age of 13, federal and state law require your consent before we can create this account and collect the information necessary to provide access.
We will collect and maintain the following information for your child:

Name, date of birth, and student identification number
Contact information (e.g., address, phone number, email assigned by the College)
Course registration and academic records
System login credentials and technical identifiers (e.g., IP address, device ID, usage logs)

This information is used only for educational and administrative purposes. We do not sell or disclose this information to third parties for non-educational or commercial purposes.

Children’s Online Privacy Protection Act (COPPA)
We must obtain your verifiable consent before collecting personal information from children under 13. You have the right to review, request deletion, and refuse further collection of your child’s data. Deleting the information or refusing further collection of information may result in your child's inability to participate in class(es). By signing this form you are providing your consent for SUNY Ulster to collect this information.

I have read the information above and consent to the creation of a SUNY Ulster account for my child under age 13

Parent or Guardian:

Parent/Guardian Completing this Form

Parent First Name:

Parent Last Name:

Address:

City:

State:

Zip:

Parent Phone Number:

Parent Email Address:

Second Parent/Guardian

Parent First Name:

Parent Last Name:

Parent Phone Number:

Parent Email Address:

Emergency Contact Information

Emergency Contact First Name:

Emergency Contact Last Name:

Emergency Phone Number:

Emergency Email Address:

Health & Medical Information

Please list any medical conditions your child has that would be importamant information fo an emergency responder. This includes any recent/current illness or injury, existing medical condition, restriction or limitations, seizure disorders, asthma, allergies (i.e. medications, food, insect stings, etc.) or special needs. Also list any medication taken by your child.

Please inform us of any medications your child is carrying on to campus - i.e. EPI-Pen, Insulin, Pills, etc.

Please review our SUNY Ulster Policies

SUNY Ulster may cancel any workshop that lacks sufficient enrollment up to one week before the start date. If cancelled, a notice and full refund will be issued. Full refunds are issued up to two weeks prior to class. Please allow, 3-4 weeks for a refund.
If you choose to cancel your child’s enrollment two weeks or less prior to the start date, you will be charged a prorated administrative fee of 25% of the cost of class (not to exceed $50).
No refunds will be granted on or after the start date of class.
Please do NOT drop off and pick up your child without ensuring your child is signed in/out by the instructor.
SUNY Ulster policies may be found in the Student Handbook
Be sure to label your child's possessions. Lost items will be given to Public Safety & Security (845-687-5023) at the completion of each workshop and held there for one week.

Following the submission of this form you will receive an email with links to register and pay for the course. The student is NOT registered until the course is paid for.

By submitting this form you acknowledge that you have read and understand all of the policies and procedures for this program.

Form owner: SUNY Continuing Education | If there are any issues or errors, please contact: cereg@sunyulster.edu

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