APPLICATION for Wayne County students entering 7th-10th grades.
Application due: January 9, 2025

Whether a first time or returning student, MASH Camp 2025 offers all new curriculum and activities, providing the opportunity to explore a variety of careers in healthcare, at no-cost to students. The experience will sow seeds of interest by introducing young minds to attainable career options.
Each camp offers:
  • Interactive presentations and hands-on activities that strengthen understanding of the health care industry.
  • Exposure to a variety of health professions, including educational requirements, and the skills needed to follow career paths.
  • Guest speakers from the healthcare field.
  • Snacks
The MASH Camp Application needs to be filled out by the parent/guardian of student along with the student applicant.

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* 1. Student Participation Information

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* 2. Parent/Guardian Information

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* 3. Grade student will be ENTERING in the 2024-2025 school year.

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* 4. Since there is no camp cost and a limit of 25 participants, WNY R-AHEC requests that parents/guardians commit to their student attending the entire camp.
Please check one camp location/date below:

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* 5. Media Consent Release and Authorization Statement:
As a MASH Camp Applicant and the Parent/Guardian of Applicant, I grant Western New York Rural-Area Health Education Center (WNY R-AHEC) permission to include and identify me or my image in any publication, photograph, or audio/visual recordings of any kind and in whatever medium it may use for educational, publicity, and/or fundraising purposes. If I am interviewed by staff of WNY R-AHEC or any affiliate programs, I also give permission to use my name, my story, and any of my direct quotes for education, publicity and/or fundraising purposes in any medium. I understand and agree that WNY R-AHEC retains all rights to the photographs, moving images, sound recordings, and other media; and I will not be compensated for any WNY R-AHEC use of the same. By completing this application, I hereby waive any right I may have to inspect or approve the media that contains my name, image, sound recordings, story, and/or biographical data.
I understand and acknowledge that WNY R-AHEC and its affiliate programs will rely on this Release and Authorization Statement, and hereby agree not to assert any claim of any nature against WNY R-AHEC, its employees and agents, and /or affiliate programs relating to the exercise of permissions granted by this Release and Authorization Statement. I understand and agree the materials developed during this period may be used indefinitely. By voluntarily filling out this application and checking the boxes below, I agree to abide by the Release and Authorization Statement. I also understand that I may revoke this Release and Authorization at any time, in writing, but that a revocation will not impact any use or disclosure made prior to the date the revocation is received.

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* 6. Student's Gender

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* 7. Is student Hispanic or Latino?

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* 8. Which best describes your RACE?

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* 9. Student participant, please check ALL statements below as a personal pledge to come to camp with a positive attitude and your best behavior.

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* 10. Please read & check all statements below:
As a participant in MASH Camp 2025, I will NOT...

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* 11. Did you attend a MASH Camp last year?

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* 12. What interests you most about seeking a career in healthcare?
What healthcare career(s) you are interested in?
Why are you interested in attending MASH Camp 2024?

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* 13. Wayne County School District you attend:

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