Acewall Scholars Mad Scientist Summer Camp Registration 2024
Please complete the below registration. The camp registration fee is $35 (Waived up until 6/1).

If you are requesting financial assistance, a QR Code is provided at the bottom of the form.  If you are registering after 6/1, a registration fee is required.  The link to pay the registration fee can be accessed at the link below:  

https://www.acewallscholars.org/mad-scientist-weekly-payments

Financial assistance information is provided at the end of the registration form.

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Email *
Student name: *
Parent/Guardian Name: *
Parent/Guardian Cell Phone: *
Parent/Guardian Email: *
Emergency Contact Name: *
Emergency Contact Phone: *
Student Address:
Guardian/Parent Address:
Student rising grade level (2024-2025): *
Does this student have any allergies, medications, dietary restrictions, or medical conditions that we should be aware of? *
Which weeks would this student like to sign up for?  *
Required
Do you permit pictures to be taken of your child to document their progression through the camp? (Pictures can be shared with the child's guardian.) *
Can your child's picture be used on our website, advertising materials, or social media to advertise for the camp? *
Does your child have any allergies? *
If you answered "yes" to the last question, please list the allergies here. If you answered, "no", please type N/A. *
If your child is sick or injured while at camp, do you give us permission to seek medical attention? *
What  is the name and number of your child's primary care physician? *
What is your child's medical insurance provider and member number? If your child is uninsured, please list N/A. *
The cost per weekly session is $150. However, for families who cannot meet this cost, please apply for our K.C. Wallace Scholarship. Is your student applying for financial assistance? (If yes,  a financial assistance form will be emailed to you.) *
Will your child need, after or before care? (Before Care last from 7:00 am-8:30 am and After care last from 3:45pm - 5:30pm) FINANCIAL ASSISTACE DOES NOT COVER BEFORE AND AFTER CARE. *
Required
Please list who is able to pick up up child from the camp. (Government issued ID is required.) *
Is there a child custody agreement in place? *
If there is a parent that is not allowed to pick up your child, please list the name here. (If this does not apply, please type "N/A".) *
For Financial Aide, use the QR Code. 
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Do you have a question?  Please leave your question(s) here, and someone will get back with you.
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