In-Person & Virtual Texas ACE Summer Program 2021: STUDENT APPLICATION
What: Free In-Person and Virtual Summer Camp for Galveston ISD Students, K-4
When: June 1 - July 2, 2021
Where: 2 options - Scott Campus (in person) & Virtual Participation (at home)
(Crenshaw students will be at Crenshaw)

Breakfast, lunch, and an afternoon snack will be provided for in-person participation.

Once we receive this completed application, parents will be notified of status (student enrolled or student on wait list) via email.

*Funded by the 21st CCLC Program administered by the U.S. Department of Education*
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Email *
Student Last Name *
Student First Name *
Will your student attend programming: *
2020-21 Grade *
2020-21 Campus *
Does the student have any Medical Issues/Learning Issues/Allergies? *
Parent/Guardian #1 First and Last Name *
Parent/Guardian #1 Phone Number *
Parent/Guardian #1 Relationship to Student *
Parent/Guardian #1 Email Address *
Parent/Guardian #2 First and Last Name
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Relationship to Student
Parent/Guardian #2 Email Address
Please list names and phone numbers of any other persons designated to pick up your child from the Texas ACE program.  Note that persons may be asked to show a picture ID for verification purposes.
Student Home Address *
In-person students only: does your student require bus transportation to and from program? (The bus will visit designated stops, it will not go to the home)
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Virtual Students Only: Please check all that your household has access to. *
Required
Virtual Students Only: How would you prefer to receive supplies for the virtual summer camp(s)? *
Texas ACE will take all measures possible to ensure that supplies are sanitized before distribution and use. However, we are unable to guarantee materials are 100% free from contamination. Do you agree to accept the supplies on these terms and agree that we shall not be held liable in any way should illness occur? (Please check "I agree" for program participation.) *
I hereby give Galveston ISD permission to use my child’s image and/or work on the district’s TV channel, website and social media, for media purposes and in district publications.  *Please note: Submission of a photo or video will be viewed as permission to share that photo or video. *
Parent/Guardians are responsible for notifying Galveston ISD/Texas ACE of all medical information pertaining to the student on this form. The parent/guardian at home remains responsible for the student's health and safety during virtual activities. (Please check "I agree" for virtual program participation.) *
I give permission for Texas ACE to share student data with our partners, including but not limited to, demographic data and pertinent medical information. (Please check "I agree" for program participation.) *
Typing my name and the date below certifies my understanding of all paragraphs above, and gives my permission for my child to participate in the In-Person and/or Virtual Galveston ISD Texas ACE/21st Century Summer Camp 2021. Please type your name and the date: *
A copy of your responses will be emailed to the address you provided.
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