Bring this form Day 1 of Camp or You may mail Registration ACES Science Labs 116 Andover Lane Huntsville, AL 35811 Summer Camp Registration Form Complete this form in its’ entirety and sign. Child’s name ___________________________ Gender ________ Age __________ Birthdate _______________ Up Coming Grade__________________ Address _____________________________________________ Phone No. _____________ City_____________________ State ______Zip_____________ Emergency Contact Name and Number ______________________________________________________ Parent/Guardian Name_____________________________ Parent/Guardian Email ________________________________________ Are there any conditions to which we should be alerted? Pick up Release Name_____________________ Name_____________________ Name_____________________ Relationship ________________ Relationship _________________ Relationship________________ Phone No._______________ Phone No. ___________________ Phone No.__________________ ____________________________________________________________ Acknowledgment of Risk and Waiver of Liability As legal guardian of _________________________, I hereby consent to the above person's participation in ACES Science Labs Summer Camp at UA Huntsville. I recognize that potentially with any activity injuries can occur with eruptions, chemicals and basic science lab procedures. I understand that it is the express intent of ACES Science Labs, llc to provide for the safety and protection of my child, while participating in these labs at Summer Camp. I hereby forever release ACES Science Labs, UA Huntsville, its officers, employees, teachers and assistants from all liability for any and all damages and injuries suffered by my child while under the instruction, supervision or control of ACES Science Labs, llc or its employees. As a legal guardian of _______________________, I hereby agree to individually provide for the possible future medical expenses which may be incurred by my child as a result of any injury sustained while with ACES Science Labs, llc. I hereby give my permission to trained medical professionals to administer emergency medical treatment to my child, should sickness or accident occur in my absence. Medication will not be administered by ACES Staff. There are no exceptions to this policy. INITIAL __________ I understand ACES will be taking pictures and videos for our own website and print materials. There will not be any compensation, financial or otherwise offered as a result to my child or our family. Please initial your preference I agree ________ or I disagree _________ Parent or Legal Guardian’s Signature _________________________________ Date ___________________ Children will not be admitted to ACES Summer Science Camp without a completed Registration Form. There are not exceptions to this policy. ------------------------------------------------------------------------------------------------------------------ Office Only NOC_____________________Fac________________________