1. 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 ________________________________________
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________________________