Registration Form - Exploring Clinical Laboratory Science Camp: From Molecules to Microscopes Student InformationStudent's Name* First Last School*Fall 2026 Grade Level* 9th Grade 10th Grade 11th or 12th Grade (Instructor will reach out to determine eligibility) Date of Birth* MM slash DD slash YYYY Dietary Restrictions* Gluten-sensitive Vegan Vegetarian Dairy-free N/A Other (please note below) Allergies or other Important Medical Information*Does your student need any special accommodations (mobility, language, sensory, learning, etc.) that we can provide? Please describe.*Why is your child interested in attending this camp, or what are they hoping to learn?*How did you hear about this camp?* Primary Contact PersonPrimary Contact Name* First Last Primary Contact Address* Street Address City State / Province / Region ZIP / Postal Code Phone Number*Alternate Phone Number*Email* Secondary Contact PersonSecondary Contact Name* First Last Secondary Contact Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone Number*Alternate Phone Number*Email* PaymentHow would you like to pay?* I want to pay $500 today via Stripe (debit/credit card) My student receives free or reduced lunch; scholarship requested $500 Standard Fee*Credit Card* Please briefly describe the circumstances for your scholarship request:*