Summer Camp 2013 Financial Aid Request Form

Thanks to the Nora K. Nicholson Scholarship Fund and contributions from generous members and donors, the Museum offers limited financial assistance to those who otherwise could not participate in this Museum program. The Museum is typically able to offer partial scholarships to 30-50% of those applying for aid. Financial assistance will be offered on a need basis. In an attempt to help as many children as possible with financial aid, the Museum will only offer one (1) week of camp per accepted applicant.

To be considered for financial assistance, please complete the following form by Monday, January 14, 2013. Scholarships will be awarded on Wednesday, January 16. If a scholarship is awarded, applicant must confirm registration with the Museum by Wednesday, January 23.

Applicants must also agree to the general release associated with summer camp registration at the Museum of Life and Science. To read a copy of this release, click here.

Camper's Name: *

Camper's Birth Date: *

mm/dd/yyyy

Summer/Fall '13 Grade: *

Parent or Guardian Name: *

Mailing Address: *

Phone Number: *

xxx-xxx-xxxx

Email Address: *

Request for Aid: *

Please share with us your case for requesting financial aid, including yearly family income (from all sources) and number of dependents in your household. 

First Choice Camp

Camp Title: *

Date of Camp Requested: *

Camp Site: *

Museum Campus - Durham

Chapel Hill

Extended Day Option:

select all extended care options you would like for this week

AM Extended Care 8-9am

PM Extended Care 3-5:30pm

Second Choice Camp

Camp Title: *

Date of Camp Requested: *

Camp Site: *

Museum Campus - Durham

Chapel Hill

Extended Day Option:

select all extended care options you would like for this week

AM Extended Care 8-9am

PM Extended Care 3-5:30pm

Camp Fees

A week of camp is $275 for Museum members and $300 for the general public.

How much of the total fees can you afford to pay?: *

Emergency Information

Name of Emergency Contact: *

This person will be contacted if neither parent/guardian can be reached.

Contact's Relationship to Camper: *

Contact Phone Number: *

xxx-xxx-xxxx

Camper Allergies:

Camper Medications:

Please specify anything which would help us better accomodate your child's learning style or personality:

Camper Release

Read release here...

Release Acknowledgement: *

I have read and understand the general release form associated with summer camp registration at the Museum of Life and Science.