Camp Registration Form

 

Fill out all the fields below and hit the "Submit" button. Then mail in payment ito:

Mad Science of Hawaii
306 Ekoa Place
Wailuku, HI 96793

 

Please fill out one form for EACH child. Registration is NOT CONFIRMED until payment has been received.

 

 

 

CAMP REGISTRATION FORM

Camp Location:
Camp Start Date:
Child's Name: 
Child's Birthday:
Child's School:
Grade Completed:
Health Concerns:
Parent/Guardian Name:
Other person/s authorized to pick up child:
Email:
Home Phone#:
Cell Phone#:
Billing Address:
City/Zip:

Would you be interested in a late pickup/extended care option if made available?      Yes        No

Would you like to receive our Mad Science Newsletter for coupon offers, updates on upcoming programs, and fun science facts?      Yes        No 

Payment Method

 You may choose from two payment methods:

Payment Method Requested:CheckCredit Card

1) CHECK: Deposits are non-refundable. Final payments will be due 3 weeks prior to camp start date. Please send to address above.

2) CREDIT CARD PAYMENT: Processed up to 3 weeks prior to camp start date. There will be a added 2% processing fee. Must call Mad Science office at 852-1516 to provide credit card info.

 

Thank you for enrolling in our Mad Science Summer Camp! An email will be sent to you to confirm your registration once payment has been received.