$230 for Fowler Members / $275 for non-members Daily snacks provided. Each camper should bring their own lunch and water bottle.

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1 KidsMUSE Summer Camp Session 1: Ages 6 8, July 9 13, 9 am 4 pm Session 2: Ages 9 12, July 23 27, 9 am 4 pm $230 for Fowler Members / $275 for non-members Daily snacks provided. Each camper should bring their own lunch and water bottle. Travel to Africa in the Fowler Museum s galleries during this immersive STEAM (science, technology, engineering, arts, mathematics) summer experience. Campers will explore iron forging across Africa through engaging hands-on activities inspired by the special exhibition Striking Iron: The Art of African Blacksmiths. Each day campers will discover original artworks, create their own masterpieces in the studio, and experiment with thoughtprovoking engineering challenges. Registration includes a full-day fieldtrip to Adam s Forge for a hands-on workshop led by a master blacksmith, who will help campers mold their own copper pendant with the assistance of Fowler staff. Required registration opens May 1, and will be filled on a first-come, first-served basis. Each session accommodates up to 15 campers. Complete applications must include the following: Registration Form Payment, $230 for Fowler Members / $275 for non-members UCLA Photo Release Form UCLA Waiver Adam s Forge Waiver Optional: Scholarship Form Complete applications may be mailed or hand-delivered to Fowler Museum Education Department, 308 Charles E. Young Drive North, Box , Los Angeles, CA , or ed to fowlereducation@arts.ucla.edu. Note: All cancellations must be made two weeks in advance of the first day of camp to receive a full refund.

2 Session No. REGISTRATION FORM Cost: $230 for Fowler Members $275 for non-members Child s Name Age Guardian s Name Primary Phone Primary Emergency Contact Information Name Phone Relationship to Child Health Information Allergies or Dietary Needs Special Needs, Medical Conditions, or Behavioral Concerns Paying by Check Please make checks payable to: UC Regents Paying by Credit Card Please complete the credit card authorization form on the following page.

3 SCHOLARSHIP FORM Scholarship Overview A limited number of scholarships will be available for each session of summer camp to assist campers who might not otherwise be able to attend. Families within the following (pre-tax) household income categories are eligible to apply for a scholarship: Families of 2 earning $3,333 or less per month ($40,000 annually) Families of 3 earning $3,750 or less per month ($45,000 annually) Families of 4 earning $4,167 of less per month ($50,000 annually) Family size includes parents/guardians living in the home and all children living in the home. A family s household monthly income is calculated pre-tax (taken from line 22 on Form 1040). Timeline for Scholarship Applications To be considered for a scholarship, you must include this form with your completed application. Scholarships will be awarded on a first-come, first-served basis. Applicants will be notified of their scholarship status within two weeks of submission. If granted a scholarship, acceptance of the scholarship (response to the Fowler Museum) is required within 2 business days to reserve your spot in camp. If you do not confirm your spot, the scholarship will be offered to the next camper in line. If you are not awarded a scholarship, you will be given the option to pay the registration fee. Today s Date Your Name Phone Number What is the best way to contact you? Name and age of camper(s)

4 One Time Credit Card Payment Authorization Form CARDHOLDER INFORMATION Name: Billing Street Address: Street Address (cont.): City: State: Postal Code: Direct Telephone: ( ) - CREDIT CARD INFORMATION Credit Card Type: MasterCard Visa American Express Discover Card Number: Expiration Month: Expiration Year: Cardholder Signature X Date / / Security Code: I authorize a one-time charge against my credit card for the following amount $

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