2025 Pharmacy Summer Camp Registration

2025 Pharmacy Summer Camp Registration

Please complete the information below to register for the 2025 UAMS COP Pharmacy Summer Camp. The 2025 UAMS Pharmacy Summer Camp will be held June 2nd-4th at the UAMS Little Rock Campus located at 4301 W. Markham St. Little Rock, AR 72205.
Name*

First NameMiddle InitialLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Of which country are you a citizen?*
E-mail Address*
Phone*

Area CodePhone Number
Birth Date*

MonthDayYear
Gender*

MaleFemaleDecline to Answer
T-shirt size*
High School/College:*

School Name

School Address

School CitySchool State / Province

School Postal / Zip Code
Classification as of August 2024?*

High School SophomoreHigh School JuniorHigh School SeniorCollege FreshmanOther
Parent/Guardian Full Name*
Parent/Guardian E-mail Address*
example@example.com
Parent/Guardian Phone*

Area CodePhone Number
Emergency Contact Full Name (if different from Parent/Guardian)
Emergency Contact relationship to student
Emergency Contact Phone

Area CodePhone Number
Please describe any special dietary requirements or restrictions*
Please provide any current medical conditions being treated, prescription and over-the-counter medications currently being taken, physical limitations and/or any other information that should be known in an emergency and/or that may require advance planning by the UAMS College of Pharmacy camp program staff to accommodate your participation in the pharmacy summer camp program. If none please indicate with N/A.
UAMS requires that all participants provide proof of COVID vaccination or documented exemption. Has your child/student received the full COVID vaccinnation with the ability to provide proof or documented exemption?
In 200 words or less, please share with us why you would like to participate in the Pharmacy Summer Camp.
The 2025 Pharmacy Summer Camp fee is $150.00 (The participation fee includes tuition, lab supplies, meals and all camp program materials and services). Will you or your parent/guardian be able to pay all fees associated with this camp? If the answer is no, please complete question regarding Tuition Assistance (Scholarship).
YesNo
Tuition Assistance (Scholarship) Application:

Scholarships for this camp are based on financial need and are not a merit based scholarship system. Meaning if you applied for the scholarship because of your academic merit, these are not those kinds of scholarships. We are providing assistance for students who may not otherwise be able to attend the camp because of financial need.In 200 words or less please describe special circumstances or any adversity/hardships you have overcome to be considered for the tuition assistance available for the 2024 Pharmacy Camp.
By checking the box below, I (student), understand and agree to the following:
- Mail or E-Mail a copy of my most recent high school transcript/academic record by Friday, May 2nd, 2025.(Mail to: UAMS College of Pharmacy ATTN: Willie Hicks 4301 W. Markham St. Slot #522, Little Rock, AR 72205) or (E-Mail to: wfhicks@uams.edu) E-Mail is greatly preferred.
- All fees ($150) are due on or before Friday, May 16th, 2025.
- All information on this application is true and complete. I understand that any misleading or incorrect statements will render this application void.
I agree (student)
Student Initials*
By checking the box below, I (parent), understand and agree to the following:
- All camp applications must be e-mailed/postmarked by Friday, May 2nd, 2025.(Mail to: UAMS College of Pharmacy ATTN: Willie Hicks 4301 W. Markham St. Slot #522, Little Rock, AR 72205) or (E-Mail to: wfhicks@uams.edu) E-Mail is greatly preferred.
- Camp applicants will be notified on or before Friday, May 9th, 2025 of their admission status.
- All camp participants will receive, along with their E-Mail of admission, the following: camp agenda, camp rules and regulations, participant agreement form, and release forms. The participant and release forms must be signed by the camp participant and their parents/guardians and returned to the UAMS College of Pharmacy no later than Friday, May 16th, 2025.
- All Fees ($150) are due on or before Friday, May 16th, 2025.
- My student must have health insurance coverage and proof of such insurance must be provided to the UAMS College of Pharmacy by Friday, May 16th, 2025.
  - (Mail to: UAMS College of Pharmacy ATTN: Willie Hicks 4301 W. Markham St. Slot #522, Little Rock, AR 72205) or (E-Mail to: wfhicks@uams.edu) E-Mail is greatly preferred.
- The UAMS College of Pharmacy reserves the right to cancel the pharmacy camp and return all fees in the event of insufficient participant registration or for other compelling and unforeseen circumstances of good cause.
I agree (parent)
Parent E-mail address as signature*
Enter your e-mail address (parent)
Should be Empty: