Summer Camp Application

*Parents First name

*Parents Last name

*Email

Phone

*Address

*Child's Full Name

*Child's Age: You must be between 13-17 during the program.

*School

*Grade

*Parent 2 Full Name, Address, email and phone number.

*T-Shirt Size

*Area of Interest

Technology

Green Building

Urban Agriculture

Electrical

Plumbing

HVAC A/C

Carpentry

Flooring

Arts & Crafts

*Why do you want to attend UCCA Summer youth program?

*Emergency Contact: Name, Phone Number, Relation, Email

*Alternate Pick Up Person: Full name, phone number, email, relation.

*Please list any food allergies or food restrictions that your child has.

*Signature: by signing this you acknowledge that meals and snacks will be provided and that I have listed any and all food allergies and restrictions for my child.

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You acknowledge that meals and snacks will be provided and that I have listed any and all food allergies and restrictions for my child.

You acknowledge that all medication will be administered at home before camp and that we do not administer medication to students while at camp.

I acknowledge that I will attend the Mandatory Parent Meeting on one of the dates as stated on the flyer in order for my child to attend the Summer Camp.

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