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.

Additional Comments

*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.

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

Yes, subscribe me to your newsletter.

bottom of page