Camp UPC 2020 - Student Applications
NOTE: Please complete this form in its entirety. There needs to be one form completed for EACH student attending. Thank you!
* Date of Birth
* Age when camp begins
* Grade entering 2020-2021
* Parent/Guardian Name
* Home/Work Phone
* Cell Phone
Parent/Guardian (2) Name
Home/Work Phone (2)
Cell Phone (2)
* Which sessions will your child be attending?
Week 1: Full Steam Ahead (June 1-5) ($95.00)
Week 2: LocoMOTION (June 8-12) ($95.00)
Week 3: Creation Station (June 15-19) ($95.00)
Week 4: Chugga Chugga Chew Chew (June 22-26) ($95.00)
* Will your child need extended afternoon care from 4:00 - 6:00 p.m. ($5 per day)?
* In Case of Emergency, Contact:
* Emergency Contact Phone #
* Emergency Contact (Relation to Student):
* (2) In Case of Emergency, Contact
* (2) Emergency Contact Phone #
* (2) Emergency Contact (Relation to Student)
Note: We cannot release your child to anyone other the parent/guardian named below or the persons listed on this form. All individuals picking up children should be prepared to show identification.
- Emergency Contact and Child Release Authorization
Please list any medical/physical limitations or precautions including food, insect, and environmental allergies. Please list any recent accidents, surgeries, or injuries
Are there any important things we should know about your child in order to provide the best care for him/her?
* I have read the Camp UPC FAQ's:
* Can your child swim without assistance?
Please list any medications your child is taking
If medication is to be given at camp, please provide the following: name of medication, dose, exact time given
What is this medication for?
What are the effects of this medication on your child?
* Name of Pediatrician
* Pediatrician Phone #
* Name of Insurance Company
* Group #
* Member ID #
Please provide a copy of your insurance card or bring it on the first day of camp.
- Medical Insurance Card
- Your digital signature is required upon reading the following forms. You hereby assert that you fully understand and agree to these waivers and agreements. By typing your name, you are signing these forms electronically. You agree your electronic signature is a legal equivalent of your manual signature.
* Permission to Secure Treatment:
* Field Trip Release:
* Waiver and Release Statement:
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