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Home » Children & Teens » Children » Summer Camps » 2009 Summer Camp Registration

2009 Summer Camp Registration

Items marked with an asterisk are required.

Child's Name & Info
Last Name*

First Name*

Middle Name

Name Used

Birth Date* (month/day/year)

Gender Identity*

Summer Camps
Please check the camps for which you are applying.

 Fields of Color– June 8th–June 12th 9am –1pm (ages 3 to going into 4th grade)
 Earth Camp – June 15th-June 19th 9am-1pm (ages 3 to going into 4th grade)
 Peace Out Camp – June 22nd -June 26th 9am-1pm (ages 3 to 5 years)
 Culture Camp - June 22nd -June 26th 9am-1pm (ages 6-10 years)

Please send your child to camp with a healthy packed lunch clearly labeled with your child’s name.

Child’s Home Address

Street*
City*
State* Zip Code*

General and Emergency Contact Information

Responsible Adult #1

Name*

Email* (Used to confirm registration)

Home Phone
Cell Phone
Work Phone

Name of Employer

Occupation

Responsible Adult #2

Name

Home Phone
Cell Phone
Work Phone

Name of Employer

Occupation

If Responsible Adult #2's address is different from the child’s, please note here:

Street
City
State Zip Code

Additional Information
Child’s previous school experience:

Does your child have any special diet restrictions:

Are there any issues that we should be made aware of so that we can make sure we can meet your child’s needs?

Volunteer
For Culture Camp only. Are you interested in volunteering?

 Yes, I will volunteer.

If you volunteer your registration fee is waived. Volunteers must commit to help the full 5 days of camp.

Permission
I give permission for my child to participate in a summer camp at UUCA and will respect the starting and ending times. In the event of an emergency, I give permission for UUCA staff and volunteers to seek medical treatment and I accept financial responsibility for all care provided. I agree to allow pictures of my child to be posted on the UUCA website and used in other promotional materials.

Parent’s Name*

Today's Date*

Registration is incomplete until payment is received. To pay by credit card, please contact the UUCA office at 404-634-5134. Checks should be made payable to UUCA with the name of the camp(s) in the memo line.

You can mail your check to:

ATTN: Alicia Karpick/UUCA Summer Camps Director
1911 Cliff Valley Way NE
Atlanta, GA 30329

Or place it in the Summer Camp mailbox in the UUCA office.


If you do not hear back from us after two weeks, please contact the UUCA office.

The Unitarian Universalist Congregation of Atlanta seek to foster a climate of purposeful inclusion of all regardless of gender, age, race, ethnicity, national origin, disability, sexual orientation, gender identity or expression.