Summer Camp Registration 2023 Summer Camp Registration Choose Your Camp Location*Freedom - 19802 (2401 Thatcher St, UP Headquarters)Hope - 19801/South Bridge (455 Townsend St, Mt Joy UMC)Victory - 19801/East Side (800 N Walnut St, Ezion Mt Carmel UMC)Promise - 19805 (1411 W 4th St, Be Ready Jesus is Coming)Harmony - 19801, 19802, & 19802 (3301 N Market St, Resurrection Center)UP Camps are intended for children who live in the immediate community surrounding each camp. Please select the camp that is located within the geographic area of your home address.Child's Name* First Last Age*Birthday* MM slash DD slash YYYY School* Grade Entering*Please enter a number from 1 to 6.Home Address* Street Address Address Line 2 City Zip Code*198011980219805Home Phone*Medical Considerations:* Allergies (food and/or medication):* Disabilities and/or IEP* Court/Legal Matters:* Gender*MaleFemaleRace*American Indian or Alaskan NativeWhiteBlack or African AmericanNative Hawaiian or other Pacific IslanderAsianEthnicity*Hispanic or LatinoNot Hispanic or LatinoNon DisclosedProgram Season*Summer CampAfterschool ProgramBothI'm interested in more information about other UrbanPromise Programs (check all that apply) UrbanPromise School (elementary school) UrbanPromise Academy (high school) StreetLeaders (teen job training program) Sports UrbanTrekkers Contact InformationParent/Guardian* First Last Relationship* Parent's Email Cell Phone*Work PhoneEmergency Contact (other than parent):* First Last Relationship to Child(ren)* Home/Cell Phone*Additional Children(living at the same address who will be attending camp)Child's Name First Last AgeBirthday MM slash DD slash YYYY Grade EnteringPlease enter a number from 1 to 6.Medical Considerations: Allergies (food and/or medication): Disabilities and/or IEP Court/Legal Matters: GenderMaleFemaleRaceAmerican Indian or Alaskan NativeWhiteBlack or African AmericanNative Hawaiian or other Pacific IslanderAsianEthnicityHispanic or LatinoNot Hispanic or LatinoNon DisclosedProgram SeasonSummer CampAfterschool ProgramBothAdditional Children(living at the same address who will be attending camp)Child's Name First Last AgeBirthday MM slash DD slash YYYY Grade EnteringPlease enter a number from 1 to 6.Medical Considerations: Allergies (food and/or medication): Disabilities and/or IEP Court/Legal Matters: GenderMaleFemaleRaceAmerican Indian or Alaskan NativeWhiteBlack or African AmericanNative Hawaiian or other Pacific IslanderAsianEthnicityHispanic or LatinoNot Hispanic or LatinoNon DisclosedProgram SeasonSummer CampAfterschool ProgramBothTake HomesMy child(ren) will:*Walk home alone from campBe picked up by someonethey will be picked up by... Please read, check that you agree* I am interested in my child(ren) receiving tutoring * I have read the Information and Regulations sheet and agree to uphold and support the standards, rules, and guidelines as outlined by UrbanPromise. * I understand that my child will need to attend a minimum of 3 days a week to stay registered in the program. If they need to be absent for a particular reason, I will communicate that reason to the Director in person or in writing. I give permission for my child to participate in the activities sponsored by UrbanPromise and other cooperating organizations in the neighborhood. In case of a medical emergency, I understand that an effort will be made to reach me. However, I do give permission for the staff of this program to authorize emergency medical care for my child. I understand the risk involved in this program and that the staff will exercise all reasonable care for my child. I will not hold UrbanPromise Ministries, Inc. or other cooperating organizations, their staff or representatives, responsible for injuries which occur to my child. * I understand that Christian education is part of the UrbanPromise camp program. * I understand that UrbanPromise and the cooperating organizations are only responsible for my child during programming hours. * I give permission for my child’s name and photograph to be used in publications produced by UrbanPromise Ministries, Inc. * I agree to support my child and the staff of this program through accepting and enforcing the discipline structure that is used. Δ
