Summer Camp Registration

Choose Your Camp Location

Hope (1st-6th) – 19801/South Bridge (455 Townsend St, Mt Joy UMC)
Victory (1st-6th) – 19801/East Side (800 N Walnut St, Ezion Mt Carmel UMC)
Freedom (1st-6th) – 19802 (1000 E 28th St, UPW Headquarters)
Promise (1st-6th) – 19805 (1411 W 4th St, Be Ready Jesus is Coming)
Harmony (7th-8th) – 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*

School*

Grade Entering*

Please enter a number from 1 to 8.

Home Address*

Street Address Address Line 2 City

Zip Code*

Medical Considerations:*

Allergies (food and/or medication):*

Disabilities and/or IEP*

Court/Legal Matters:*

Gender*

Race*

Ethnicity*

Program Season*

Contact Information

Parent/Guardian*

First Last

Relationship*

Parent's Email

Cell Phone*

Work Phone

Emergency 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

Age

Birthday

Grade Entering

Please enter a number from 1 to 8.

Medical Considerations:

Allergies (food and/or medication):

Disabilities and/or IEP

Court/Legal Matters:

Gender

Race

Ethnicity

Additional Children

(living at the same address who will be attending camp)

Child's Name

First Last

Age

Birthday

Grade Entering

Please enter a number from 1 to 8.

Medical Considerations:

Allergies (food and/or medication):

Disabilities and/or IEP

Court/Legal Matters:

Gender

Race

Ethnicity

Take Homes

My child(ren) will:*

they will be picked up by…

I'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

Please read, check that you agree

I have read the Information and Regulations sheet and agree to uphold and support the standards, rules, and guidelines as outlined by UrbanPromise.

My home address meets the eligibility requirements for my chosen camp location

I understand that all field trip fees must be paid by June 25 in order for my child to participate in the trips.

I understand that my child will need to wear an UrbanPromise T-shirt for all camp field trips.

I understand that my child will receive a t-shirt size based on what’s available.

I understand that my child will not be allowed to walk home from camp unless indicated above, and will only be able to be picked up by those listed above. Any changes must be communicated to the director.

I have enclosed a $10 deposit (pre child) to hold my space(s). (Cash or money order only; no personal checks)