Middle School After School Program Registration Middle School After School Program Registration Choose your camp location* Harmony - 19802/North Side (2616 Carter St, Union Baptist Church) Amen - 19801,19805/South Bridge, East Side, West Side (408 E 8th St, Peoples Settlement) 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* Date Format: MM slash DD slash YYYY School*Grade ('18-19 School Year)*Home Address* Street Address Address Line 2 City ZIP / Postal Code Home Phone*Medical Considerations:*Allergies (food and/or medication):*Disabilities and/or IEP*Court/Legal Matters:*Gender:* Male Female Non Disclosed Race* American Indian or Alaskan Native White Black or African American Native Hawaiian or other Pacific Islander Asian Other Race Non Disclosed Ethnicity* Hispanic or Latino Not Hispanic or Latino Non Disclosed Program Season:* Summer Camp Afterschool Program Both Contact InformationParent/Guardian* First Last Relationship*Parent's Email Cell Phone*Work PhoneEmergency Contact (if unable to reach 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 Date Format: MM slash DD slash YYYY Grade EnteringMedical Considerations:Allergies (food and/or medication):Disabilities and/or IEPCourt/Legal Matters:Race American Indian or Alaskan Native White Black or African American Native Hawaiian or other Pacific Islander Asian Other Race Non Disclosed Ethnicity Hispanic or Latino Not Hispanic or Latino Non Disclosed Program Season: Summer Camp Afterschool Program Both Additional Children(living at the same address who will be attending camp)Child's Name First Last AgeBirthday Date Format: MM slash DD slash YYYY Program Season: Summer Camp Afterschool Program Both Grade EnteringMedical Considerations:Allergies (food and/or medication):Disabilities and/or IEPCourt/Legal Matters:Race American Indian or Alaskan Native White Black or African American Native Hawaiian or other Pacific Islander Asian Other Race Non Disclosed Ethnicity Hispanic or Latino Not Hispanic or Latino Non Disclosed Program Season: Summer Camp Afterschool Program Both Take HomesMy child(ren) will:* walk home alone from camp be picked up by someone they will be picked up by...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 of my chosen camp locations * I understand that all field trip fees must be paid by June 25th 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 not be allowed to walk home from camp unless indicated aboce, and will only be able to be picked up by those listed above. Any changes must be communicated to the director.
