Summer Camp Online Registraion 2022 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) 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* 19801 19802 19805 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 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 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: 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 MM slash DD slash YYYY Program Season: Summer Camp Afterschool Program Both Grade EnteringPlease enter a number from 1 to 6.Medical Considerations: Allergies (food and/or medication): Disabilities and/or IEP Court/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 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 * My home address meets the eligibility requirements of my chosen camp locations 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, and not just what is on this form. * I will be dropping off a $10 deposit (per child) to hold my space(s). (Cash or money order only; no personal checks, please). UntitledFirst ChoiceSecond ChoiceThird ChoiceUntitled First Choice Second Choice Third Choice Δ
