UAU Camp Cash or Check I Would Like To:(Required)Pay for IS 34 Camp ($2100)Pay For Gaynor McCown Camp ($1800)Pay For PS 53 Camp ($1200)Admin Payment Type:(Required)CheckCashCheck Number(Required) Camper's Name:(Required) First Last Camper's Date of Birth(Required) MM slash DD slash YYYY Camper's Age:(Required)Camper's Gender(Required)MaleFemaleCamper's T-Shirt Size(Required)Please select a Youth Or Adult SizeYouth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XLAdult XXLHome Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home Phone Number(Required)School Currently Attending:(Required) Grade Level As of September 2024(Required) Parent/Guardians Name:(Required) First Last Parent/Guardians Email(Required) Enter Email Confirm Email Parent/Guardian's Cell Phone:(Required)Emergency Contact InformationIn case of an emergency and the parent/guardian listed above cannot be reached please list two other individuals as points of contact.Emergency Contact 1 Name:(Required) First Last Emergency Contact Cell Phone Number(Required)Relationship To Child:(Required) Emergency Contact 2 Name:(Required) First Last Relationship To Child:(Required) Emergency Contact 2 Cell Phone Number(Required)Emergency Medical TreatmentIt is understood that the final disposition in an emergency case, the judgment of the camp authorities will prevail. The recommendation of the parent as indicated below will be respected as far as possible.Doctor's Name:(Required) First Last Doctor's Phone Number(Required)Should Any Camp Activity Be Restricted? Please list any/all here along with reason why.(Required)Child's Medical FormPlease upload your child's physical form by clicking browse files. If you prefer to email the form please complete and email a copy to josorio@unitedactivities.orgMax. file size: 128 MB.Release of Liability(Required)I hereby give permission for my child/children to participate in the activities at UAU Summer Camp. I hereby exempt, release, and agree to hold harmless United Activities Unlimited, Because We Can Sports, I.S. 34 and their respective trustees, directors, officers, employees, servants and volunteers from an responsibility for any injury that may occur in connection with my child/children's participation, to the extent permitted by law. I AgreeConsent(Required)By submitting and digitally signing this registration form I agree to the following: -To have my child treated for any non-emergency situations -To have my child participate in all of the activities at the camp -In case of an accident or injury, emergency medical care may be given in the event i cannot be reached -that camp participants my be photographed or filmed for social media and/or promotional purposes -I understand that my payment/registration fee is nonrefundable as I am taking advantage of early registration pricing I agreeHiddenCoupon Code Δ
