More than a Summer Camp…It’s An Experience!

Camp Registration ADMIN ONLY

THIS FORM IS TO BE USED BY ADMINISTATORS ONLY

Online Registration form

I Would Like To:(Required)

Admin Payment Type:(Required)

Check Number(Required)

Camper's Name:(Required)

First Last

Camper's Date of Birth(Required)

Camper's Age:(Required)

Camper's Gender(Required)

Camper's T-Shirt Size(Required)

Home Address(Required)

Street Address Address Line 2 City State 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 Information

In 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 Treatment

It 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 Form

Please 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.org

Max. file size: 128 MB.

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