Second UP Summer Camp
Registration Form
Camper Information
Camper Name
First Name
Last Name
Parent's Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Information
Emergency Contact Name
First Name
Last Name
Relationship
Emergency Phone Number
-
Area Code
Phone Number
Medical Information
Please state if the camper have any allergies, illnesses or medical conditions.
Weeks you plan on attending
Week 1 June 10-14 Building Engineers
Week 2 June 17-21 Robots
Week 3 June 24-28 Creative Cooking
Week 4 July 1-3 Red, White & Blue
Week 5 July 8-12 Art
Week 6 July 15-19 No Camp
Week 7 July 22-26 Super Science
Week 8 July 29-August 2 Olympics
Week 9 August 5-9 Fitness
Week10 August 12-16 Water Fun
How many days do you think you will attend each week?
Please Select
One day
Two days
Three days
Four days
Five days
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Summer Camp Deposit
This deposit is non-refundable, but will be applied to your first day of summer camp.
$
25.00
Quantity
1
2
3
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5
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10
Credit Card
Submit
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