Summer Camp Enrollment Form

Registration For ULSA Summer Camp

****************************Serving Children Ages 5-13********************************
Summer Camp: June 6 - August 5, 2022 : 7:00am - 6:00pm

**The Registration/Deposit Fee must be paid when the form is submitted in order to ensure your child's enrollment
CHILD's INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
School Child Attends:
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Registration & Deposit Fee: Weekly Tuition Rates:

One Child: $50.00 (NON-REFUNDABLE) One Child: $110.00

Two or More Children: $35.00 Each

***ABC VOUCHERS ACCEPTED

SCHOLARSHIPS: A limited number of Scholarships for Registration, Tuition & Other Fees are available for Residents of Harbison Gardens & Irmo Village. PROOF OF RESIDENCY REQUIRED.

Camp Activities: Daily: Grade level academic enrichment, limited tutorial support, STEAM focus, faith-based instruction. WEEKLY: outdoor swimming, bowling, sports, skateboarding, field trips,guest speakers.
Check Payable to UCIOCashApp: $ULSAcademyABC Voucher (must submit Voucher Client Connection Card Form with application)
For ABC Voucher Form of Payment Only (Print and Upload Below)
Required documents:

Browse Files
(For example: proof of residency and etc.) Cancelof
Parent/Guardian Name Print
Parent Signature

Clear
Date

MonthDayYear
Date
Telephone: (803) 233 - 9299 Cell: (803) 528 - 7995

Website: www.ulsteamaca.org

Email: infoulaa@gmail.com

Address: (P.O. Box 1481) 220 N. Royal Tower Dr., Irmo, SC 29063
Should be Empty:

Registration For ULSA Summer Camp

CHILD's INFORMATION:

PARENT/GUARDIAN INFORMATION: