Day Camp Registration Form

School Break Day Camp Registration
Student Information
Student's Name*

First NameLast Name
Grade*
School*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Team Upward during the selected camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Team Upward and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Tem Upward including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball.

Refunds will not be issued for no-shows. 
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

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Day Camps 8:30 a.m. - 3:30 p.m. - Lunch Included *

Digital Learning Day ~ FULL-(no more slots available) November 5, 2024

$60.00

Thanksgiving BreakMonday, November 25, 2024

$60.00

Thanksgiving BreakTuesday, November 26, 2024

$60.00

Thanksgiving BreakWednesday, November 27, 2024

$60.00

Thanksgiving BreakFriday, November 29, 2024

$60.00

Before Camp Care - starting @ 7:30 a.m.

$10.00 Quantity

After School Care - latest pickup @ 4:30 p.m.

$10.00 Quantity

Total

$0.00

Credit Card

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School Break Day Camp Registration

Student Information

Credit Card