Summer Camp Interest Form
Fill out the form carefully for registration
Parent 1
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your child currently enrolled, previously enrolled, or a newcomer to UCUMC Weekday School?
*
Currently Enrolled
Previously Enrolled
Newcomer
How many children are you applying for?
Back
Next
Student Information
Name
*
First Name
Last Name
Gender
*
Male
Female
Birthday
*
-
Month
-
Day
Year
Date
Previous Preschool/Daycare
Allergies:
Developmental Delays:
Speech/OT Services:
Potty Trained?
*
Yes
No
Working
Which weeks would you like to attend?
June 1-5 (Colors)
June 8-12 (Bubbles)
July 6-10 (Rainforest)
July 13-17 ( Messy Art)
Back
Next
Student Information
Name
*
First Name
Last Name
Gender
*
Male
Female
Birthday
*
-
Month
-
Day
Year
Date
Previous Preschool/Daycare
Allergies:
Developmental Delays:
Speech/OT Services:
Potty Trained?
*
Yes
No
Working
Which weeks would you like to attend?
June 1-5 (Colors)
June 8-12 (Bubbles)
July 6-10 (Rainforest)
July 13-17 ( Messy Art)
Back
Next
I verify the information provided is correct.
Signature
Submit
Submit
Should be Empty: