Clone of Summer Camp 2025 Participation Waiver And Release Form

Registration, Participation Waiver And Release Form

Summer Camp 2026 | UrbanPromise Los Angeles
Details

UrbanPromise LA is proud to offer its 7th Annual Summer Camp program in Canoga Park for students ages 5 - 13! Camp Dates: Monday, June 29th - Friday, July 31st | Time: 8:15 am - 4:00pm (8:15 am - 2:30pm on Fridays)
UPLA Summer Camp details:
- Dates: June 29 - July 31 2026
- Fee Waiver: Scholarships are available to cover weekly camp fees, up to $1,500, for families with financial need and for returning participants. Scholarships do not cover the $100 registration fee or field trip costs.
  
  All families are required to pay a $100 per child registration fee to reserve a spot.
  
  If you need financial assistance, complete the Scholarship Application first. Do not register until your scholarship application has been submitted and reviewed.
For five consecutive weeks (June 29 - July 31), UrbanPromise’s Summer Camps provide opportunities for elementary & middle school students to improve their academic performance, develop necessary life skills, create positive relationships with caring adults, explore the arts, and nurture their faith. Students attend daily Enrichment classes such as STEM, Reading/Literacy, Bible, Art, and many more elective daily. Also, students go on weekly field trips every Friday!

Goals for our Summer Camp include:

Academic Growth: Our goal is for all students to make at least two months of growth in their reading and writing skills.
Character Growth: Our goal is for all students to gain confidence in their academic abilities and improve their attitude about school.
Educational Equity: Our goal is to help support families in need by providing supplemental education
Spiritual Growth: Our goal is for all students to grow in their understanding of who God is and their relationship with Christ.
Child Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Has Your Child Attended Summer Camp at UrbanPromise Before?
Parent/Guardian Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Name #2

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Language Spoken
Languages Spoken

Other
Emergency Contact Person

First NameLast Name
Emergency Contact Person Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Participant Details
Child's Name

First NameLast Name
Child's Grade (2026-2027 School Year)
Child's School Name
Allergies? (please list all allergies)
Please list all medications that this child takes and frequency of use.
T-shirt Size
Does your child have any specific needs, medical conditions, or disabilities (including but not limited to autism, ADHD, or other neurodivergent conditions) that we should be aware of to provide the best possible experience and accommodations?
Are there any court or legal matters (eg. custody) that we should be aware of?
I understand that UrbanPromise is not responsible for my child(ren) until and unless they arrive at the program site.
1. I give permission for my child to participate in the activities sponsored by UrbanPromise Los Angeles and its partners. I understand that information will be available in advance of UrbanPromise activities, and it is my responsibility to ensure my child and I communicate about all such activities. If my child attends an UrbanPromise activity, UrbanPromise has my permission to allow them to participate in that activity.

2. I understand the risks involved in this program and that the staff will exercise all reasonable care for my child. I release UrbanPromise Los Angeles and UrbanPromise International, along with all cooperating organizations and their respective staff, employees, and representatives, from any and all claims that may arise from injuries that occur to my child.

3. In the event of a medical emergency, I understand that an effort will be made to reach me. However, I do give permission for the UrbanPromise staff of this program to authorize emergency medical care for my child(ren).

4. I will not hold UrbanPromise Los Angeles or other cooperating organizations, their staff, or representatives responsible for injuries that occur to my child(ren).

5. I understand that part of the UrbanPromise program includes Christian education.

6. I agree to support my child(ren) and the staff of this program by accepting and enforcing the discipline structure that is used. Disruptive behavior will be communicated to the parent/guardian, initially by verbal warning. This will be followed by a written warning and may result in temporary or permanent removal from the program by the Director.

7. I give permission for photographs, video, and/or the name of my child(ren) to be used in UrbanPromise materials and on the UrbanPromise website.

8. I authorize my child(ren)’s school to release my child(ren)’s grades and academic records to UrbanPromise staff.

9. I acknowledge that I have been informed and understand that UrbanPromise Los Angeles is not a licensed childcare center with the State of California. I give my full consent and permission for my child(ren) to attend its programs.

10. I understand that UrbanPromise is not responsible for my child(ren) until and unless they arrive at the program site.
Parent Name

First NameLast Name
Parent Signature
Today's Date

MonthDayYear
Date

Payment: Complete Registration

Summer Camp Registration

$100 Registration Fee (per child; non-refundable). This fee reserves a space for your child.

$100.00

Add-on: Field Trip Fee

$100 for 4 field trips (including Field Day). This fee guarantees your child's space for each field trip

$100.00

Summer Camp ($300/week = $1500 total)

Week 1: June 29 - July 2

Week 2: July 6 - July 10

Week 3: July 13 - July 17

Week 4: July 20 - July 24

Week 5 July 27 - July 31

$1,500 per student is how much it costs UrbanPromise LA to provide five weeks of summer camp. Thanks to our donors, sponsors, and partners, UPLA is proud to offer scholarships to returning UPLA students and those with financial need.

To request/apply for a scholarship for Summer Camp 2026, please follow the link to complete the scholarship application before completing your enrollment: https://docs.google.com/forms/d/e/1FAIpQLScExcpeN2WC5_5KW5vM0ehpVuBtaWGJcvNQWEkT8qw_8B2Fmw/viewform?usp=sharing&ouid=109734977272642688866

$1,500.00

Enter coupon

Total

Payment Methods

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Registration, Participation Waiver And Release Form

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Participant Details

Payment: Complete Registration

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