26-27 Elementary Interest Form

DAY CAMP SELECTION

Urban Roots provides day camps to Elementary School students on select weekdays when AISD is closed.
Below are the dates Urban Roots will offer Elementary Day Camps. Please select the date(s) your youth will attend.
How did you hear about our Elementary Day Camp program?

Other
Space in Elementary Day Camps is limited - submitting this form does NOT guarantee your child's spot in the program. Urban Roots will reach out to you to confirm your child's spot in the Day Camp(s) you have selected.

YOUTH INFORMATION (1 of 2)

Personal information will be stored confidentially and handled with care.
Youth Name

First NameLast Name
Legal Name, if different
Youth Email Address, if applicable
Please make sure this is a valid email that you check regularly. example@example.com
Youth Phone Number, if applicable
Please enter a valid phone number where we can reach you.Format: (000) 000-0000.
Primary Address

Street Address

Apartment Number

CityState / Province

Postal / Zip Code
SCHOOL INFORMATION

Provide youth information for the 2026-2027 school year.
What school does your youth currently attend?
What grade is your youth currently in?

PARENT / GUARDIAN CONTACT INFORMATION

Urban Roots will primarily communicate program information with the person listed below.
Parent / Guardian Name

First NameLast Name
Parent / Guardian Email Address
example@example.com
Parent / Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does this phone number receive text messages?

HOUSEHOLD INFORMATION

Urban Roots provides free programming with support from local grant partners. The information gathered in this section is used to confirm that we are serving the intended populations supported by our funding. This information does not impact admissions decisions. Information is stored confidentially and handled with care.
How many individuals live in your household?
What is your household's estimated annual income?
You will NOT be asked to provide supporting documents.
To the best of your knowledge, does anyone in your home participate in any of the following programs? (Select all that apply)

Almost Done!

Thank you for completing this interest form. We will contact you with next steps and to confirm your child's spot in upcoming Day Camps. Send questions to programs@urbanrootsatx.org
Should be Empty:

INTEREST FORM: ELEMENTARY DAY CAMPS