SUMMER CAMP

Step 1 of 5

Parent/Guardian Information (1)

Name(Required)

First Middle Last

Address(Required)

Street Address City State ZIP Code

Phone (Cellular)(Required)

Phone (Work)

Email(Required)

Occupation(Required)

Employer(Required)

Parent/Guardian Information (2)

Name

First Middle Last

Address

Street Address City State ZIP Code

Phone (Cellular)

Phone (Work)

Occupation

Employer

Emergency Contact 1

Name(Required)

First Middle Last

Address(Required)

Street Address City State ZIP Code

Phone (Cellular)(Required)

Phone (Work)

Email(Required)

Relationship to Student(Required)

Emergency Contact 2

Name(Required)

First Middle Last

Address(Required)

Street Address City State ZIP Code

Phone (Cellular)(Required)

Phone (Work)

Email(Required)

Relationship to Student(Required)

Alternate Pickup/Release Contact

Name

First Middle Last

Address

Street Address City State ZIP Code

Phone (Cellular)

Phone (Work)

Relationship to Student

Food Allergies / Special Diet

List of food allergies or restrictions:(Required)

By signing below, I have acknowledged that meals and snacks will be provided and that I have listed any and all food allergies and restrictions for my child.

Parent or Guardian Signature(Required)

Name(Required)

First Middle Last

Address(Required)

Street Address City State ZIP Code

Phone (Cellular)

Phone (Work)

Parental Agreement

This document is an official agreement between the UCCA Summer Youth Academy and the Parent or Guardian of the child listed in this document. One important goal of the UCCA Summer Youth Academy is to ensure the safety and security of the youth in our care, at all times.

Parental/Student Policies:

Students are not permitted to leave the UCCA campus.
Students must stay in designated areas during program hours.
Cell phones are allowed only during breaks.
Proper behavior shall be exhibited at all times.
Students are expected to be respectful and courteous to each other, Academy staff as well guests and visitors while on campus or while representing UCCA and participating in any off-campus activities.
Physical or verbal altercations with fellow students or staff will not be tolerated and will be grounds for expulsion from the program.
Students must be picked up by 2:30 PM each day. Abuse of this policy could result in expulsion from the program.

Director, Urban Construction Craft Academy-Summer Youth Academy

I have read and understand the above requirements. My child understands these policies and by signing below, I acknowledge that this signed document will be placed in my child’s file.

Parent or Guardian Name(Required)

First Last

Relationship to Student(Required)

Phone (Cellular)(Required)

Signature(Required)

Navigation

Registration Application

AREA OF INTEREST

Parent/Guardian Information (1)

Parent/Guardian Information (2)

Emergency Contact 1

Emergency Contact 2

Alternate Pickup/Release Contact

Food Allergies / Special Diet

By signing below, I have acknowledged that meals and snacks will be provided and that I have listed any and all food allergies and restrictions for my child.

Parental Agreement

I have read and understand the above requirements. My child understands these policies and by signing below, I acknowledge that this signed document will be placed in my child’s file.

Click Flyer to Enlarge