2019 UUCB Summer Camp Registration

Household Information

Parent 1 Name

Parent 1 Pronouns

Parent 1 Email Address

This address will receive a confirmation email

Parent 1 Phone Number

Parent 1 Preferred Communication

Email Phone Call Text No preference

Parent 2 Name (if applicable)

Parent 2 Pronouns (if applicable)

Parent 2 Email Address (if applicable)

This address will receive a confirmation email

Parent 2 Phone Number (if applicable)

Parent 2 Preferred Communication (if applicable) Email Phone Call Text No preference

Communication should be directed to...

Parent 1 Parent 2 Both parents

Emergency Contact Name

What is the relationship between this Emergency Contact and your child?

Emergency Contact Email Address

Emergency Contact Phone Number

Information about Child

Name

Pronouns

Birth Date

School Attending (or note homeschool)

Health issues to be aware of including allergies. Please include severity of medical issues and, if relevant, whether the child has an epi-pen, or other medications.

What should we know about your child in order to help them succeed? - If they have an IEP in school this is a good place to let us know. It's also useful for us to know some about your child's personality.

Child's T-Shirt Size

XS S M L XL

By checking this box you grant permission for the Unitarian Universalist Church of Boulder (UUCB) to use pictures or digital images of your child.

I hereby grant permission to use photographic and digital images of my child.

Registration

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2019 UUCB Summer Camp Registration

Description

Please Fix the Following