Summer Camp Registration

Parent / Guardian Information

Parent / Guardian Name

This address will receive a confirmation email

Phone

Mailing Address

Camper Information

Child Name

Date of Birth

Pronouns

What grade will your camper be entering in Fall 2024?

Please name all adults who will be authorized to pick up your child.

Please provide a code word for anyone else who may pick up the registered minor(s). This code word must be provided at pick up by the non-legal guardian.

Does your child have any dietary restrictions?

None Dairy-Free Gluten-Free Vegan Vegetarian Other

Does your camper have any access or support needs or activity restrictions we should know about? If so, please list them below.

What else should we know to make your child feel more welcome? Please share your child's interests and ways you see them thriving (e.g., if they play a sport, are budding musicians, are neurodivergent, enjoy alone time, are always moving, etc.).

Medical Information

Emergency Contact Name & Relationship (in the event the parent is unreachable)

Emergency Contact Phone And Email

Will your child need to receive any medications or treatments during camp?

Yes No

Does your child require an EpiPen?

Yes No

Please list any known allergies and medical conditions of your child.

Please list your health care insurance and policy/member number.

Family Physician and Contact Information

Required Waivers

Medical Consent for Emergency Care: I hereby authorize UUCMP’s employee(s) or agent(s) who is supervising my child at Nature Camp, to act on my behalf in authorizing and consenting to emergency medical care including surgery, if necessary, dental care, and/or hospitalization for said minor if they become ill or are injured while participating in Nature Camp activities. I agree to pay for the minor’s medical expenses, including the cost of emergency medical services, if they are injured. I understand that an effort will be made to contact me prior to rendering treatment, but any of the above treatment or emergency services will not be withheld if I cannot be reached.

Yes No

Release of Liability and Hold Harmless: I hereby release, discharge and covenant to hold harmless the Unitarian Universalist Church of the Monterey Peninsula, its officers, employees and volunteers, from any and all claims, causes of action, and liability of any kind or nature, including personal injuries or death, or in any way arising out of, directly or indirectly, the child's attendance or participation in Nature Camp.

Yes No

Media Permissions: I give permission for electronic or hard copy images of my child and myself to be used by UUCMP in its non-profit media.

Yes No

How did you hear about this camp?

Payment Information

We don't store full card numbers on our servers nor do we have access to them. Instead that data is securely stored by our payment processor (Stripe) as they specialize in areas like this. Stripe is one of the industry leaders in online payment processing.

Camp Registration Fees

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Summer Camp Registration

Description

Please Fix the Following