It's a Jungle Out There
Please complete one form for each child

Date: July 12-15
Time: 5:30-7:30.
Address: 53555 Olive St
Contact us at uccatlantic2@gmail.com
Email *
Address *
Child's Name *
Age *
Grade Completed as of June *
Birthday
MM
/
DD
/
YYYY
Parent/Guardian Name *
Cell Phone Number *
Emergency Contact if different than guardian (name and number)
Do we have permission to photograph your child? Photos will be screen shots of activities/gatherings. *
Food Allergies; please list (please put NA if none) *
Medical Concerns (please put NA if none)
Permission to use bug spray and sunscreen? *
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