2019 Ecojustice Camp Registration
PLEASE FILL OUT SEPARATE REGISTRATION FORMS FOR EACH CAMPER.
Camp location: UUCPA, 505 E Charleston Rd., Palo Alto, Calif.
Dan Harper and Lorraine Kostka, Camp Directors; Mike Abraham, Business Manager
Camp Web site: www.ecojusticecamp.com
Which camp are you registering for? *
CAMPER INFORMATION
Please fill out a separate registration form for each camper, thanks!
Name of Camper *
Your answer
Grade as of May, 2019 *
Your answer
Camper birth date *
MM
/
DD
/
YYYY
Special camper information (allergies, etc.)
Your answer
PARENT/GUARDIAN INFORMATION
Please give contact information for all custodial parents.
Name of Parent/Guardian 1 *
Your answer
Mailing address of Parent/Guardian 1 *
Your answer
Email of Parent/Guardian 1 *
Your answer
Cell phone of Parent/Guardian 1
Your answer
Name of Parent/Guardian 2
Your answer
Mailing address of Parent/Guardian 2
Your answer
Email of Parent/Guardian 2
Your answer
Cell phone of Parent/Guardian 2
Your answer
Anything else you want us to know?
Your answer
ELECTRONIC SIGNATURE
By submitting this registration form, I commit my child to participating in the camp checked above.
1. I understand that my registration is not complete until I submit a deposit to the camp's fiscal sponsor, UUCPA.
2. I agree to pay the remainder of the registration fee on the first day of camp.
3. I agree to pay any extended care fees on the last day of camp.
4. I agree that I will complete a Media Release Form before my child begins camp.
5. I agree that I will complete a Permission/Medical Release Form before my child begins camp.
Signed (enter your name) *
Your answer
SEND YOUR DEPOSIT
Don't forget your deposit — $210 for full-day camp + overnight, or $120 for half day camp.
Our fiscal sponsor uses PayPal to accept your deposit:
a. Go to their Giving page at: http://www.uucpa.org/connection/donate/
b. Click the Donate button.
c. On the Donate page, enter the amount, and where it says "Write a note (optional)" enter "Ecojustice Camp registration".
d. Complete your personal information.
OR if you prefer, you can mail a check to Ecojustice Camp, UUCPA, 505 E Charleston Rd., Palo Alto, CA 94306. Please make out the check to "UUCPA" and enter "Ecojustice Camp Registration" on the memo line.
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