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:
Which camp are you registering for?
"Sea Otters" (completing K-1, Young 5s in 2019), half-day camp 9-1 p.m.
"Gray Foxes" (completing gr. 2-5 in 2019), full day camp 9-3, plus overnight
"Peregrine Falcons" (completing gr. 6-8 in 2019), full day camp 9-3, plus overnight
Please fill out a separate registration form for each camper, thanks!
Name of Camper
Grade as of May, 2019
Camper birth date
Special camper information (allergies, etc.)
Please give contact information for all custodial parents.
Name of Parent/Guardian 1
Mailing address of Parent/Guardian 1
Email of Parent/Guardian 1
Cell phone of Parent/Guardian 1
Name of Parent/Guardian 2
Mailing address of Parent/Guardian 2
Email of Parent/Guardian 2
Cell phone of Parent/Guardian 2
Anything else you want us to know?
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)
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:
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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