Shelter Neck Summer Youth Camp 2017 July 9-15 2017 (Rising 7th-12th graders, graduated senior under 18)
CONFIDENTIAL. The information in this registration form is confidential. The information will only shared with the Camp Directors and Counselors who will be working directly with your child and will be held in confidence.
A separate form has to be filled out for each camper.

Fees: $380 per camper (scholarships available)

Deposit: A deposit of $50 per camper is required to hold your place. Filling out the form alone does not guarantee a place for your child. A deposit is required to hold your place.

Payment in full is due by June 1, 2017. In May you will receive a handbook and additional medical forms to complete. The forms are due by June 1.

Refund Policy: Cancellations after June 1, 2017 will not be refunded unless the camper's place is filled by another camper.
Deposit Checks and full payment checks should be payable to “UCONCI” and in the memo line put "Camp" and the name of the participating youth and should be mailed to:
Susan Wasilewski
7305 Fiesta Way
Raleigh, N.C. 27615
Phone Number: 919-523-6301

Registration Deadline is June 1, 2017
Please register early to assure a space for your child. The camp has a limited number of spaces available, with priority given to those from UCONCI member congregations and alumni of the summer camps for campers who register before April 1.

Camper Information
Last Name *
Your answer
First Name *
Your answer
Congregation *
Your answer
Gender *
Transgender and gender fluid youth are welcome at Shelter Neck Youth Camp! Please include any information about the camper that will help us to make the camper comfortable. All restrooms are gender neutral. However, sleeping arrangements are gender segregated.
Your answer
Age *
Camper's age at the beginning of camp.
Your answer
Grade *
Grade camper will be entering in the fall. If the camper is homeschooled, please indicate what grade the camper would be in if in traditional school. Recently graduated seniors may attend camp if they are under 18 during the week of camp.
Your answer
Birthdate *
in the form: Month/Day/Year Example: 1/14/2000
Your answer
Dietary Needs
Please share with us any dietary needs you child may have. We can accommodate vegetarian, vegan, gluten-free, lactose free diets and most allergies.
Your answer
Special Needs
Please let us know if the camp has any special needs, including ADHD, autism, behavioral issues, mental health challenges, need for medications, unsual fears, shyness. It helps us to know if the camp has an IEP or 504 accommodations at school.
Your answer
Information for Parent/Guardian #1
Parent/Guardian Last Name *
Your answer
Parent/Guardian First Name *
Your answer
Mailing Address *
Your answer
Email Address *
Your answer
Primary Phone Number *
Please include area code. Let us know if this a landline or mobile number.
Your answer
Secondary Phone Number
Another number where you might be reached. Please include area code and if it is a landline or mobile number.
Your answer
Family circumstances
Please let us know anything about the camper's home situation that would might impact the camper's experience at camp, including custody issues, adoption, recent significant family illness, death, job loss or move.
Your answer
Information for Parent/Guardian #2 (optional)
Please fill this information if the child is also in a second home or if you want include information for a second parent or guardian.
Parent/Guardian Last Name
Your answer
Parent/Guardian First Name
Your answer
Mailing Address
Your answer
Email Address
Your answer
Primary Phone Number
Please include area code. Let us know if this a landline or mobile number.
Your answer
Secondary Phone Number
Another number where you might be reached. Please include area code and if it is a landline or mobile number.
Your answer
Confidential Financial Statement
We strive to keep camp affordable at Shelter Neck, and this year estimate that we will need $375 for each camper that attends. We realize that, while this amount is very reasonable for a weeklong summer camp, it can also be a lot of money for some family budgets. For camp this year, we will do our best to provide financial aid to all who request it. We strongly encourage those who can pay the full amount to do so, and if possible to donate more to support those families who cannot.

We are committed to providing financial assistance if it is needed.

Financial Need *
Description of Financial Need
We have scholarships available for youth who are associated for the Shelter Neck Camp. These scholarships are reserved for youth associated with UU congregations in North Carolina with preference to congregations which are members of the Universalist Convention of North Carolina. Please let us know much of a scholarship you will need to make it possible for your child to attend the camp. We will contact you to let you know the status of the scholarship request.
Your answer
Thank you!
Camp is a life-changing experience for your child. We hope that this week will help your child to make lasting friends and memories, to learn more about the world, and to deepen his/her ties to Unitarian Universalism. If you have further questions or concerns, please do not hesitate to contact us.
Sara Gush
Camp Program Director of Shelter Neck Youth Summer Camp
919-357-2319
sgush.c3huu@gmail.com
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