West Village Participant Application Summer 2021
*CUMEP ~ Community Unity Music Education Program
DAYS: Monday-Thursday
TIMES: 8:00am-12:00pm
AGES: 4-16 years {under 4 welcome w/ parent or older sibling}
CUMEP is a 16-day early morning adventure filled with music, dance, art lessons, instrument lessons, academic enrichment, & performance

CONTACT:: Dr. Nia Nunn Organization: Community Unity Music Education Program
CUMEPithaca@gmail.com

*Climate Crusades Education
DAYS: Monday/Wednesday/Friday
TIMES: 12pm-2pm
Ages: 6-13 years
The Climate Crusades a program designed to inspire kids to become environmental superheroes in class and at home. Any science specific and hands on teaching.

CONTACT:: Harry Smith Organization: Black Hands Universal
blackhandsuniversalbhu@gmail.com


*Climate Crusades Gardening
DAYS: Tuesday/Thursday
TIMES: 12pm-2pm
{all ages}
(W. Village/Chestnut Hill Apartments)
Participants will have hands-on experience in the community garden where each student will grow their own little piece of agricultural masterpieces. Here they will study and research their plants and observe the growth and development plants.

CONTACT:: Anthony Hayton Organization: Our Children's Future
Anthony.hayton@outlook.com

****Free breakfast & lunch provided for all participants****
Please choose any & all of these free camp options that you are interested and available to commit to for the summer... *
Required
Campers First name *
Campers Last Name *
Age *
Date of Birth *
MM
/
DD
/
YYYY
School and Grade in Fall 2021 *
Where do you live? (For purposes of gearing our program this year to Ithaca's West End) *
Three words that describes your child's character/personality
What kind of supports will help your child access a full learning experience
Parent/Caregivers name *
Relationship to camper
Address *
Apartment Number
Email
Phone (home and/or cell) *
What is your preferred method to receive communication?
Clear selection
Emergency contacts *
Medical Information medications/allergies/asthma/ any other medical conditions or limits *
Doctors Name and Phone#
Medical Release I understand that the summer program staff is not a trained medical staff or professionals and give permission to allow my child to be transported by emergency medical personnel if I can not be reached in the event of illness or injury
Clear selection
Dietary restrictions *
Required
List any Food Allergies or other allergies *
Plans For Pickup/After Camp *
Required
People who have my permission to pick up my child:
Camper T-shirt size *
Photo / Video Approval *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy