Summer Camp Registration
Exploring Identity and Justice
Northwoods Unitarian Universalist Church
Summer Camp 2017
Monday, June 26 to Friday, June 30
9am to 4pm

Cost: $140 per camper; $100 each sibling after the first; Please inquire about available financial assistance.
Ages: For children who have completed kindergarten thru 6th grade.
Hours: 9am to 4pm
Extended Hours: 8am to 5pm. Cost is an additional $20, with maximum weekly charge being $160 (or $120 for siblings) for 8am to 5pm all week. Parents can sign up for after-hours and pay at the time of registration.

Number of Children Registering *
Name of Child #1 *
Your answer
Birthday of Child #1 *
Your answer
Shirt Size - #1
Name of Child #2
Your answer
Birthday of Child #2
Your answer
Shirt Size - #2
Name of Child #3
Your answer
Birthday of Child #3
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Shirt Size - #3
Name of Child #4
Your answer
Birthday of Child #4
Your answer
Shirt Size - #4
Name of Parent/Caregiver *
Your answer
Phone Number for Parent/Caregiver *
Your answer
Name of Emergency Contact (besides parent/caregiver) *
Your answer
Phone Number of Emergency Contact
Your answer
Name of Second Emergency Contact (besides parent/caregiver) *
Your answer
Phone Number of Second Emergency Contact
Your answer
Please provide physician's name, address, and phone number:
Your answer
Please provide health insurance provider, policy number, and phone number.
Your answer
Are there any restrictions to your child(ren)'s participation in a complete camp activity program? If yes, please specify. *
Your answer
During the last three years, has your child received counseling? *
Do any children take medications that will need to be administered at camp? *
If yes, please explain:
Your answer
Do any children have allergies? *
If yes, please explain:
Your answer
Do any children have illness, disability, chronic condition, or special needs that we should be aware of? *
If yes, please explain:
Your answer
Is there anything we should know to make this week successful and enjoyable for your child?
Your answer
Who is permitted to pick your child(ren) up at the end of the day?
Your answer
Will you need before or after care for your child(ren)? (Before/after care is available for $20 for the week, with a maximum charge of $160 per child, including camp and before/after care).
Are you interested in helping at camp in any capacity?
If you can help at camp please specify days/times that you are available:
Your answer
Do you have a teen that would like to help? If so, provide name, contact information, and available days/times.
Your answer
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