uCamps

uCamps accepts credit cards, checks, and money orders. All credit card payments must be made for the full tuition amount. If you are paying by check or money order, you may pay the full camp tuition or a $200 per week non-refundable deposit. Payment must be received within 7 days of the date you register. All balances must be paid no later than 30 days prior to the start of the camp session for which you are registered. Upon submitting your registration form, you will receive a confirmation email. If you do not, please contact us ASAP to avoid losing your spot in our program.

* indicates required information (If required information does not apply, please enter N/A)

Section 1: Family Information

Parent/Guardian Name(s):

*	1.	First:	Last:
	2.

Mailing Address (If this is a two household family, list the primary contact address)

* Street Address:

* City:

* State:

* Zip Code:

Parent/Guardian #1:

Work Phone:

* Home Phone:

Cell Phone:

* Email address:

* Confirm Email:

Parent/Guardian #2:

Work Phone:

Home Phone:

Cell Phone:

Email address:

Confirm Email:

If this is a two household family, please check the guardian who will be the primary contact:

Mother:

Father:

Other:

If "Other", please explain relationship:

If the above people are not available, please contact the following person:

Name:

Relationship:

Work Phone:

Home Phone:

Cell Phone:

Section 2: Camper Information

* First Name:     * Last Name:

*Date of Birth: - -      *Age:

*Gender: M  F    Grade (during '09 - '10 school year)

School currently attending?

School attending in fall ('10-'11)

Camper's email address:

Camper's MySpace page:

Camper's Facebook page:

Friend(s) to be cabinmates with: (*No more than 2 names please*)

Is this camper a vegetarian? Yes No

This will be his/her first time at any overnight camp? Yes No

This will be my year attending uCamps.

T-Shirt size: (For Summer Campers Only)
CS(6-8) CM(10-12) CL(14-16) AS(34-36)
AM(38-40) AL(42-44) AXL(46-48)

*How did you here about uCamps?

Are you currently or have you ever taken an arts-based class at school?
If yes:

     Teacher's Name                  Type of Class                      School
1.

2.

3.

If you were referred to uCamps by a former camper, what is that person's name?

* Which camp(s) would you like to attend:

WE STRONGLY ENCOURAGE ALL CAMPERS TO TAKE THE BUS!!! The bus ride is a time for campers to receive information, make friends, play games, hang out with staff, and begin the transition from home life to camp life or vice versa.

Camp	Session	Location	Dates	Grades	Fees before 10/1/10	Fees after 10/1/10
Winter	o	Camp Sempervirens	12/27 - 12/31	3 - 12	$445	$495
Camp Photo						$10
Roundtrip Bus TO and FROM Winter Camp						$60
**** Airport Shuttle (San Jose International - SJC)						$60
*I would like to contribute this amount to the uCamps Scholarship Fund
Total Amount						$
Sibling Discount ($25 per sibling)
Amount after sibling discount						$
If you have a gift certificate, please enter the gift certificate number and then click here to ADJUST PRICE
Amount to be Charged						$

**Campers traveling by airplane: uCamps will provide an airport shuttle service to and from camp for an additional $60. Plan to fly into and out of San Jose International Airport SJC: arrive 11am - 1pm (PST) on the 1st day of camp, leave 1pm - 4pm (PST) the final day of camp. Please call us with your flight information (415.240.6852), so we can make the necessary arrangements.

Payment Method

* Credit Card (PayPal) * Check or Money Order

Credit Card Information

Please double-check to make sure your credit card information is correct. If your information is not correct, we will contact you to verify your credit card info to process your payment.

First Name:
Last Name:
Card Type:
Card Number:	(digits only, no dashes or spaces)
Expiration Date:
Card Verification Number:
Billing Address:
Address 1:
Address 2:	(optional)
City:
State:
ZIP Code:	(5 or 9 digits)
Country:	United States

The person herein described has permission to engage in all overnight uCamps activities. I hereby give permission to uCamps to provide routine health care, administer prescribed medications, and seek emergency medical treatment including ordering x-rays or routine tests. I agree to the release of any records necessary for insurance purposes. I give permission to uCamps to arrange necessary related transportation. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by uCamps to secure and administer treatment, including hospitalization, for the person named below. This completed form may be photocopied for trips out of camp. I also agree to allow my child to be used in any or all promotional photographs and videos, including but not limited to documentary and/or commercial footage (i.e. websites, brochures, posters, myspace.com, youtube.com, facebook.com, etc). I knowingly give up all rights to any and all financial gain that may come from this footage and material created by uCamps campers and/or uCamps staff.

I have enrolled the child or children ('Child') named below in the program ('Program'). I understand the Child's participation in the Program involves exposure to inherent risks that cannot be eliminated. I also understand that the Child's participation in the Program may involve some or all of the following activities which have the potential risk of injury: high and low ropes courses, swimming pool, lake activities, archery, BMX dirt bicycle track, mountain bikes, rock wall, zip-line, tree climbing, rock climbing, hiking, skateboarding, roller-skating, horseback riding, contact with wildlife, motor ski boat, slip ‘n’ slide and other like activities. While uCamps discourages communication between campers and staff outside of camp and while uCamps does not condone inappropriate behavior by any of our staff members and campers, still I am aware that the child named below may be in communication with fellow campers and camp staff members outside of camp via telephone, text message, email and/or in person. Individually and as the parent or guardian of the Child, I HEREBY EXPRESSLY ASSUME ALL RISKS associated with the Child's participation in and outside the Program including all risks associated with the above and other uCamps activities. Despite my understanding of the foregoing risks, I, individually and as the parent or legal guardian of the Child, AGREE NOT TO SUE AND TO RELEASE FROM LIABILITY AND TO DEFEND, INDEMNIFY AND HOLD HARMLESS uCAMPS, and their representatives, owners, employees and agents for any damage or injury arising out of the Child's participation in the Program regardless of the cause, including NEGLIGENCE.

I understand that the foregoing is a LIABILITY RELEASE and a MEDICAL AUTHORIZATION that is legally binding on me, the Child, our heirs and our legal representatives and I sign it of my own free will. I acknowledge that the foregoing is binding during the 2010-2011 camp season.

*UCAMPS CANCELLATION POLICY *

I agree to all terms and conditions listed above, including the uCamps cancellation policy.

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multiple times will result in you being charged multiple times.