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 45 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 (CURRENT '11 - '12 school year)

School currently attending?

School attending in fall ('12-'13)

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

Please list any allergies or special needs:

I have attended uCamps since:

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 hear 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.

Bus Stop Locations: NorCal Camps (Berkeley & San Ramon) / SoCal Camp (Costa Mesa) / Sequoia Lake Camps (San Jose). {Times and Maps will be available one month before camp begins}

Camp

Location

Dates

Grades

Fees Before 2/15/12

Fees After 2/15/12

FAME Acting Camp

MayMac

7/09 - 7/15

6 - 12

$745

$795

FAME Music Camp

MayMac

7/09 - 7/15

6 - 12

$745

$795

FAME Film Camp

MayMac

7/09 - 7/15

6 - 12

$745

$795

FAME Visual Arts Camp

MayMac

7/09 - 7/15

6 - 12

$745

$795

FAME Speech Camp

MayMac

7/09 - 7/15

6 - 12

$745

$795

Bus TO Camp (From Berkeley or San Ramon)

$40

CAMP PHOTO

$15

LIT (Leaders in Training)

MayMac

7/09 - 7/22

10 - 12

$1,045

$1,095

Bus TO Camp (From Berkeley or San Ramon)

$40

CAMP PHOTO WEEK 1

$15

CAMP PHOTO WEEK 2

$15

Discovery Camp

MayMac

7/17 - 7/22

3 - 9

$695

$745

Bus TO Camp (From Berkeley or San Ramon)

$40

CAMP PHOTO

$15

uCamps SDC

MayMac

7/24 - 8/4

6 - 12

$1,395

$1,495

Bus TO Camp (From Berkeley or San Ramon)

$40

CAMP PHOTO

$15

SoCal Camp

Pilgrim Pines

8/12 - 8/18

6 - 12

$745

$795

Bus TO Camp (From Costa Mesa)

$40

CAMP PHOTO

$15

Forest Footsteps (session 1)

Sequoia Lake

7/23 - 7/28

3 - 9

$445

$495

Bus TO Camp SESSION 1 (From San Jose) JOIN US FOR FINAL DAY BBQ!

$40

CAMP PHOTO

$10

T-Shirt

Forest Footsteps (session 2)

Sequoia Lake

7/30 - 8/4

3 - 9

$445

$495

Bus TO & FROM Camp SESSION 2 (From San Jose)

$70

CAMP PHOTO

$10

T-Shirt

Forest Footsteps 1&2

Sequoia Lake

7/24 - 8/4

3 - 9

$845

$945

Bus TO & FROM Forest Footsteps 1&2 (From San Jose)

$70

CAMP PHOTO Forest Footsteps WK 1

$10

CAMP PHOTO Forest Footsteps WK 2

$10

T-Shirt

Earth Adventure Camp

Sequoia Lake

7/24 - 8/4

8 - 12

$895

$995

Bus TO & FROM Earth Adventure Camp (From San Jose)

$70

CAMP PHOTO Earth Adventure WK 1

$10

CAMP PHOTO Earth Adventure WK 2

$10

T-Shirt

**Airport Shuttle for all Northern California camps (San Jose International - SJC)
***There is no airport shuttle service available for uCamps SoCal or Forest Footsteps / Earth Adventure Camps.

$60

* I would like to contribute this amount to the uCamps Scholarship Fund

$0
$25
$50
$100
$200
$500

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

Please choose to either Pay in Full or to pay the Non-Refundable Deposit
(If you choose to pay in full, the Non-Refundable Deposit is automatically calculated into your total)

Pay In Full
Deposit

Amount to be Charged

Remaining Balance Due 45 days before camp begins

BUSES ARE AVAILABLE TO CAMP IF YOU ARE ATTENDING FAME, ORIGINAL SDC, LIT, DISCOVERY, SoCal Camp or Forest Footsteps Camp SESSION 1. On the final day parents are invited to drive to camp, tour the facility, watch performances, and then bring their camper(s) home with them. ROUNDTRIP BUSES ARE ONLY AVAILABLE FOR uCAMPS FOREST FOOTSTEPS SESSION 2 & EARTH ADVENTURE CAMP TO AND FROM SEQUIOA LAKE.

**Campers traveling by airplane to the Summer Sessions: uCamps will provide an airport shuttle service to and from camp for an additional $60 (no shuttle service available for uCamps SoCal or Forest Footsteps / Earth Adventure Camps). Plan to fly into and from San Jose International Airport SJC: arrive 11am - 2pm (PST) on the 1st day of camp, leave 5pm - 6pm (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 2012-2013 camp season.

Cancellation Policy*

Participants who wish to cancel their camp registration must provide notification in writing via mail or email and should include the reasons for cancellation from the program. Cancellation is effective from the date postmarked on the written notice, or, for email, the date received by uCamps. Participants will continue to accrue non-recoverable costs based on the chart below until official notification is received.

Refund Policy*

Upon a camper’s acceptance into the program and receipt of the non-refundable deposit, or payment in full, uCamps incurs certain non-recoverable costs. Therefore, any participant who cancels at any time after the deposit has been received automatically forfeits the deposit amount ($200.00 per week). In addition, the following late cancellation penalties apply:

Cancellation Period	Penalty
60 days or more before start of program	deposit only
45–59 days before start of program	50% of total program fee
30–44 days before start of program	75% of total program fee
29 days or less before start of program	Full program fee

* Exceptions to this policy will be made for camper medical emergency or death of a loved one only and requires written verification from a physician or appropriate institution.

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

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