Youth Summer Camp : : UMass Lowell

Camper Information

Last

First

Middle

Birth Date (MM/DD/YYYY):

Age as of 6/25/2012

Gender Male
Female

T-Shirt Size 6-8 Youth 8-10 Youth 10-11 Youth
Adult - Small Adult - Medium Adult - Large

Please indicate how you heard about RecKids:

Friend
Website
Brochure
Other

Emergency Contact Information

Name

Relation

Work #

Cell #

E-mail (recommended)

Name

Relation

Work #

Cell #

E-mail (recommended)

Enrollment Selection

Select Session:

Session I (June 25 - 29)
Session II (July 9 - 13)
Session III (July 16 20)

Are you a CRC Member or UMass Lowell faculty/Staff?

Yes No

Do you require after camp care?

Yes No

Are you registering another child for the same session?
Instructions for this question: If you are registering multiple children, when registering your first child select NO for this question. For each additional child select YES for this question.

Yes No

Parent/Guardian Contact Info

Name

Address

City

State

Zip Code

Preferred Phone #

Work Phone #

Additional Phone #

Name

Address

City

State

Zip Code

Preferred Phone #

Work Phone #

Additional Phone #

Acknowledgement of Terms

FULL PAYMENT MUST BE RECEIVED NO LATER THAN TUESDAY, MAY 31st, 2012

Camp is a tuition-for-service program based on confirmation enrollments and secured deposits. A $50 per-session non-refundable non-transferable deposit is required. Enrollment forms will be processed as outlined in the camp brochure. I understand that the reservation will be held by my deposit until May 31st, 2011. At that time, the balance in full must be received. If full payment is not received by this time, my reservation(s) will be cancelled.

Parent or Guardian - Your signature below indicates compliance with summer camp regulations.

Parent/Guardian Signature

Date

Registration Form