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Programs
After-School Programs
Summer Camp
Annual High School Writing Contest
Community Collaborations
About Us
Our Impact
Our Story
Our Team
Get Involved
Writing Gallery
donate now
Programs
After-School Programs
Summer Camp
Annual High School Writing Contest
Community Collaborations
About Us
Our Impact
Our Story
Our Team
Get Involved
Writing Gallery
Programs
After-School Programs
Summer Camp
Annual High School Writing Contest
Community Collaborations
About Us
Our Impact
Our Story
Our Team
Get Involved
Writing Gallery
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Summer Camp Registration
Home
Summer Camp Registration
Student Information
-
Step
1
of 3
Child #1 Name
*
First
Last
Week(s) of camp
*
Week 1: Rising 2nd + 3rd | June 6 - 10
Week 2: Rising 4th + 5th | June 13 - 17
Week 3: Rising 6th - 8th | June 20 - 24
Week 4: Rising 9th - 12th | June 27 - July 1
Week 5: Rising 2nd + 3rd | July 11 - 15
Week 6: Rising 4th + 5th | July 18 - 2
Week 7: Rising 6th - 8th | July 25 - 29
Gender
*
Female
Male
Other/Prefer not to answer
Date of Birth
*
(MM/DD/YY)
Ethnicity/Race
*
American Indian/Alaskan Native
Asian
African American/Black
Hispanic/Latino
Caucasian/White
Native Hawaiian/Pacific Islander
Multi-Racial (no single race applies)
T-shirt size
*
youth small
youth medium
youth large
adult small
adult medium
adult large
adult XL
adult XXL
Each camper receives a Page 15 shirt with registration
Allergies/Medications/Special Needs
Grade for 2022/2023 school year
*
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
School for 2022/2023 school year
*
Next
Parent or Guardian Name
*
First
Last
Parent/guardian PRIMARY phone number
*
Parent/guardian SECONDARY phone number
Authorized Pick-Up Name #1 (optional)
Authorized Pick-Up Name #2 (optional)
Authorized Pick-Up Name #3 (optional)
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
How did you hear about Young Writers Camp?
Returning camper
Page 15 email
Social Media
Teacher or school recommendation
Word of mouth
Other/Not sure
Friend request?
Next
PARTICIPATION AGREEMENT
*
I certify that I am the legal Parent/Guardian of the child(ren) registering and I voluntarily assume all associated risks and liabilities related to participating in the summer camp for which we are enrolling. Furthermore, I agree to indemnify, defend and hold harmless, Urban Think Foundation/Page 15 including its officers, employees, agents, affiliated entities and representatives, from and against any and all claims, demands, actions, damages, losses, costs, penalties, liabilities, expenses or deficiencies asserted related to or arising from exposure or transmission of COVID-19 or for any injuries which may be incurred by my child in any or all activities at the Summer Camp for which we are enrolling. I understand that Urban Think Foundation Inc./Page 15 may not provide insurance for my child, and I am financially responsible for all treatment or medical care of my child. I understand that Urban Think Foundation (dba Page 15) reserves the right to limit participation of any child for disciplinary reasons or non-payment of fees. My child is required to abide by the policies and procedures of the Urban Think Foundation and Page 15 staff.
Authorization for Medical Treatment
*
I give my consent to Urban Think Foundation/Page 15 or its representative(s) to acquire emergency medical treatment for my child from competent medical personnel/facilities should that become necessary for any reason. In case of a minor accident or illness, I request that the Program Representative contact me. If I am unable to be reached, I request that one of the persons listed on this form be contacted to care for my child.
Refund policy
*
I agree to the following refund and cancellation policy: (1) If cancelling more than 15 days (2 weeks+) before the first day of camp, a full refund will be applied less a 5% processing fee. (2) If cancelling 7-14 days (1-2 weeks) before first day of camp, a full refund will be applied less a 20% cancellation fee. (3) If cancelling within 1 week of the first day of camp, no refunds will be processed.
PHOTO RELEASE STATEMENT
I agree to allow my child to participate in all Urban Think Foundation/Page 15 programs and activities and to appear in person or in voice, video or photographic presentation for radio, television, website or print media reports and/or media campaign(s) resulting from participation in a Urban Think Foundation/Page 15 program and/or event.
Name
SUBMIT REGISTRATION