Contact Information
Student Name: (*)
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Age: (*)
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Grade student is entering in fall 2013: (*)
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School: (*)
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Parent/Guardian Name: (*)
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Home Address: (*)
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Primary Phone Number: (*)
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Work Phone Number:
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Additional Phone Number:
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Email Address:
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In Case of Emergency Contact Person: (*)
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Emergency Contact Phone Number: (*)
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List any allergies the student has: (*)
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Waiver
Two of the middle school camps, Hometown History (Week 2) and Wild about Animals (Week 3) involve field trips to venues in Birmingham. The cost of the field trips is included in the camp fee, and lunch will be provided as usual. By typing your name in this box, you are indicating that you allow your student to participate in these field trips. Also by typing your name in this box, you are waiving all rights to hold UAB or its staff responsible for any injuries or loss of property that occur on these field trips. This also includes any injuries or loss of property that may occur on the UAB campus. (*)
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Select your camp(s)
Middle School Camps are for students entering grades 5-8. High school camps are for students entering grades 9-12. You may attend as many weeks as you like within your age category. Please indicate which camp sessions you would like to attend (check all that apply)
Middle School Camps
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High School Camps
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Required Camp Registration Fee (*)
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Method of Payment (*)
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