Summer Camp Reservation

This is an initial registration to reserve a spot on the camp. To complete your registration, please click to download the complete application. Fill it out and submit it to the Summer Camp Director at ICUC. Click here to Reserve and Pay Today

Camper Name

First Name

Last Name

Gender

Male

Female

Age

Date of Birth

YYYY

Grade

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Parent/Guardian Name

First Name

Last Name

Relationship to child

Address if different than camper

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Best way to contact you

Cell Phone

Emergency Contact

First Name

Last Name

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Relationship to child

List 3 individuals other than parent mentioned, who are permitted to pick up your child