United Endowment Fund

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for registering for the Children’s Summer Camp. We appreciate your commitment to help build-up children and families. This website will register your child as well as pay for the camp. There is no need to fill out or turn in a hand written registration.

Qty

Description

Amount

Total

Regular Registration - Full Payment

$155.00

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Registration Deadline: June 1st
(no registrations accepted after this deadline)

Deposit - Regular Registration

$50.00

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Regular Registration is $155.00
Due at time of registration and full payment by June 1st.

Balance Due After Deposit

$105.00

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Total: $0.00

Consent to Attend: *

I give consent for my son/daughter to attend this event with United Endowment Fund.

Waiver to Hold Harmless: *

Further, the undersigned agrees that United Endowment Fund, its agents, employees, successors and affiliates shall be held harmless from any liability for damages to person or property to the minor named herein that might arise out of, en route to, en route from, while in residence or as a result of any involvement or participation in activities sponsored by United Endowment Fund.

Consent to Treat: *

I give my consent for emergency medical treatment of this minor in a licensed hospital by a licensed physician should his/her condition so require it in my absence. I understand that, in such a case, reasonable attempts will be made to contact me, time and conditions permitting. As long as the medical or surgical treatment considered necessary in the situations in accordance with generally accepted standards of medical practice for the particular type of injury or illness involved, I impose no specific limitations or prohibitions regarding treatment.

Your Information:

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Please enter the Name, Grade and School for all registrants:

Name:

Gender:

Grade:

School:

T-Shirt Size:

Name:

Gender:

Grade:

School:

T-Shirt Size:

Medical Information:

Insurance Company:

Insured’s Name:

Policy Number:

Please note any medical conditions or allergies:

Comments/Questions:

Your Payment Information:

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *

Name on Account: *

Routing Number: *

Account Number: *