USCA Ultimate Summer Camp Adventure Registration Form

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USCA Ultimate Summer Camp Adventure
Registration Form
Mail with payment to: USC Aiken, Office of Continuing Education
471 University Parkway, Aiken, SC 29801
Or Email form to Amy Westra at [email protected]
Download additional copies for each additional child
Camper's Name ___________________________________________________________
Camper's Age _____________________________
Birthdate: _______________
Address: _________________________________________________________________
City, State, Zip: ___________________________________________________________
Parent/Guardian: _________________________________________________________
Phone: ___________________________ Email: _________________________________
Camp Selection:
Session 1 for Rising 5th-8th Graders: June 27-July 1
AM - ___________________________________________________________
PM - __________________________________________________________
Session 2 for Rising 1st-4th Graders: July 5-8
AM - __________________________________________________________
PM - __________________________________________________________
Session 3 for Rising 5th-8th Graders: July 11-15
AM - __________________________________________________________
PM - __________________________________________________________
Fees Calculation:
Fees: 1/2 day 8:30-12:00 or 1:00-4:30 = $90
Eligible Camper Discounts
$10 off - Multiple Camp Discount*
USE DISCOUNT REFERENCE CODE #1475
$15 non-refundable Registration Fee = $15.00
# of sessions _____ x 1/2 day $90 = _______
DISCOUNT REFERENCE CODE: ____________
* (applies to second camp and beyond)
$15 Registration Fee
⁺ $ __________
Less Discounts ____________
TOTAL = $_______________
Payment Information:
Campers are not registered for their camp until payment is received in full
Check payable to USCA is enclosed
Mastercard, Visa, Discover, or Am/Ex __________________________________________
Exp Date: _____________________________
Or call Amy at 803-641-3741 during business hours to pay with credit card
PLEASE VISIT OUR WEBSITE TO DOWNLOAD ADDITIONAL PARENTAL CONSENT FORMS
www.usca.edu/summercamps
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