Upward Bound Summer Camp Registration Form

(For best results, please fill out this form using the Google Chrome Browser.)

Please fill out this form to inform us of Summer Camp or Summer Bridge attendance.

Personal Information

First Name *

Last Name *

Grade *

T-shirt Size

Select Size *

Guardian Information

First Name of Emergency Contact *

Last Name of Emergency Contact *

Emergency Contact Phone Number *

Dorm Room Information

Preferred Roommate Name (if none, put "none") *

Other

Please List All Medication or Prescriptions: (i.e. benadryl, birth control, ibuprofen 800mg) *

Please List All Food/Medication/Environmental Allergies: (i.e. peanut allergies, specific food dyes, Tylenol allergies, grass allergies, insect stings/bites) *

Camp Information

Please let us know how many family members will be joining us for dinner on Check-In Night on May 26th, 2024. (Please do not include the Upward Bound camper in your total) *

Students are only allowed to miss up to eight (8) summer dates to still be eligible for the end of camp cultural trip. (If submitting for a timed pick up and drop off i.e. Doctor's Appointment- Please see Summer Excused Absence Form in summer packet) Please list all dates student will miss:

Miss 1

Miss 2

Miss 3

Miss 4

Miss 5

Miss 6

Miss 7

Miss 8

Please feel free to contact us at anytime at 580-327-8114.
Offices located in Vinson Hall 301, 303, 307, 309