C.U.P.C Summer Camp Application

*NOTE* This html rendering IS NOT the form! The correct form is the PDF.

Click Here for Printer Friendly Version of this Application [To Print]

C . U . P .C . A P P L I C A T I O N ' 12

Summer Camp / Special Programs
1. Advance Payment for grades 1-7 - seven weeks - $750 per child, paid in total in advance (BY May 31st, 2012 ),
for 8th grade - seven weeks - $540 per child, also paid in total in advance (BY May 31st, 2012)
2. Weekly Payment for grades 1-7 - $125 per child. To reserve a place, send 50% of total registration. Payment in full by May 31st, 2012
for 8th grade - $90 per child. Also, to reserve a place, send 50% of total registration. Payment in full by May 31st, 2012.
3. Weekly Payment for Extended Sessions, $150 per child per week.
4. NO REFUNDS. NO EXCEPTIONS

Complete forms and send with payment to:

C.U.P.C. Summer Camp
1700 Sutter St.
San Francisco, CA 94115

Overnight Trip: Advance payment: $125 by May 31st, 2012 . After May 31st,
the cost will be $150 . To register for the overnight trip, you must be
registered for the week of June 27th - July 1st.
T-Shirts: C.U.P.C. Summer Camp T-shirt can be ordered at a cost of $10
per t-shirt. To order, please indicate the child's size, (children's sizes S, M, L;
or adult sizes S, M, L, XL, XXL) and include payment with the
registration form. T-shirts are 50/50 cotton polyester blend. Replacement or
extra T-shirts will also be sold during camp.

CHILD'S NAME:

Gender: M F
Grade in Sept:
T-shirst ($10) Size:
Check Weeks Attending

CHILD'S NAME:

Gender: M F
Grade in Sept:
T-shirst ($10) Size:
Check Weeks Attending

CHILD'S NAME:

Gender: M F
Grade in Sept:
T-shirst ($10) Size:
Check Weeks Attending

Adv. Payment 7 Weeks: $750
Adv. Payment
8th Grade Special: $540

1. 06/06 - 06/10 $___________
2. 06/13 - 06/17 $___________
3. 06/20 - 06/24 $___________
4. 06/27 - 07/01 $___________
5. 07/05 - 07/08 $___________
6. 07/11 - 07/15 $___________ 7. 07/18 - 07/22 $___________

Special Programs ($150/week) Extended Weeks
1. 07/25 - 07/29 $___________
2. 08/01 - 08/05 $___________
Overnight Trip $___________

Subtotal: $________

Special Programs ($150/week) Extended Weeks
1. 07/25 - 07/29 $___________
2. 08/01 - 08/05 $___________
Overnight Trip $___________

Subtotal: $________

1. 06/06 - 06/10 $___________
2. 06/13 - 06/17 $___________
3. 06/20 - 06/24 $___________
4. 06/27 - 07/01 $___________
5. 07/05 - 07/08 $___________
6. 07/19 - 07/23 $___________ 7. 07/19 - 07/23 $___________

Special Programs ($150/week) Extended Weeks
1. 07/25 - 07/29 $___________
2. 08/01 - 08/05 $___________
Overnight Trip $___________

Subtotal: $________

My child(ren) has attended C.U.P.C.
Summer Camp in the past.

Important: Remember that a health form must also be
included with registration for
each child.

Grand Total:	$__________
Payment Enclosed:	$__________
Balance Due:	$__________

(Due by May 31, 2012 )

I would like to receive the Church's monthly newsletter, The Visiting Pastor, to read about the latest events and articles about Christ United Presbyterian Church in Japantown.

I would like to be added to the online mailing list. Email

Please check your dates and payments carefully before registering with us. In sending payment for C.U.P.C. Summer Camp, you agree to the terms and conditions as stated in this brochure. You understand that there will be no refunds, and that there will be NO EXCEPTIONS to this policy. You also acknowledge that any weeks not paid for by May 31, 2012 will result in the cancellation of your reservations for those weeks.