Ujima SEP

Liberty Community Development Corporation Inc.

Camp Fees:
Registration fee is $50.00 if paid before May 17th, 2012
Registration fee is $75.00 if paid after May 17th, 2012
Camp fee is $140.00 per week

UJIMA Summer Enrichment Camp Registration Form

Please fill out application completely and hit the SUBMIT button only after you have checked the form for accuracy. After you submit your application you will be redirected to the payment. Fields with (*) are required fields.
Gender of Applicant: *	Male Female
Age of Applicant: *
Grade of Applicant: *
Applicant's First Name: *
Applicant's Middle Name: *
Applicants Last Name: *
Birthdate of Applicant: *
Address of Applicant *
Applicant's City: *
Applicant's State: *
Applicant's Zipcode: *
Applicant's Contact Number:
	Please use the areas below to list the name, birthdate, gender and contact number of each additional child attending camp.
Child 2 Information
Child 3 Information
Child 4 Information
Child 5 Information
Guardian's Full Name: *
Guardian's Contact Number: *
Guardian's Contact Email:

Once you submit your application you will be redirected to
the payment options page.