UPWARD BOUND CAMP 2014

Serving people with special needs since 1978

Calendar of Events &

Early Registration Info

Visit the website: www.http://upwardboundcamp.org or Email: upward.bound.camp@gmail.com

CAMP IS ALL ABOUT FRIENDS CELEBRATING PURPOSE TOGETHER

Camp is about relationships; more than a week of fun in the sun. Over 95% of Upward Bound Campers have been coming without missing a season for over ten years. Activities Selections: More 2014 Camps! (just some of the fun) Spring Break, March 24-28 Making friends Easter, April 18-21 Leadership, April 25-27 Fall, October 24-27 Thanksgiving, Nov. 26-29 Campfires Winter, Dec. 4-7 Christmas, Dec. 24-26 Talent Show Skits/Drama Upward Bound is state licensed Dancing and fully accredited by the Music & Singing American Camp Association. All staff are adults with a heart Swimming for service. Each has underPaddle Boating Partial Scholarships Available gone a background check and Archery intensive training on site before Leadership Camperships Fishing interacting with campers. Military Family Stipend Sessions are designed for a Nature Hikes wide variety of interests and First Time Camper Pony Rides personalities, abilities, and Arts & Crafts Financial Need ages. Staff and campers are Bowling welcomed from all over the To be eligible for scholarships, world to come explore and campers must apply by April 1. Games No scholarships will be issued to create camp memories. Basketball campers receiving scholarships in Campers choose indoor bunk, Bible Studies previous two years. Forms and (top or bottom) or platform tent additional information available on Stories bed. Some campers may want line or by contacting the camp office. to sleep under the stars! Gold Panning Special diet needs, behavioral To schedule a visit, please call the camp office concerns or chronic health at 503-897-2447. issues are important to menApplications may be faxed to 503-897-4116. tion in order for staff to prepare Campers may be required to submit a photo, for a safe and satisfying camp It isn't just about catching the big fish. physical or additional information to confirm experience. Relationships, reservation. Campers will be contacted if camp recreation and respite. session is full or alternate dates are necessary.

Camp Dates for Summer 2014 Select 1st, 2nd Choice from the Dates Below
August 4-8 (3:1, ages 12+) August 11-15 (3:1, ages 12senior adults) August 18-22 (3:1, ages 12-senior adults) August 25-28 (2:1, ages 25+) September 2-5 September 9-12 Additional Respite/Camps Requested: _________________________________________ _________________________________________

Camp Fees 2014

All Sessions
Summer fees paid in full by Jan 1, 2014 Summer fees paid in full by April 1, 2014 Summer fees paid after June 1, 2014 Steps to Register: #1 Select choice (s) dates $745 $790 $820 (at left) (reverse)

June 18-21 (2:1, ages 30+) June 23-27 (3:1, ages 12-25) July 1-5 (3:1, ages 18+) July 7-11 (3:1, ages 18+) July 13-17 (Easter Seals, ages 7-21) July 20-24 (Easter Seals, 22+) July 27-30 (2:1, ages 18+) Additional days of respite may be available during July by application.

#2 Complete this Pre-Registration #3 Mail with fees to: Upward Bound Camp PO BOX C, Stayton, OR

97383

UBC Pre-registration 2014

Received: _________ Receipt # _________ Confirmation Sent: _____ Supervising Staff ______

UBC Office Use

Person completing this registration, please circle Camper Supervision Ratio Recommended for Community Events: 1:1 1:2 1:3 1:4 1:5 1:10 1:30 Tee Shirt Size: Adult S M L XL 2X 3X

Please indicate sessions of choice on reverse. Bunk Preference:

Indoor Bottom

Indoor Top w/rail

Platform Tent

Camper Full Name ______________________________ Birthdate ____________ Gender _____ Previously Attended UBC ____ Mailing Address ________________________________ City ________________ State _________ Zip ___________ Contact Person ________________________________ Contact Phone _______________ Mobile Phone __________________ Email _______________________________ Fax ________________ Name of Group Home (if applicable)_________________ Guardian Name__________________________________ General Comments/Expectations/Concerns: Special needs with regards to vision, hearing or speaking: Dietary Needs (Gluten free, no dairy, no meat, etc.): Chronic Health Issues (heart, diabetes, asthma, arthritis, etc.): Self Guardian Guardian Email ___________________________

Does camper take medications daily? _____ Does camper take medications more than two times a day? _____ CPap ______ Please list any behavioral concerns: Does camper have history of abuse towards others? _____ Please list assistance needed for mobility, communication, personal hygiene or daily routines that require one to one assistance: Please indicate with yes or no or not sure: Able to shower, brush teeth and change clothes independently____ Able to toilet self without cues or assistance ______ Able to use eating utensils independently ____ Participates with group in social environment ____ Sleeps through the night ____ Will sleep in room with others ____ Able to follow one or two part directions _____ Has enjoyed camp in past ____ Communicates needs ____ Swimmer _____ Some reading _______ Comments:_____________________ Please list any third party billing information: Contact/Personal Agent/Case Worker Name/Agency_____________________________ Contact Phone _________________ Contact Email____________________ Fax #__________________ Address_____________________________________ Camp friends expecting to attend with_____________________________________________________________________ Please list any restricted activities (horseback riding, swimming, boating, archery, long hikes, etc.):_________________________

Campers favorite activity at home____________________ Favorite activity away from home or outside ____________________ Other Camps camper has or will be attending____________________________________________ How do you know camper wants to attend Upward Bound Camp? ___________________________________________________________
Person completing pre-registration (please print name) ____________________________ Time known camper _____________