Camp Registration Irish Camp 2022 - June 13 - July 1 Name of Participant* First Last Preferred Name First To Which Gender Identity Does Participant Most Identify?* Male Female Non-Binary Prefer Not To Answer Prefer to Self-Describe, (in field below) Self-Described Gender Participant's Date of Birth* MM slash DD slash YYYY Participant's Age on First Day of Camp*T-Shirt Size* Child's Small Child's Medium Child's Large Child's Extra Large Adult Name of Parent/Guardian* First Last Parent/Guardian Phone*Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parent/Guardian Primary Email* Parent/Guardian Secondary Email Emergency Contacts*NameRelationshipPhoneAuthorized for Pickup (Yes or No) Camp Dates* Week 1 (June 13 - June 17) Week 2 (June 20 - June 24) Week 3 (June 27 - July 1) Registration Fees* Camp Hours (9am-3pm): $300 per camper per week Payment Options* Pay by Check Make check payable to "United Irish Cultural Center" and send to: United Irish Cultural Center Attn: Irish Camp 2700 45th Avenue San Francisco CA 94116 Instructions on paying online will be sent to you after completion of this form. If you have any questions, please contact camp@irishcentersf.orgParticipant's Areas of Interest (Select Top 3 Choices)* Drama Keyboard Singing Hip Hop Tik Tok style Irish language Art Graphic Design Costuming Stage management Rap/poetry Does Participant sing or play an instrument?* No Yes If Yes, please briefly state the instrument (if applicable), level of playing reached and any experience performing:*How did you hear about UICC Irish Camp? Website Online Newspaper Instagram Flyer Bulletin Family/Friend Participants are expected to carry their own insurance and/or medical insurance . In the event of injury or illness, every effort will be made to contact the parent or guardian. Participants specifically assume all risks of injury arising out of his/her presence on the premises of the United Irish Cultural Center (UICC) , and use of its equipment or facilities and participation in activities, whether on its premises or at another location , and for myself and my heirs and assigns hereby waive, release and agree to hold free from all claims for damages the United Irish Cultural Center and dangers involved in participating in the programs and activities of the UICC, am physically capable of participating in such programs and agree not to participate on any activity that may injure myself or others. My Name/Date below also indicates my permission to use photographs or any other media for promotional purposes. Teachers and coaches are safety conscious and follow appropriate safety procedures. Type your Name for Agreement & Consent* Today's Date* MM slash DD slash YYYY Know thyself...
