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Menu
About
Open menu
Who We Are
Careers
Services
Open menu
Intervention
Enrichment
Prevention
Events and Programs
Open menu
Retreat
2022 High School Boys Basketball
Previous Events
Covid-19
Open menu
Managing Stress and Anxiety
Speaking with your children about COVID-19
Videos
Reopening Guidelines
Community Resources
Parenting
Donate
Contact
Upward Community’s 3rd Annual High School Girls Retreat- Supported by the Walder Foundation
Participant Legal Name
(Required)
First
Last
Participant Preferred Name/Nickname
Participant Birthdate
(Required)
MM slash DD slash YYYY
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Particpant Home Phone
(Required)
Participant Cell phone
(Required)
Participant Email
(Required)
School Participant Attends
(Required)
High School Grade Fall 2022
(Required)
Room Requests
(Required)
Participants are allowed to make 2 requests. Upward Community will do our best to place with one of the requests but does not make any guarantees:
Sweatshirt Size
XS
S
M
L
XL
Parent or Guardian 1
Name
(Required)
First
Last
Home Phone
(Required)
Cell Phone
(Required)
Email
(Required)
Parent or Guardian 2
Name
(Required)
First
Last
Home Phone
(Required)
Cell Phone
(Required)
Email
(Required)
Emergency Contact
Name
(Required)
First
Last
Relationship to participant
(Required)
Home Phone
(Required)
Cell Phone
(Required)
Email
(Required)
Pediatrician Info
Pediatrician Name
(Required)
Pediatrician Phone Number
(Required)
Any medication that participant will be taking during the weekend:
(Required)
Yes
No
Please list the medication and describe what the medication is for
(Required)
**Please note: Upward Community will not administer medicine or oversee it.
Anything staff should know about your daughter (anxiety for event, sleep issues, eating, etc)
Any known allergies (Food or medication)
Health and Safety
(Required)
I agree to the Health and Safety Policy
HEALTH AND SAFETY: The Parent or Guardian certifies that the child is healthy and able to participate in all Upward Community activities at the time of application. Parent/guardian gives permission to secure proper medical treatment in case of an emergency, when parent/guardian cannot be reached. Parent or Guardian please sign your name:
Waiver for Photo Release
(Required)
I agree to the Photo Release Waiver
WAIVER FOR PHOTO RELEASE: I give my consent for any photos/videos taken of my child involved in Upward Community programs to be used for, Upward Community and/or promotions or display. Parent or Guardian please sign your name:
Please sign your name to agree to the Health and Safety and Photo Release Waiver
(Required)
Reset signature
Signature locked. Reset to sign again
Payment
Payment Type
(Required)
Lump Sum - $180
Payment Plan - $60 x 3
If you would like a payment plan you can do 3 payments of $60.
Registration Fees
(Required)
Price:
Registration Fees
(Required)
Price:
Payment Mode
(Required)
Online
Offline (Offline may only be used with Upward Staff PRE-Approval Only.)
Credit Card
Card Details
Cardholder Name
Comments
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