UFCC Student Application UFCC Application Step 1 of 5 20% Name & AddressName(Required) First Middle Last What name do you go by?(Required)Mailing Address(Required)City(Required)What county do you live in?(Required)AlleganyAnne ArundelBaltimore CityCalvertCarolineCarrollCecilCharlesDorchesterFrederickGarrettHarfordHowardKentMontgomeryPrince George'sQueen Anne'sSomersetSt. Mary'sTalbotWashingtonWicomicoWorcesterOut-of-state('Out of State' is at bottom of list)State(Required)Zip Code(Required)CAPTCHA PersonalHome Phone(Required)Mobile Phone(Required)Email(Required) Gender(Required) Female Male Non-binary Preferred PronounsDate of birth(Required) MM slash DD slash YYYY Your T-shirt size (adult sizes)(Required) Small Medium Large X-Large SchoolEntering Year in School in September 2024(Required) Freshman Sophomore Junior Senior Name of High School (or College)(Required)School City(Required)School State(Required)2-Letter School State AbbreviationPrincipal(Required)Are you planning on attending college?(Required) Yes No Still deciding In which area of study are you most interested?(Required) Medical/Emergency ContactAll medical information is sent in a separate pdf to the Camp Director to be used in case a medical visit is required. The information is treated as confidential and will be kept in a secure location.- Insurance Information -Is your child covered by medical insurance?(Required) Yes No (If 'No' please enter NA to questions below.)If Yes, Insurance Company(Required)If Yes, Policy Number(Required)If Yes, Policy Holder(Required)If Applicable, Prescription Insurance CompanyIf Applicable, Policy NumberIf Applicable, Policy Holder- For Parents/Guardians ~ Health Information -Do you know of any health factor that makes it advisable for your child to follow a limited program of physical activity while participating in the Natural Resources Careers Camp?(Required) Yes No If yes, please describe.(Required)Is your child on any prescription medication?(Required) Yes No If yes, please describe.(Required)Is your child vegetarian?(Required) Yes No Is your child vegan?(Required) Yes No Does your child require a special diet?(Required) Yes No Does you child have allergies?(Required) Yes No List any allergies or special dietary requirements or restrictions.Has your child had a tetanus shot?(Required) Yes No If yes, most recent shot date:(Required) MM slash DD slash YYYY - Emergency Contact Information -Mother/Guardian First Name(Required)Mother/Guardian Last Name(Required)Street Address(Required)City(Required)State(Required)Zip Code(Required)Day Phone(Required)Evening Phone(Required)Email(Required) Father/Guardian First Name(Required)Father/Guardian Last Name(Required)Street Address(Required)City(Required)State(Required)Zip Code(Required)Day Phone(Required)Evening Phone(Required)Email(Required) Emergency Contact First Name(Required)Emergency Contact Last Name(Required)Street Address(Required)City(Required)State(Required)Zip Code(Required)Day Phone(Required)Evening Phone(Required) Reasons for InterestPlease let us know how you originally found out about UFCC (please be specific!) How did you hear about UFCC?Teacher (please ask where the teacher heard of UFCC and fill in next section)Parent (please ask where your parent heard of UFCC and fill in next section)Newspaper (please specify name in next section)Flyer (please specify where flyer was posted in next section)Online (please specify UFCC website, Facebook, etc. in next section)Other (please specify in next section)Source of InformationDescribe (in up to 150 words) why you are interested in attending UFCC 2024.(Required)List your outside activities (clubs, volunteer work, scouts, etc.).(Required)List awards or special recognitions you have received.(Required) 45698
