Summer UU Chalice Camp Registration

Welcome to Summer Chalice Camp 2026 registration!
Camp will be held August 3-7th at Live Oak Unitarian Universalist Church, 3315 El Salido Parkway, Cedar Park, TX 78613, from 9:00 am to 3:00 pm each day. Summer Chalice Camp is designed for children ages 5–12, and one registration form is required per child.

Registration fees are as follows: $100 for church members, $75 for each additional sibling, $200 for non-members, and $50 for Counselors-in-Training (ages 13+). Please complete the information below for you and your child, submit the form, and watch for a confirmation email.

At Live Oak Unitarian Universalist Church, we are committed to creating a safe, welcoming, and inclusive environment for all children. All information is kept confidential and used solely to support your child’s well-being while at camp.

Camper Information

Camper's Full Name

Preferred Name / Pronouns

Age & Grade

Parent / Caregiver Information

Primary Caregiver Name

Relationship to Camper:

Phone

This address will receive a confirmation email

Secondary Caregiver Name:

Relationship to Camper

Phone

This address will receive a confirmation email

Emergency Contacts (other than parent/caregiver)

Name

Phone

Relationship to Camper

Name

Phone

Relationship to Camper

Authorized Pick-Up Persons

Please list all individuals authorized to pick up your child. Photo ID may be required.

1. Name & Relationship

2. Name & Relationship

3. Name & Relationship

Medical & Health Information

Primary Care Physician

Phone

Health Insurance Provider

Policy Number

Allergies (food, medication, environmental, insect, etc.)

None Yes (please describe and note severity)

Medications

My child does not take medication during camp hours. My child requires medication during camp hours (please complete a Medication Authorization Form with the camp director)).

Medical Conditions or Support Needs

Please share any medical, emotional, sensory, behavioral, or learning needs that will help us best support your child.

Accessibility & Inclusion

At UU Chalice Camp, we strive to be fully inclusive.

Does your child need any accommodations to fully participate?

No Yes

If yes, please describe

Dietary Needs

No dietary restrictions Vegetarian Vegan Gluten free Other

If other, please specify

Photo & Media Permission

Photos or videos may be taken during camp activities for church communications.

Yes, I give permission for my child’s image to be used. No, I do not give permission for my child’s image to be used.

Field Trips & Off-Site Activities

I give permission for my child to participate in walking or local off-site activities under staff supervision.

Yes No

Behavior & Community Expectations

UU Chalice Camp follows Unitarian Universalist values, including respect, inclusion, and care for self and others.

I have discussed camp expectations with my child and understand that repeated unsafe behavior may require caregiver pick-up.

Emergency Care Authorization

In the event of an emergency, I authorize camp staff to seek medical treatment for my child if I cannot be reached.

Caregiver Signature

Date

Volunteer Opportunities

Summer Chalice Camp is made possible through the care and support of our community. While volunteering is not required for your child to attend camp, families who are able are warmly invited to help in ways that support our staff and campers.

Please check any areas where you might be willing to help:

Morning Support (8:30–9:30 am) – helping with arrivals and settling in Afternoon Support (2:30–3:30 pm) – help with clean-up and departures Supply Prep – cutting, organizing, or preparing materials ahead of camp Snack Support – providing or organizing snacks (details provided later) Substitute / On-Call Volunteer (available if needed) Lead an activity you have cool skills with I am not able to volunteer at this time

Volunteer Name (if different from caregiver):

Best Contact Email or Phone:

All volunteers working directly with children must meet Live Oak UU Safe Congregation requirements. A background check and brief orientation may be required. We will follow up with details.

Payment

Is your family a member of Live Oak UU?

Yes No

Financial Accessibility: Partial and full scholarships and payment plans are available. If you are requesting support, please select any option below to complete registration, then contact Chris Jarman, Director of Faith Development, at dlfd@liveoakuu.org Your payment will be adjusted. All requests are handled confidentially.

Payment

We are grateful for the trust you place in us. Summer UU Chalice Camp is grounded in our shared values of love, justice, and respect for every person.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Summer UU Chalice Camp Registration

Description

Please Fix the Following