UW-Green Bay Rock Academy Camp

Please fill in your camper's information below:  
*Filling in your camper's last four digits of their social security number is optional. It is requested for reporting purposes in evaluating access to UW-System schools.
**By checking the Liability Signature checkbox you agree to hold harmless and indemnify the State of Wisconsin, the Board of Regents of the University of Wisconsin System, and the University of Wisconsin-Green Bay, their officers, agents, and employees, from any and all liability, loss, damages, costs, or expenses which are sustained, incurred, or required arising out of the actions of the undersigned in the UW-Green Bay Summer Camps program.
First Name
Middle Initial
Last Name
Parent Name(s)
Parent Home Phone
Parent Work Phone
Parent Cell Phone
Camper Cell Phone
Parent E-mail Address
Camper's Age
School Attending in Fall
School Attending in Fall if Not Listed in Dropdown
Grade Level (Fall)
Graduation Year
*Last Four Digits of Social Security Number
T-Shirt Size
Do you qualify for free or reduced lunches in the school system?
Do you receive state or federal support?
Do you authorize UW-Green Bay to take photos/video footage of your camp participant?
**Liability Signature
Roomate Request
How did you learn about UWGB Summer Camps?
License Plate Number (If you will be parking a car on campus during the camp week)
Promo Code From Back of Brochure/Postcard
Family Discount Request-Receive a $30 credit if you register siblings for UWGB Summer Camps
= required field

Any registration notes you would like to include?

= required field