150 State Street, Louisville, KY 40206 5028930346

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2021 Application

We collect this information for grant reporting purposes.
A donation is not required to attend our camp. We provide a suggested donation amount only if you are interested in financially contributing to our program and supporting our efforts monetarily.

Emergency Contact Information

Additional Persons Authorized to Pick-up My Child

Medical Information

These forms can list supports children use in schools to help them learn and strategies to help teachers understand behaviors.
Include nasal/respiratory, food, skin, any other our child has and please indicate the severity.

Camper Information

Please enter the grade that the child will be entering in the 2019-2020 school year. Children must have completed Kindergarten to be eligible for K-3 camps.
We collect this information for grant reporting purposes. Selection is optional if you wish not to identify.


By checking each box you are providing your consent/release for each item.
The United Learning Summer Camp includes 2-3 field trips per week. If you wish that your child not attend field trips, we cannot guarantee that we will have a staff member to remain on site during field trips.


$ 0.00