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Bruin Woods Summer Family Camp
Summer 2018 — Application Form
If you have any questions regarding your application please contact us at (909) 337-2478.
*
Fields marked with an asterisk below are required.
Eligibility
*
Select all that apply.
I am a UCLA Alumnus/Alumna
I am a current UCLA Full-Time Faculty
I am a current UCLA Full-Time Staff
I am a current UC Alumnus/Alumna, Staff, or Faculty (eligible for Weeks 9 & 10 only)
Name Used While Attending UCLA
*
Degree & Year (or Years Attended)
*
Major / School
*
UCLA Alumni Membership Number
Expiration Date
MM slash DD slash YYYY
Department
*
Staff / Faculty ID#
*
UC Campus
*
Select One…
UC Berkeley
UC Davis
UC Irvine
UC Merced
UC Riverside
UC San Diego
UC San Francisco
UC Santa Barbara
UC Santa Cruz
UCOP
Affiliation
*
Select One…
Alumni
Staff
Faculty
Contact Information
Name
*
First
Last
Address
*
Street
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Indiana
Iowa
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Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
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New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Mobile Phone
Email
*
Guest Information
Bruin Woods Week Preference
*
Select the desired Week of attendance, in order of preference.
— First Choice
Select One…
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
2018 Bruin Woods Summer Family Camp Dates
Week 1
June 23 – 30
Week 6
July 28 – Aug 4
Week 2
June 30 – July 7
Week 7
Aug 4 – 11
Week 3
July 7 – 14
Week 8
Aug 11 – 18
Week 4
July 14 – 21
Week 9*
Aug 18 – 25
Week 5
July 21 – 28
Week 10*
Aug 25 – Sep 1
*Weeks 9 & 10 are open to all UC system alumni or current staff or faculty from any of the nine affiliated campuses.
2018 Bruin Woods Summer Family Camp Rates
Adult:
$1,477
3 Years – 1st Grade:
$840
6th – 12th Grade:
$1,253
Under 3 Years:
$175
2nd – 5th Grade:
$1,085
— Second Choice
Select One…
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
— Third Choice
Select One…
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
— List Additional Weeks (if any):
i.e. Week 10, Week 6, Week 9
Guest 1 (Qualifying Applicant — must attend entire week)
*
First Name
Last Name
Adult / Child 1
*
ADULT
Guest 2
First Name
Last Name
Adult / Child 2
Select One…
ADULT
Infant
1 Year Old
2 Years Old
3 Years Old
4 Years Old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
For child, please select grade entering Fall 2017 or the age during camp for 4 years and under.
Guest 3
First Name
Last Name
Adult / Child 3
Select One…
ADULT
Infant
1 Year Old
2 Year Old
3 Year Old
4 Year Old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
For child, please select grade entering Fall 2017 or the age during camp for 4 years and under.
Guest 4
First Name
Last Name
Adult / Child 4
Select One…
ADULT
1 Year Old
2 Years Old
3 Years Old
4 Years Old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
For child, please select grade entering Fall 2017 or the age during camp for 4 years and under.
Guest 5
First Name
Last Name
Adult / Child 5
Select One…
ADULT
Infant
1 Year Old
2 Year Old
3 Year Old
4 Year Old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
For child, please select grade entering Fall 2017 or the age during camp for 4 years and under.
Guest 6
First Name
Last Name
Adult / Child 6
Select One…
ADULT
Infant
1 Year Old
2 Year Old
3 Year Old
4 Year Old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
For child, please select grade entering Fall 2017 or the age during camp for 4 years and under.