Urban Youth Impact: Summer Jam Registration 2021

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Dear Parents/Guardians,



We are very excited that you have expressed an interest in Urban Youth Impact's summer program, Summer Jam! We are very excited for a fun filled, COVID safe and friendly summer.  There will be regularly scheduled academic lesson plans, spiritual enhancement activities, field trips, life skills, and team-building challenges all within CDC COVID guidelines. 

Summer Jam times  are from 9:00 am- 4:00 pm, Monday through Friday with a half-day on the last day. A parent handbook is provided on the first week of Summer Jam with a calendar, important dates, COVID guidelines and with a page that must be signed and returned upon reading it with your child. The fee per child is $50 for the summer. Your application is not considered complete until your payment is submitted. 


The theme of this year's Summer Jam is:


When we compare the stories of Jesus and his his disciples to those in the Marvel Superhero Universe, we can see how these stories are relevant for our lives today, and how Jesus, the true hero of the story, inspires us to be heroic in the battles of our lives. 

The goal of Summer Jam is to make camp exciting, engaging, realistic, and most of all, memorable for all the campers. 


Please read the following important information regarding Summer Jam:

Summer Jam dates are June 28-August 6th, 2021. 

Summer Jam applications must be completed by Monday, June 15, 2021 for all children who you would like to attend to our summer program. Please note that children currently enrolled in TLA and TAC students take priority enrollment and each application is accepted on a first come first serve basis. 

We provide lunch and snack everyday of Summer Jam.  In the event that we are unable to do so, parents/guardians will be required to provide lunch for their children. We do require every child wear a face mask and that every child participates in a temperature check upon entry of the building. 


If you have any other questions, comments and/or concerns, please do not hesitate to contact me at ddarling@urbanyouthimpact.com. 


Kind regards,

Daniella Darling

Programs Administrator

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Only one child per application. This application must be completed by Monday, June 15, 2021. 

*Please notify Urban Youth Impact if any of the following information changes*


Child's Information


Home Address


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Child's Info (cont'd)

If None Please type "None".

If None please type "None".

If None, please type "None".

Authorization For Insurance (Required Info)

In the event of an injury or illness that may require medical attention from a physician or clinic, please note your child's medical care must be covered by your primary health insurance carrier.  If your child is currently without healthcare coverage, you are solely responsible for any medical expenses incurred.

If no Insurance, please put None.

If None, Please type "None".

*Note that UYI will contact a different physician if we are unable to contact the child's primary care physician*
All Information is Confidential

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Family Data

Please use proper capitalization. 

Parent or Legal Guardian's Information

Please add (Name - Relationship - Phone Number)

Emergency Contact's Information


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The transportation radius listed below is our transportation zone. 

    Northbound: 36th Street

    Eastbound: Spruce Avenue/Broadway/Rosemary

    Westbound: Australian/Mangonia Circle/7th Street

    Southbound: 3rd Street

Mark N/A if not applicable

Mark N/A if not applicable
*** Please note: If you do not live in our transportation zone, it will be your responsibility to provide transportation to and from program for your child.***


Signature/Authorization to Review

Enrollment Conditions

Please note that Urban Youth Impact is making every effort to follow all health department and CDC COVID guidelines as well as to implement sanitization processes. All staff who are working with children will adhere to the CDC and health department suggested guidelines. By submitting this application, you waive the right to hold Urban Youth Impact liable should your child contract any illness or virus during their time at our summer program. 

You can submit your payment with cash or card by calling our mainline at 561-832-9220. You an also come to our main administration building and pay online. Remember, your application is not considered complete until payment is submitted.