Urban Youth Impact: Summer Jam Registration 2022

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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! There will be regularly scheduled academic lesson plans, spiritual enhancement activities, field trips, life skills, and team-building challenges. 

Summer Jam times are 9:00 am- 3:30 pm, Monday through Friday. Dismissal will be 3:30 - 3:45 pm. A parent handbook is provided on the first week of Summer Jam with a calendar and important dates. Please review the handbook with  your child(ren). The handbook will be sent to you prior to enrollment for your electronic signature. 


The theme of this year's Summer Jam is:


The happiest place is the kingdom of Hesed! Hesed is a word for love in the bible that is the all encompassing love of the kingdom of God. It is a word that best describes love as an action rather than a feeling. We will be focusing on the kingdom mindset as we dive deep into the themes of God's love being enduring, steadfast, equal, and devoted. 

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 21st - July 15th, 2022. 

Summer Jam applications must be completed by Tuesday, May 31st, 2022 for guaranteed enrollment in our summer program. Please note that children currently enrolled in TLA and live in the Tamarind Avenue Corridor take priority enrollment. Applications are accepted on a first come first serve basis. 

We provide breakfast, 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. 


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


Kind regards,

Will Mydock

Programs Administrator

Daniella Darling

Program Manager

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Only one child per application. Summer Jam ages are Rising 1st-9th Grades.This application must be completed by Tuesday, May 31st, 2022. 

*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