Basic InformationPlease enter the contact information for your WorkGroup (church, school, business, etc.). Name Phone Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Coordinator InformationPlease enter the contact information of the coordinator or director of your particular WorkGroup. Name Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Home Phone Work Phone Cell Phone Email Emergency Contact InformationPlease enter emergency contact information for an individual who is NOT part of your WorkGroup. Name Home Phone Work Phone Arrival & DeparturePlease provide your tentative date and time of arrival and departure. This assists us in coordinating your particular WorkGroup schedule. During summer, groups typically arrive mid-afternoon on Sunday and depart by 10:00 a.m. the following Saturday. During the school year, groups usually arrive on Sunday between 3:00 and 4:00 p.m. and depart the following Friday afternoon or Saturday morning. The following dates available are: July 5- 8 at reduced cost of $225, July 9 - 14, July 16 - 21 , July 23- 28, July 30 – August 4, and Aug 6 -11. Requested Dates Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Notes: WorkGroup Fees UrbanPromise's one-week WorkGroup trips costs $375 a person. These fees fund work supplies, lodging, utilities, and administrative costs associated with the WorkGroup Program, AfterSchool Program, and Summer Camps. A $100 deposit is due within 30 of submitting this application, $500 is due 60 days prior to your start date. The balance is due upon arrival. Number of WorkGroup Participants Teens Adults Males Females Special SkillsPlease select any special skills members of your group possess. If a skill is not listed, select "other" and enter it in the space provided. Skills Masonry Carpentry Electrical Plumbing Landscaping Auto Drywall Painting Other Other TransportationPlease indicate how your WorkGroup intends to travel to Camden, NJ. If you intend to fly, please plan to rent a vehicle to travel around the city. Traveling Options Car Van Bus Plane T-Shirts WorkGroup t-shirts aid UrbanPromise youth and staff to identify your group members while on our campus. One t-shirt per person is included in your WorkGroup fee. Please place your t-shirt order two weeks in advance from our provider, Printworks, by calling (856) 365-1424. Exact size orders are required. Sizes range from 3XL, 2XL, XL, L, M, and S. Additional t-shirts can be ordered at an additional cost. Submit Application Please review the information entered for accuracy. If everything is in order, click the "Submit" button to send us the completed form. Leave this field blank
