Summer Camp 2010 - Boys & Girls Clubs

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2COMPLETE CA MP REGISTR ATIONCAMPER’S FIRST AND LAST NAME ___________________________________________________________________________TODAY’S DATE ________________________________________________REFER TO “CAMP AT A GLANCE” ON PAGE 11 FOR CAMP AVAILABILITYWEEK DATES NAME OF CAMP DAYS TIME LOCATION FEE1 6/14-6/182 6/21-6/253 6/28-7/24 7/6-7/9*5 7/12-7/166 7/19-7/237 7/26-7/308 8/2-8/69 8/9-8/1310 8/16-8/20Post Camp Session(Only when enrolled in Archery Camp – Week 1) Mon-Fri 12 PM-4 PM Los Cerritos Club $65.00*Camp closed on 7/5/10.TOTAL FEES:Extended care is provided free of charge when enrolled in Full-Day Programs (9 AM – 4 PM) and include the hours of 7:00 AM – 9:00 AM and 4:00 PM – 6:30 PM.METHOD OF PAYMENT: (Please do not mail cash. For mail-in and fax registrations, a receipt will be mailed.)❏ MasterCard ❏ VISA ❏ Discover ❏ Debit Card with VISA/MasterCard logo ❏ Check/Money Order - #: ________ (Make checks payable to: BGC/CLV)Print Cardholder’s First and Last Name: ______________________________________________ Signature:________________________________________VISA, MasterCard or Debit Card #:___________________________________________________ Exp Date (month/year):____________________________3READ AN D SIGN PARENT AUTHORIZATIONThis health history is correct so far as I know and the person herein described has permission to engage in all prescribed Boys & Girls Clubs Of Conejo & Las Virgenes (BGC/CLV)activities, except as noted. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the BGC/CLV Director to hospitalize, secureproper treatment for, and to order an examination, x-ray, injection, anesthesia or surgery for my child as named above. If I cannot be reached, I give my permission to the BGC/CLV,and/or its agents, to obtain whatever medical assistance is necessary for my child at my expense.The undersigned hereby agrees to defend, indemnify and hold harmless the BGC/CLV, Conejo Valley Unified School District, and its officers, employees and agents against any andall loss, liability charges, expenses (including attorney fees), and costs of whatsoever character which may arise by reason of participation in any program. (BGC/CLV does not provideaccident, medical, liability, workers’compensation insurance, or any other insurance for program participants.) I agree to carefully inspect and satisfy myself that the facilities providedare reasonably safe for their intended use. Once having conducted the inspection, I agree to expressly assume the risk of participation at the premises.• I understand the BGC/CLV retains the right to use photographs, slides or video taped material of my child taken during activities for promotional purposes.• I give permission for my child to be transported to and from program areas, on field trips, and in the case of an emergency.• I give permission for my child to walk within a one mile radius of the clubhouse with a staff member for various club activities.• I understand BGC/CLV will periodically show movies rated pg-13 or lower.• I have received a copy of the Boys & Girls Clubs Parent Handbook. I understand it is my responsibility to read the handbook, become familiar with its contents, and abide by theprogram requirements and parent responsibilities outlined in it. I have signed and provided a copy of the parent handbook agreement to the BGC/CLV. (Parent Handbook canalso be found on our website, www.bgcconejo.org.)Print name of Parent/Guardian: ______________________________________________________ Best contact number: (___________) _______________________________________10Signature of Parent/Guardian:_______________________________________________________ Date: _________________________________________________________________
NAME OF CAMPTRADITIONALDAY CAMPARCHERYBASEBALLBASKETBALLFLAG FOOTBALLSOCCERVOLLEYBALLWET 'N WILD(maximum 22 campers)TSUNAMI SPLASH(maximum 22 campers)SKATE(maximum 22 campers)FOOD FRENZY(maximum 22 campers)AMAZING ANIMALS(maximum 22 campers)A MAMMOTHEXPERIENCE(maximum 22 campers)POST-CAMP SESSIONFOLLOWING SPORTS CAMP: ARCHERYSPORTS LEAGUE:SOCCERS U M M E R C A M P AT A G L A N C EENTERINGGRADE1st - 9th5th - 9th5th - 9th5th - 9th5th - 9th3rd - 9th4th - 9th5th - 9th5th - 9th5th - 9th5th - 9th5th - 9th4th - 9th5th - 9th3yrs to6yrsWEEK1WEEK2WEEK3FEE LOCATION TIME 6/14-6/18 6/21-6/25 6/28-7/2$140$120$170$170$170$170$120$285$190$220$210$265$300$65$85LOS CERRITOSCLUBLOS CERRITOSCLUBLOS CERRITOSCLUBLOS CERRITOSCLUBLOS CERRITOSCLUBLOS CERRITOSCLUBCOLINA MIDDLESCHOOL GYMLOS CERRITOSCLUBLOS CERRITOSCLUBLOS CERRITOSCLUBLOS CERRITOSCLUBLOS CERRITOSCLUBMEET AT LOSCERRITOSCLUBLOS CERRITOSCLUBSUMACELEMENTARYSCHOOL9am-4pm9am-12pm9am-4pm9am-4pm9am-4pm9am-4pm9am-12pm9am-4pm9am-4pm9am-4pm9am-4pm9am-4pm8am12pm-4pm9am-10amWEEK4TR ADITIONAL DAY CA MPWEEK5MON-FRI MON-FRI MON-FRI TUE-FRI MON-FRI MON-FRI MON-FRI MON-FRI MON-FRI MON-FRIMON-FRIMON-FRIMON-FRISPORTS CA MPMON-FRIMON-FRITR AVELI NG CA MPMON-FRISU N DAY SPORTS LEAGU E (Six Weeks)WEEK6WEEK7WEEK8WEEK9WEEK107/6-7/9* 7/12-7/16 7/19-7/23 7/26-7/30 8/2-8/6 8/9-8/13 8/16-8/20POST-CA MP SESSION (Campers will participate in the Traditional Day Camp from 12 PM - 4 PM.)MON-FRITUE-FRI*CA MP-OUT ADVENTU REMON-FRIMON-FRIMON-FRISUNDAY7/11MON-FRIMON-FRISUNDAY7/18MON-FRIMON-FRIMON-FRISUNDAY7/25MON-FRISUNDAY8/1MON-FRISUNDAY8/8SUNDAY8/15REFUNDS. . .CANCELLATIONS. . .WITHDRAWALS. . .FEES...REFUNDS AND CANCELLATIONS: All deposits and/or payments arenon-refundable. If cancellation of a Session is due to a medical emergency, aPhysician’s note is required, minus the $25.00 Administration Fee. If you desirean account credit, there is no Administration Fee, and credit will remain onyour account for one year.WITHDRAWALS: If a camper discontinues attending the camp Session onceit has started, there will be no refunds or credits. BGC/CLV reserves the rightto dismiss a camper whose conduct is dangerous, illegal, or in the judgmentof the Camp Director, detrimental to the camp and/or to other campers. Theunused tuition will not be refunded.FINANCIAL AID IS AVAILABLE ON A CASE-BY-CASE BASIS. A CONFIDENTIAL‘REQUEST FOR FINANCIAL ASSISTANCE’ FORM IS REQUIRED TO BE COMPLETED.REQUIREMENTS INCLUDE: TOTAL INCOME OF HOUSEHOLD MEMBERS,PREVIOUS YEAR’S TAX RETURNS, AND MOST RECENT FORM OF INCOME.* Camp Closed on Mon, 7/5/10EXTENDED CARE is provided free of charge only when enrolled in Full-Day Programs (9 AM - 4 PM) and include the hours of 7:00 AM - 9:00 AM and 4:00 PM - 6 PM.visit us online: www.bgcconejo.orgFEES:• $25.00 – Annual BGC Membership Fee per child is required (if not currently a BGCmember;Registrarwillconfirmmember’sstatuspriortocompletionofregistration.• Summer Camp fees are specific to the Session (please refer to CampDescriptions or Registration Form for fee amounts.)• A Late Fee of $25.00 will be added if Session is not paid fourteen (14) daysprior to the start of the camp Session. Campers will not be permitted toattend camp if a balance remains. If a balance is not paid fourteen (14) daysprior to the Session, the child’s spot may be given to someone else if there isa waiting list.• $65.00 – Special Post-Camp Session (12 PM – 4 PM) is available whencampers are enrolled in the half-day Archery Sports Camp held at the LosCerritos Boys & Girls Club.11
Page 2 and 3: Enroll Your Childin Summer CampToda
Page 4 and 5: OUT-OF-THIS-WORLD ACTIVITIES...ALL
Page 6 and 7: A FIELD TRIP EVERY DAY OF THE WEEK!
Page 8 and 9: HIKING, CAMPFIRES, S’MORES AND MO
Page 12: Boys & Girls Clubs of Conejo & Las

Summer Camp 2010 - Boys & Girls Clubs

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