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2011 SAMBICA Summer Camps

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					Dates & Costs
 Day Camps                                                                                                                                                                           Resident Camps




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 Classic Day Camp      $   
                          369.00        369.00
                                     $                       369.00
                                                          $                    369.00
                                                                            $               $   
                                                                                               369.00          369.00
                                                                                                            $                    369.00
                                                                                                                              $                 $   
                                                                                                                                                   369.00                              Junior Resident                479.00
                                                                                                                                                                                                                   $                 $   
                                                                                                                                                                                                                                        479.00




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 Wake Up                  235.00
                       $                235.00
                                     $                       235.00
                                                          $                    235.00
                                                                            $                  235.00
                                                                                            $                  235.00
                                                                                                            $                 $   
                                                                                                                                 235.00         $   
                                                                                                                                                   235.00                              Young Teen Resident         $   
                                                                                                                                                                                                                      479.00




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                                                                     Adventure Camps




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                         419.00
 H2O Extreme Day Camp $   




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                                                                                                                                                                                                               485.00
                                                                                                                                                                                       H2O Extreme Resident $                           485.00
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                                                                      Leavenworth                  594.00
                                                                                                $   
                                                                                                                                                                      ELITE Programs
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 Little Tikes             320.00
                       $   




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                                                                                          594.00
                                                                      Stonewater Ranch $                         $   
                                                                                                                    594.00                                            Staff in Training (SIT)             270.00 $   
                                                                                                                                                                                                       $            270.00                  270.00
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                                                                                                                                                                      Leader in Training (LIT)            445.00 $   
                                                                                                                                                                                                       $            445.00                  445.00
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                                                                                                                                                                      Counselor in Training (CIT)         315.00 $   
                                                                                                                                                                                                       $            315.00                  315.00
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                                                                                                                                                                      Program Asst in Training (PIT)      315.00 $   
                                                                                                                                                                                                       $            315.00                  315.00
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                                                                                                                                                                      Junior Counselor | Choose a minimum of 3 weeks. $ 385.00
                                                                      Tygh Valley                  594.00
                                                                                                $                   594.00
                                                                                                                 $   




4114 W Lake Sammamish Pkwy SE
Bellevue, WA 98008
1-888-SAMBICA

Register Now: www.sambica.com




    “The Snoqualmie Valley School District neither sponsors nor endorses
    this event and the District assumes no responsibility for it.”




                                                                                                                                                                                                           Summer
                                                                                                                                                                                                            Camp
                                                                                                                                                                                                            2011
                                                                                                                                                                                                       • Day Camps
                                                                                                                                                                                                       • Resident Camps
                                                                                                                                                                                                       • Adventure Camps
                                                                                                                                                                                                       • ELITE High School
                                                                                                                                                                                                         Leadership Program


                                   www.sambica.com
There’s always plenty
of fun at SAMBICA!




Shaping Hearts & Changing Lives...                                                           SCHOLARSHIP | NEVER AN EMPTY SPACE
                               ABOUT US                                         The goal of the “Never an Empty Space” Scholarship Fund is to make
Headed into our 92nd year, SAMBICA is blessed to have the opportunity           camp available for every child regardless of financial situation. If you or
to affect the lives of area children helping them build friendships, gain       someone you know could benefit from this fund, please download an
leadership skills and grow in their relationship with Jesus. SAMBICA is         application from the web site at: www.sambica.com.
known for hiring caring and engaging counselors who love to invest in           Would like to help a child go to camp this summer? Visit our web site at:
the future of our campers. Add in jam-packed days of swimming, tubing,          www.sambica.com/support to donate.
archery, high ropes, games & much more and you get an exciting and safe         All proceeds designated to scholarships
camp experience for your kids.                                                  will help us give the gift of camp to
                                                                                deserving kids.
                               OUR STAFF
We tell our summer staff that working at SAMBICA is the “toughest job                        DISCOUNTS
you’ll ever love” and they tell us summer after summer that it is! SAMBICA      One discount per camp session. The
is truly a generational place with many of our counselors sending their         Early Bird Discount may be applied along
own children to camp here!                                                      with 1 other discount. Discounts must be
                                  We go to great lengths to recruit caring,     requested at the time of registration; they are not applied automatically.
                                  college-age staff that demonstrate a          Early Bird Discount: Receive $20 off registration for each camp session
                                  heart for serving children, are emotionally   when paid in full by June 1st. Registration and final payment must be
                                  and spiritually mature and exercise good      postmarked by 6/1/11.
                                  judgment. All applicants go through           First Timer Discount: Receive $25 off the registration fee of the first week
                                  a comprehensive selection process             of camp for a camper who has never been to camp at SAMBICA.
                                  including a detailed application, in-
                                                                                Multiple Week/Family Plan Discount: Families registering for 3 or more
                                  depth interview, personal & professional
                                                                                camp sessions receive $35 off the 3rd camp session and each additional
                                  references and a background check.
                                                                                camp session after that. Children must be siblings and reside in the same
                                  We want you to feel completely secure
                                                                                household.
sending your kids to SAMBICA.



Program Details
              DAY CAMPS All day camps run Monday — Friday                            ADVENTURE CAMPS Includes High Ropes activity at SAMBICA.
Classic Day Camp (entering grade 1 — 5)                                  Leavenworth Adrenaline Camp (entering grade 6 — 12)
Campers enjoy a variety of age-appropriate activities each day including This thrill-charged off-site program includes a week of hiking, rock climbing,
                                                                         team-building, and river rafting. Also included is a stop in beautiful
the flying squirrel activity on our high ropes course (8am — 5pm). Includes
an optional Thursday B-B-Q and overnight stay.                           Leavenworth, WA.
                                                                         Tygh Valley Camp (entering grade 6 — 12)
Little Tikes Day Camp (entering grade 1 — 3)
                                                                         Hiking, climbing, and TWO days of river rafting hosted at our Oregon location.
Engaging programming and activities for our youngest campers. Each day Experience the sights and thrills of Tygh Valley!
(8am — 4:15pm) includes interaction and fun with special characters.     Stonewater Ranch Saddleback Camp (entering grade 6 — 12)
H2O Day Camp (entering grade 4 — 8)                                      Love horses? This off-site program gives you the chance to ride some of the
Longer days (8am — 6pm) include more waterfront time, more tubing, most breath-taking trails in the Northwest under the guidance of top-notch
and more watersports time!                                               instructions. All skill levels welcome.
Wake Up (entering grade 4 — 12)                                                       RESIDENT CAMPS Overnight camps run Sunday — Friday.
Intense wakeboard instruction for all skill levels mornings 7am — 9am. Junior Resident Camp (entering grade 4 — 6)
Light dock-side breakfast is served.
                                                                         The days are packed with all the on-site activities SAMBICA offers including
                                                                         tubing, water activities, ropes course, relevant speakers and more.
                  ELITE LEADERSHIP PROGRAM                               Young Teen Resident Camp (entering grade 7 — 9)
The ELITE program is a wonderful opportunity for high school students to Campers enjoy a variety of on-site activities including tubing, water activities,
work within a team while gaining leadership skills and earning volunteer ropes course, team competitions, games, relevant speakers and more.
hours for school — all within SAMBICA’s unique outdoor setting.          H2O Resident Camp (entering grade 6 — 9)
For more information about various ELITE program offerings please visit Experience the ultimate in watersports with more water activities and extra
www.sambica.com/camps.                                                   time on our ski boats in addition the all the fun camp has to offer.
                                                     SAMBICA 2011 · SUMMER CAMP REGISTRATION FORM
              4114 W Lk Sammamish Pkwy SE · Bellevue, WA 98008 · Ph: (425) 746-9110 · Fax: (425) 746-7082 · www.sambica.com
 • Complete one form per camper and mail or fax, along with payment in full or a $50 non-refundable deposit per camper, per session.
 • PAYMENT IS DUE IN FULL BY JUNE 1st. If registering after June 1st, payment in full will be due at time of registration.
 • Registration Acknowledgement and Parent Handbook will be mailed within two weeks after registration is processed.
 • Scholarships may be available based on financial need. Please contact our main office for more details.
 • Transfers may be allowed based on availability for a $15 processing fee. Please see the Parent Handbook for other important information.
 CAMPER INFORMATION
Camper First Name:                                                                                        Camper Last Name:
Camper Address:                                                                              City:                                      State:           Zip:
      Male:               Date of Birth:                                        Grade Next Fall:                          Cabin buddy requests: (Buddies must be of the same gender
                                                                                                                          and grade, and must be mutual. Only 2 requests will be honored.)
  Female:                 School:                                                                                                                                      &

 PARENT/GUARDIAN INFORMATION
Primary Parent/Guardian First Name:                                                                                     Last Name:
Address:                                                                                                  City:                                                 State:                    Zip:
Home phone:                                                                    Work phone:                                                        Cell phone:
Email:                                                                                                    Relationship To Camper:
Secondary Parent/Guardian First Name:                                                                                   Last Name:
Address:                                                                                                  City:                                                 State:                    Zip:
Home phone:                                                                    Work phone:                                                        Cell phone:
Email:                                                                                                    Relationship To Camper:
 EMERGENCY CONTACTS’ INFORMATION (In the event that parent/guardians listed above cannot be reached)
Name:                                                                           Home #:                                                           Cell #:
Name:                                                                           Home #:                                                           Cell #:
 CARPOOL INFORMATION (In addition to parents/guardians only people listed will be able to pick up your child. Photo ID required)
1.                                                                                                        2.
3.                                                                                                        4.
 HEALTH INFORMATION (Please use additional paper if necessary)
Allergies:
List all medications & instructions:
Special needs/concerns:
Tetanus booster:               Yes         No (If unsure, was it within the last 5 years?                      )    Are all immunizations up to date?                         Yes         No
Health insurance carrier:                                                                    Policy holder’s name/Date of birth:
Family physician name:                                                                                     Family physician phone:
 WAIVER AND RELEASE FROM LIABILITY
1. The undersigned parents or legal guardians (“Parent”) grants permission for their son or daughter (“Camper”) to participate in SAMBICA camp programs and all its associated activities, unless stated otherwise
in writing to SAMBICA. This may include but is not limited to, boat activities, water activities and high ropes course.
2. The Parent agrees that health information is correct to the best of his or her knowledge. The Parent gives permission to SAMBICA and its designated medical staff to give the Camper over-the-counter medica-
tions, such as Tylenol, Pepto-Bismol, etc. unless otherwise stated in writing to SAMBICA. In an emergency, the Parent grants permission to hospitalize, to secure proper treatment for, and to order injection, anes-
thesia or surgery for the Camper in the event that SAMBICA is unable to contact the Parent. The Parent agrees to assume the responsibility for any charges incurred in the event that the Camper should need any
medical attention; this includes all costs associated with transportation, rescue and other related expenses incurred on behalf of the Camper.
3. The Parent consents for the Camper to be transported in a vehicle and/or boat, with the understanding that the vehicle/vessel will be driven by a trained and qualified SAMBICA staff member for the purpose of
some camp activities. (SAMBICA staff members will use their best efforts to ensure that Camper’s wear seat belts or life jackets at all times while being transported in SAMBICA vehicles or boats.)
4. The Parent recognizes that photographs, video and interviews of the Camper may be taken during the camp session. The Parent gives permission for SAMBICA to use the recorded sounds and images of the
Camper in any media publication for the purpose of advertising, promotion and marketing of SAMBICA. The Parent agrees that all rights to the recordings and images belong to SAMBICA. The Parent also consents
for the Camper to be included in the weekly camp picture and camp DVD, unless stated otherwise in writing to SAMBICA.
5. The Parent releases the corporation of SAMBICA and its directors, officers, employees, agents and volunteers from and against any and all claims for personal injury, property damage and any other losses and
damages that the Camper or Parent may suffer as a result of the Camper’s participation and/or enrollment in SAMBICA programs.
6. The Parent, for themselves and for the Camper, will defend, indemnify and hold SAMBICA, its directors, officers, employees, agents, and volunteers harmless from any and all third party claims, injuries, dam-
ages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Camper’s participation in SAMBICA’s programs, unless caused by SAMBICA’s sole negligence. In any claim
or lawsuit for damages arising from the Camper’s participation in SAMBICA’s programs, each party shall pay all its legal costs and attorney’s fees incurred in defending or bringing that claim or lawsuit, including
all appeals.
I have read, completed, and fully understand the above information.
Parent / Guardian Sign Here X                                                                                                                                   Date
 How did you hear about SAMBICA?                                I am a Returning Camper                        Friend/Family               Mailing            Website            Radio           Other

 How many years has this camper been attending SAMBICA summer camps?                                                          1st year           2 years           3        4       5        More: ____
CAMP SELECTION


Classic Day Camp                                     Junior Resident Camp                                               Staff in Training
(entering 1st - 5th grades)                          (entering 4th - 6th grades)                                        (entering 9th - 10th grades)
      June 20 - 24                  $369                  July 10 - 15                          $479                          June 19 - July 8                 $270
      June 27 - July 1              $369                  July 24 - 29                          $479                          July 10 - 29                     $270
      July 4 - 8                    $369             Young Teen Resident Camp                                                 July 31 - Aug 19                 $270
      July 11 - 15                  $369             (entering 7th - 9th grades)
      July 18 - 22                  $369                  July 31 - Aug 6                       $479                    Leader in Training
                                                                                                                        (entering 10th-11th; Includes Wilderness Exp.)
      July 25 - 29                  $369             H2O Extreme Resident Camp
                                                     (entering 6th - 9th grades)                                              June 19 - July 8                 $445
      Aug 1 - 5                     $369
                                                          June 26 - July 1                      $485                          July 10 - 29                     $445
      Aug 15 - 19                   $369
                                                          July 17 - 22                          $485                          July 31 - Aug 19                 $445

Little Tikes Day Camp
(entering 1st - 3rd grades)                                                                                             Counselor in Training /
      Aug 8 - 12                    $320                                                                                Program Assistant in Training
                                                     Leavenworth Adrenaline Camp (Held Offsite)                         (entering 11th-12th; Application process required)
                                                     (entering 6th - 12th grades; Additional paperwork required)              June 19 - July 8                 $315
H2O Extreme Day Camp
(entering 4th - 8th grades)                               Jun 20 - 24                           $594                          July 10 - 29                     $315
      Aug 8 - 12                    $419                                                                                      July 31 - Aug 19                 $315
                                                     Stonewater Ranch Horseback Camp (Held Offsite)
Wake-Up                                              (entering 6th - 12th grades; Additional paperwork required)
                                                          July 4 - 8                            $594                    Junior Counselor
(entering 4th - 12th grades — 7am to 9am)                                                                               (entering 12th; Application process required)
      June 20 - 24                  $235                  Aug 15 - 19                           $594                          3+ variable weeks                $385
      June 27 - July 1              $235
      July 4 - 8                    $235             Tygh Valley Adrenaline Camp (Held Offsite)
                                                     (entering 6th - 12th grades; Additional paperwork required)
      July 11 - 15                  $235
                                                          July 11 - 15                          $594                          Early Bird Discount
      July 25 - 29                  $235
      Aug 1 - 5                     $235                  Aug 1 - 5                             $594                    Save $20 by paying in full before
      Aug 8 - 12                    $235                                                                                           June 1st.
      Aug 15 - 19                   $235


PAYMENT INFORMATION

  C                                                     Total Tuition Due (For all selected camps above):          $
  A                                Minus Early Bird Discount (Account must be paid in full by June 1st):           -$20.00 x           (# of camps) = $
  M
  P            Minus Applicable Discounts or Gift Certificate (See sambica.com for more details):                  -$                 Discount Name:

            Camp Store Funds (All funds available during first camp attending; Average: $10 per camp):             $

  E       Extended Care (Classic Day & Little Tikes AM $25 | Classic Day PM $15 / Little Tikes PM $25):            $
  X
  T                                                        Picture Order (8x12 print of whole camp) ($7):          $7.00 x             (# of camps) = $
  R                Photo CD (All pictures taken during camp session, including a cabin group picture) ($13):       $13.00 x            (# of camps) = $
  A
  S                                                                                  Care Package ($20):           $20.00 x            (# of camps) = $

                                 Scholarship Donation (Please help a less fortunate child attend camp):            $

                                                                                                 TOTAL:            $

      TOTAL PAYING TODAY (Minimum $50 Deposit PER CAMP SESSION, Balance Due June 1st):                             $

PAYMENTS We accept VISA, MasterCard, Discover or American Express. Please make checks payable to SAMBICA.
Credit Card # /
                                                                                    Exp Date
Check #
                                                                 Authorized
Name on Card
                                                                 Signature
          4114 W Lk Sammamish Pkwy SE · Bellevue, WA 98008 · Ph: (425) 746-9110 · Fax: (425) 746-7082 · www.sambica.com

				
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