2010 DAY CAMP APPLICATION AGREEMENT

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2010 DAY CAMP APPLICATION AGREEMENT Powered By Docstoc
					                                                                       PENINSULA BAY CITIES DAY CAMP
                                                 P.O. BOX 5229, PALOS VERDES, CA 90274 (310) 541-3664 (310) 541-3125 fax                           info@pbcdaycamp.com
                                                                                    www.PBCDayCamp.com

                                          2010 DAY CAMP APPLICATION & AGREEMENT
PARENT/GUARDIAN

Last Name ________________________________ First Name ____________________________ E-Mail_____________________

Home Address ________________________________________ City __________________________ State ____Zip ___________

Home Phone (____) _______________ Work Phone (____) ____________________ Mobile Phone (____) ___________________

    This year will be our _______ summer at PBC Day Camp.                                  We first learned about PBC from_______________________.

                         PLEASE RESERVE A SPACE FOR MY CHILD (CHILDREN) IN THE PROGRAM & SESSION INDICATED BELOW
  Complete the Camper information for each child. Place an “X” in the box to the right of the desired program and below the desired dates.
Camper #1                                                                                Age           Gender                   Date of                   Grade in                 T-Shirt
                                                                                                                                Birth                     Fall ‘10                 Size
Name:
                                                                            Pre-Camp        Week 1      Week 2       Week 3       Week 4        Week 5    Week 6 Week 7            Week 8
Programs                                        Session Dates               6/14-6/18      6/21-6/25    6/28-7/2     7/5-7/9     7/12-7/16     7/19-7/23 7/26-7/30 8/2-8/6         8/9-8/13

Traditional Day Camp                     (4 years old thru 8th Grade)        Pre-Camp       Week 1       Week 2       Week 3         Week 4     Week 5      Week 6        Week 7    Week 8

AdventureTrek                                     (5th thru 8th Grade)                            Session 1                Session 2                  Session 3               Session 4

Academic Enrichment                                (K thru 4th Grade)                          Beneath the Sea         Rocks & Fossils              NatureNauts           Crazy Chemistry

Sports Specialty                                 (2nd thru 8th Grade)                              Archery                  Tennis                    Soccer                Basketball

Horsemanship                                     (2nd thru 8th Grade)        Pre-Camp             Session 1                Session 2                  Session 3               Session 4

Golf Academy                                     (2nd thru 8th Grade)        Pre-Camp             Session 1                                                                   Session 4


Camper #2                                                                                Age           Gender                   Date of                   Grade in                 T-Shirt
                                                                                                                                Birth                     Fall ‘10                 Size
Name:
                                                                            Pre-Camp        Week 1      Week 2       Week 3       Week 4        Week 5    Week 6 Week 7            Week 8
Programs                                        Session Dates               6/14-6/18      6/21-6/25    6/28-7/2     7/5-7/9     7/12-7/16     7/19-7/23 7/26-7/30 8/2-8/6         8/9-8/13

Traditional Day Camp                     (4 years old thru 8th Grade)        Pre-Camp       Week 1       Week 2       Week 3         Week 4     Week 5      Week 6        Week 7    Week 8

AdventureTrek                                     (5th thru 8th Grade)                            Session 1                Session 2                  Session 3               Session 4

Academic Enrichment                                (K thru 4th Grade)                          Beneath the Sea         Rocks & Fossils              NatureNauts           Crazy Chemistry

Sports Specialty                                 (2nd thru 8th Grade)                              Archery                  Tennis                    Soccer                Basketball

Horsemanship                                     (2nd thru 8th Grade)        Pre-Camp             Session 1                Session 2                  Session 3               Session 4

Golf Academy                                     (2nd thru 8th Grade)        Pre-Camp             Session 1                                                                   Session 4


  TRANSPORTATION
  _____ I WILL DELIVER my child to the camp between 8:30 and 8:55 AM and call for him or her promptly at 3:30 PM.
                 If you wish transportation for your child please check your preference. A transportation card with specific locations will be provided for each child.
  _____ DOOR TO DOOR TRANSPORTATION - $110 child per week. Address: ____________________________________
                                                                                                                                               AFTER SCHOOL CLUB
  EXPRESS TRANSPORTATION to and from the camp is available from (select one) - $65 per child per week.                                for Miraleste Intermediate Summer School
              Manhattan Heights Park, Manhattan Beach                    Live Oak Park, Manhattan Beach                              _____Please enroll my child in After School Club
              To Be Determined             _____Please Enroll my child(ren) in Peninsula Club (Extended Day) - $90 per wk                      Four Week Session $575


                                  DEPOSIT, TUITION PAYMENT, and AGREEMENT TO TERMS
___ Enclosed, please find a check for my child's deposit of $_______                      ___ Enclosed, please find a check for my child's entire tuition of $ ______
___ Please charge my child's deposit of $_______                                          ___ Please charge my child's entire tuition of $_______
                     VISA / MASTERCARD # ____________/____________ /____________/_____________ Exp. Date ________
Cardholder Billing Address ____________________________________________City _____________________ State______ Zip ______________

I have read, I understand, and I agree to all of the terms and conditions contained on the reverse side of this form. I further understand that
a deposit of $250.00 (per child) will hold and reserve the programs indicated above and any remaining balance is due in full no later than the
date specified herein. I understand and agree that there will be NO REFUNDS other than those provided for on the reverse side of this form.
Any questions about the tuition, payment of fees, policies, activities, and operations of Peninsula Bay Cities Day Camp have been answered
to my satisfaction.
Parent/Guardian Signature __________________________________________________________________ Date _______________________
      Please carefully read the following Terms & Conditions of Enrollment which represent the entire agreement
     between the parent or guardian identified on the reverse side of this form and Peninsula Bay Cities Day Camp.

REGISTRATION: Upon receipt of this application and deposit of $250 per child, a packet of Registration forms will be provided for each child. Camp enrollment
will be complete only when all Registration forms have been completed and returned to the camp. Enrollment is by full session only.
PAYMENT OF TUITION AND FEES: It is understood and agreed that all tuition and fees are due and payable in advance by June 1, 2010. Tuition for enrollments
received after June 1, 2010 will be due in full and in good funds at the time of enrollment.
CANCELLATION: The entire tuition, including deposit, will be refunded when WRITTEN NOTICE of cancellation is received by May 1, 2010. Cancellations
received between May 2, 2010 and June 13, 2010 will result in a forfeiture of all deposits.
ABSENCE AND EARLY WITHDRAWAL: I understand that Peninsula Bay Cities (PBC) Day Camp has a limited enrollment, trained full time staff and
fixed operating costs; and that these commitments remain the same regardless of individual camper attendance. Therefore, once the camp season has started (June 14,
2010), I understand that:
1.     THERE WILL BE NO MAKE-UP DAYS OR REFUNDS GIVEN FOR ABSENCE, OR ILLNESS REGARDLESS OF CIRCUMSTANCES.
2.     IN THE EVENT ANY CIRCUMSTANCE NECESSITATES THE EARLY WITHDRAWL OF MY CHILD FROM THE CAMP PROGRAM, THE
       CAMP AND I SHALL SHARE EQUALLY IN THE LOSS, AND FIFTY PERCENT (50%) OF THE UNUSED TUITION SHALL BE REFUNDED.
LATE CHARGES - A late charge of $5.00 for each five minutes, or portion thereof, will be charged parents, for children not been picked up by 3:55 P.M.



ACTIVITIES AND PARTICIPATION - Swimming, sports, and vigorous outdoor and recreational activities are integral parts of the camp program. Campers are
encouraged to participate in all activities deemed appropriate for their age and ability. Any physical activity carries hazards proportional to its respective degree of
difficulty; however, the camp administration believes that with proper instruction and supervision, the benefits derived far outweigh the hazards. Without the full
support and confidence of the parent in all aspects of the program, the child cannot derive full benefit as he or she often reflects the parent's fears. Therefore, if you do
not wish your child to participate in any given activity, please notify Peninsula Bay Cities Day Camp, IN WRITING, of those activities in which you do not wish
your child to participate. Any camper who engages in camp activities assumes the risk of potential injury arising from the same. All parents and guardians are
recommended to have their child/camper obtain a complete medical physical before the applicable camp session, and report any adverse findings to the camp.

       If my child is accepted for enrollment, I agree that:
       1.   I understand and certify that my child's participation in Peninsula Bay Cities is completely voluntary and I have familiarized myself with the camp's
            program, policies and activities. Unless the Camp is notified, IN WRITING, my child may participate in all appropriate activities.
       2.   I will notify Peninsula Bay Cities Day Camp IN WRITING if my child has any physical limitations or allergies of any kind. This includes “food
            allergies” and “bee” or insect bite allergies.
       3.   I agree to hold harmless, indemnify, and defend Peninsula Activities Incorporated, DBA Peninsula Bay Cities Day Camp, its officers, employees, and
            agents for and from all liability, claims, expenses, demands, fees, judgments and/or damages arising directly or indirectly from my child's participation in
            camp programs or at any time my child is on the activity premises of Peninsula Bay Cities Day Camp, save and except claims arising out of the sole willful
            misconduct of Peninsula Bay Cities Day Camp. I will reimburse Peninsula Bay Cities Day Camp, its officers, staff, employees or agents for all expenses
            including reasonable attorney fees for all such claims made.
       4.   If my child requires medical attention, Peninsula Bay Cities Day Camp has my authorization to obtain it from any licensed physician or hospital as the
            Camp deems necessary and the Camp may act in my place in this regard. I shall be responsible for all physicians, hospital and medical charges incurred. If
            feasible, the Camp will attempt to contact the parent/guardian before seeking medical services.
       5.   Peninsula Bay Cities Day Camp may use my child's photograph or electronic likeness in promotional materials.
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            Camper Standards of Behavior: Campers are expected to treat other campers and staff with respect at all times, and value
            each individual’s right to have a positive and fun experience.
            THE FOLLOWING BEHAVIORS AND ARTICLES ARE NOT PERMITTED AT PENINSULA BAY CITIES DAY CAMP:
            ·    Teasing, taunting, threatening, discriminating comments, gender-based or sexual harassment or violence of any kind.
            ·    Use of foul language or discussion of inappropriate topics as determined by the Camp Directors.
            ·    Possession or use of tobacco, alcohol, or illegal drugs. Camper medications will be stored in and dispensed from the office.
            ·    Abusive or disrespectful behavior towards any member of the camp community.
            ·    Possession or use of personal electronic equipment (mobile phones, electronic games, CD/MP3 devices), weapons of any kind, and animals is
                 strictly prohibited while at camp.
            ·    Clothing with any logos or graphics depicting violence, drugs, alcohol, or inappropriate language, gestures or topics.
                            The Camp reserves the right to immediately and summarily dismiss any camper whose behavior is disruptive
                                               or not in the best interest of the group and no refund will be given.


CONFIRMATION PACKAGE: The Day Camp handbook, a REGISTRATION/EMERGENCY FORM, TRANSPORTATION INFORMATION CARD, and
LUNCH PROGRAM information will be sent following receipt of this application. Registration will not be complete and confirmed until the REGISTRATION and
EMERGENCY HEALTH HISTORY information and other applicable forms have been completed and returned.