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					                                                               OASIS SUMMER CAMP
                                                                2009 Enrollment Forms

  STEP 1: Child/Parent Information:


     Child’s Last Name____________________________________ First Name__________________________________ MI__________
     Parent/Guardian Last Name_____________________________ First Name______________________________________________
     Home Address______________________________________City___________________________State_________Zip__________
     Relationship to Child_______________________________ Email Address______________________________________________
      Home Phone #_________________________________________ Other Phone #_________________________________________
      Birth date______/______/______ Grade_______ Age________ Sex M F School____________________________________

      Responsible for payment: (circle) Parent/Guardian       Other: (specify) ________________________________________________

              Guardians will be held responsible for all payments not collected from other specified entities listed on form above.



  STEP 2: Circle the week(s), and day plan your child will be attending Oasis Summer camp.

Age Group:                  6 -8                    9 - 12                    13 - 14

                      Circle Weeks                                       Circle Plan

                                           Daily M           Week           Week         4 Weeks                                      Camp
  Week #                Dates                                                                           4 Weeks **        10 Wk
                                            TWTF            1/2 day        Full day      1/2 day **                                   Total
      1           June 15 - June 19           $35.00        $100.00        $162.50

      2           June 22 - June 26           $35.00        $100.00        $162.50

      3            June 29 - July 2           $35.00        $100.00        $162.50

      4             July 6 - July 10          $35.00        $100.00        $162.50         $370.00       $595.00

      5            July 13 - July 17          $35.00        $100.00        $162.50                    camp:

     6
    Week #         July 20 - July 24
                                  Dates       $35.00                   $162.50
                                                            $100.00 plan 3 day plan
                                                              2 day                              4 day plan        5 day plan

      7            July 27 - July 31 - June $35.00
                           June 15          19              $100.00
                                                                 $75.00 $162.50
                                                                              $105.00                $130.00       Not available
    Week 1
      8    August 3 - August 7     $35.00                   $100.00     $162.50     $370.00     $595.00
                    June 22 - June 26                            $75.00       $105.00       $130.00       $150.00
   Week 2 August 10 - August 14
     9                             $35.00                   $100.00     $162.50
                     June 29 - July 2
                                                                 $75.00       $105.00       $130.00     Not available
    10
   Week 3 August 17 - August 21 July 3rd)
                 (closed Friday    $35.00                   $100.00     $162.50                              $1,487.50
** 4 Weeks can include your choice of any four weeks - does not have to be consecutive
                             July 6 - July 10                     $75.00           $105.00           $130.00
                                                                                                                      Subtotal
                                                                                                                     $150.00
    Week 4
                            July 13 - July 17                     $75.00           $105.00           $130.00         $150.00
    Week 5
  STEP 3: Amount Due
                          July 20 - July 24                    $75.00             $105.00            $130.00         $150.00
   Week 6
Line 1: Subtotal Fees for Oasis Summer Camp                                                                              $__________
                          July 27 - July 31                    $75.00             $105.00            $130.00         $150.00
   Week 7
Line 2: $35 Registration fee per child (Non-refundable/non-transferrable and includes T-shirt)                           $__________
                        August 3 - August 7                    $75.00             $105.00            $130.00         $150.00
   Week 8
Line 3: Drop in hourly rate (minimum 10 hours deposit)                                                                    $__________
                      August 10 - August 14                    $75.00             $105.00            $130.00         $150.00
   Week 9
Total Due Today: (Add lines 1, 2, & 3)                                                                                   $__________
                         August 17 - August 20                    $75.00           $105.00           $130.00       Not available
   Week 10
                                                               OASIS SUMMER CAMP
                                                                2009 Enrollment Forms

Child’s Last Name______________________________________ First Name_______________________________________ MI__________
Home Address_________________________________________City______________________________State_________Zip_____________
Birth date_______/______/______ Grade___________ Age___________ Sex M F School______________________________________

Parent/Guardian Last Name__________________________________ First Name_________________________________________________
Address________________________________________________City____________________________State_________Zip______________
Relationship to Child_____________________________________ Email Address_________________________________________________
Phone Number__________________________________________ Business Phone________________________________________________

2nd Parent/Guardian Last Name_____________________________ First Name____________________________________________________
Address________________________________________________City_____________________________State_________Zip_____________
Relationship to Child_____________________________________ Email Address_________________________________________________
Phone Number__________________________________________ Business Phone________________________________________________

EMERGENCY CONTACTS (People who are authorized to pick up your child, and in your absence, may be contacted in case of an emergency)
Name____________________________________ Relationship_____________________________ Phone Number_______________________
Name____________________________________ Relationship_____________________________ Phone
Name____________________________________ Relationship_____________________________ Phone Number_______________________

Do you carry family medical/hospital insurance? Yes No Carrier_______________________________ Group #________________
Doctor’s Name______________________________________ Doctor’s Phone #__________________________________________________
Dentist’s Name______________________________________ Dentist’s Phone #__________________________________________________

Has your child had the necessary vaccinations required by school?        Yes       No

Has your child had any of the following? If so, please explain. (If more space is needed please attach a separate page).
Operations or serious injuries?___________________________________________________________________________________________
Chronic or recurring illness?_____________________________________________________________________________________________
Allergies or dietary restrictions?__________________________________________________________________________________________

  Is your child taking medications? Yes        No      Will your child need medication administered during the camp day? Yes No
  List medications and dosage._______________________________________________________________________________________________________
  Provide a brief description of your child’s condition(s).__________________________________________________________________________________
  ______________________________________________________________________________________________________________________________

Status of child’s vision, hearing, and speech? _______________________________________________________________________________

Any specific activities to avoid?   Yes       No If so, what and why___________________________________________________________

Are there any behaviors/concerns that Avila Hot Springs staff should be aware of?__________________________________________________

Does your child have a communicable disease or condition, which may prove to be a risk to others? Yes No
If yes, please comment_________________________________________________________________________________________________

Other significant information about your child that would be helpful to know?_____________________________________________________

Parent’s Authorization
In the event that my child need immediate medical attention for injuries received while participating in an Avila Hot Springs program, I give my
permission for Avila Hot Springs staff members to administer necessary medical treatment. Avila Hot Springs staff may also admit my child to a
hospital emergency room for emergency medical treatment without my consent if I cannot be reached to give permission.
Hospital Preferred_______________________________________________City__________________________________________________

I hereby give my consent to the Avila Hot Springs and it’s designated leaders to transport my child (named above) by means of walking, public
transportation, private bus companies, and Avila Hot Springs vehicles on walking trips, community service learning projects, and field trips with
the understanding that such trips are under supervision of authorized personnel of the Avila Hot Springs and that all possible precautions are taken
to insure the health and safety of my child.




  __________________________________________ _________________________________________ _________________
  Signature of Parent or Guardian            Print Name of Parent or Guardian           Date
                                         OASIS SUMMER CAMP
                                          2009 Enrollment Forms
                      RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEEMENT
             In consideration of being permitted to utilize the facilities, services, and programs of Avila Hot Springs for any purpose, including, but
not limited to observation or use of facilities or equipment, or participation in any sports activity or off-site program affiliated with the AVILA
HOT SPRINGS, or off-site program affiliated with the AVILA HOT SPRINGS, the undersigned, for himself or herself and any personal
representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or
participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into
the AVILA HOT SPRINGS for observation or use of facilities or equipment thereon and such affiliated program have been inspected and carefully
considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use of
participation.

          In further consideration of being permitted to enter AVILA HOT SPRINGS for any purpose including,
but not limited to, observation or use of facilities or equipment, or participation in any off-site program affiliated
with the AVILA HOT SPRINGS, the undersigned hereby agrees to the following:

           The undersigned hereby releases, waives, discharges and covenants not to sue
            1.
AVILA HOT SPRINGS, its directors, officers, employees and agents (hereinafter referred to as “releasees”) from all liability to the
undersigned, his or her personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on
account of injury to the person or property or resulting in death of the undersigned, whether caused in whole or in part by the negligence of the
releasees or otherwise while the undersigned is in, upon or about the premises of any facilities or equipment therein or participating in any program
affiliated with AVILA HOT SPRINGS.

             2.         The undersigned hereby agrees to defend, indemnify, save and hold harmless the releasees and each
of the from any loss, liability, damage or coast they may incur, including attorneys’ fees and cost of suit due to the presence of the undersigned in,
upon or about AVILA HOT SPRINGS premises or in any way observing or using any facilities or equipment of AVILA HOT SPRINGS or
participating in any program affiliated with AVILA HOT SPRINGS, whether caused by the negligence of the releasees or otherwise.

         3.    The undersigned hereby assumes full responsibility for and risk of bodily injury, death, or
property damage due to negligence of releasees or otherwise while in, about or upon the premises of AVILA HOT SPRINGS and/or while
using the premises or any facilities or equipment thereon or participating in any program, sport, or activity affiliated with AVILA HOT SPRINGS.

             The undersigned further expressly agrees that the foregoing release, waiver and indemnity agreement is intended to be as broad and
inclusive as is permitted by law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall,
notwithstanding, continue in full legal force and effect.

       THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER
OF LIABILITY AND INDEMNITY AGREEMENT , and further agrees that no oral representations, statements, or inducement
apart from the foregoing written agreement have been made.

            For valuable consideration, I hereby give the AVILA HOT SPRINGS it’s successors, and assigns, the absolute and irrevocable right
and permission with respect to photographs, videos, motion pictures, and/or sound recordings being taken of my child; (a) to use, reuse, publish,
and republish in the same, in whole or in part separately or in conjunction with other photographs or recordings, in any medium, and (b) to use my
child’s name herewith.

            I hereby release and discharge AVILA HOT SPRINGS from any claims and demands arising out of or in connection with the use of
such photographs, videos, motion pictures, and/or recordings. I also agree that the photographs, videos, motion pictures and the negatives thereof,
and recordings, shall constitute your (AVILA HOT SPRINGS) sole property, with full right of disposition whatsoever.

            I have read this release and agree to these terms.

         FOR PARTICIPANTS OF MINORITY AGE (under age 18 at the time of registration):
         THE UNDERSIGNED, AS PARENT/GUARDIAN WITH LEGAL RESPONSIBILITY FOR THE MINOR PARTICIPANT,
DOES HEREBY CONSENT AND AGREE WITH THE TERMS AND CONDITIONS OF THIS RELEASE AND HOLD HARMLESS.
THE UNDERSIGNED FURTHER AGREEES TO THE RELEASE AND INDEMNIFY THE RELEASEES FROM ANY AND ALL
LIABILITIES INCIDENT TO THE SAID MINOR’S INVOLVEMENT IN THESE PROGRAMS.


           Parent/Guardian Signature                                                              Signature of Applicant

           Date


           Minor’s Name                                               Date of Birth               Emergency Telephone
                                  OASIS SUMMER CAMP
                                   2009 Enrollment Forms




                   AUTHORIZED PICK UP LIST

Child’s Last Name_______________First Name_________________ MI_____


People who are authorized to pick up your child, and in your absence, may be
contacted in case of an emergency


Name__________________ Relationship___________ Phone #____________


Name__________________ Relationship___________ Phone #____________


Name__________________ Relationship___________ Phone #____________


Name__________________ Relationship___________ Phone #____________


Name__________________ Relationship___________ Phone #____________
                                              OASIS SUMMER CAMP
                                               2009 Enrollment Forms


Guidelines
Registration
Registration, beginning April 20, 2009, is ongoing throughout the summer, given available space. Families must
complete the registration packet, pay the registration fee and program fees before children may attend camp. All
registrations must be processed by Oasis Summer Day Camp offices, located at 250 Avila Beach Drive. A camper’s
space will be reserved once the program fees are paid.

Food
Parents/Guardians must provide a sack lunch for their camper(s) daily. Soda, candy, and gum are not permitted; these
items will be returned home at the end of the day. Please do not send items that need to be refrigerated as space is
limited. Nutritious snacks are provided twice a day, once in the morning and once in the afternoon. Special snacks are
served only on occasion. Families are encouraged to alert program staff of any medical food allergies so alternative
snacks can be provided.

Dress / Belongings
Campers are asked to wear comfortable clothing that allows for exercise, movement and potentially messy projects.
Campers are required to bring closed-toe shoes. Campers who do not have closed-toe shoes may be limited on
activities to ensure safety. There will be times throughout the day when the children will be outside and it gets chilly, so
please send a lightweight jacket or sweat shirt for campers, and a bag for their belongings, including swimsuit (if
swimming), towel, and sunscreen, if desired. Please mark all clothing with the camper’s name. All lost and found items
not claimed will be disposed of at the end of summer or placed in the AHS lost and found.

Authorized Pick-Ups
If a child is to be picked up by a person other than the person who registered the child in the camp, written permission
must be provided on the Authorized Pick-Up List. Avila Hot Springs Oasis Summer Day Camp reserves the right to ask
for proper identification at any time a child is leaving camp. Children will only be released to those on the
Authorized Pick-Up List. Even if a person is on the “Emergency Pick-up” list, written permission from the
parent/guardian is required. Staff at the program do not take phone authorizations. This is for the safety and welfare
of the children.

Sick Campers
A camper who has symptoms of a fever, vomiting, pinkeye, head lice, diarrhea or any communicable disease may not
attend camp. Campers must be free of any symptoms for at least 24 hours prior to attending camp. In the case of a child
who gets sick or symptoms are noticed at camp, the parent/guardian will be called immediately to pick up the camper. If
the parent/guardian is unable to be reached in 30 minutes, those listed on the Emergency Pick Up list will be contacted to
pick up the camper.

Cash / Toys
Cash is not permitted at the camp. Please do not send campers to camp with cash. All cash brought to camp will be
returned at the end of the day to the parent/guardian. Please leave all toys (electronic or other types) at home.

Signing Campers In & Out
Parents/guardians must physically sign their camper in and out at camp each day. Campers will be released to only those
person listed on the registration form unless written authorization is received from the parent/guardians. Please see
Authorized Pick Up policy.
                                              OASIS SUMMER CAMP
                                               2009 Enrollment Forms
Communication
Staff asks that families share anything that might affect a camper’s behavior while at Camp so that the individual need of
each child and family can be met. We encourage open and positive communication between campers, family, and all
Staff at Oasis Summer Camp.

Guidance Policy
Staff aims to provide the best day camp experience for each camper attending camp. The Oasis Summer Day Camp
guidance philosophy is to encourage, guide, and promote a positive and enriching environment. Each child and each
behavior warrants individual action, however, the goal is to set examples of positive communication and the use of
redirection skills. Logical, natural consequences are used when unsafe or unhealthy choices are made. If a situation
occurs that is serious, but does not warrant calling the family, a written note will be sent home explaining the child’s
inappropriate behavior and the subsequent action taken by the Program Staff. If necessary, the child will be put on a
behavior contract, mutually agreed upon by staff, the child’s’ family, and the child.

NOTE: The Oasis Summer Day Camp at Avila Hot Springs reserves the right to ask any child to leave camp at any time,
without following the above steps, if a serious discipline situation occurs or if the child is a danger to herself/himself, or
others. The family will be notified immediately and alternative child care will be advised.

Medication
If a child needs to take prescription medication while at the camp, please adhere to the following procedures:
      1. A written prescription from their physician must be submitted, signed and dated by the parent/guardian;
      2. The child must be able to take the medication by themselves;
      3. Medicine must be in its original bottle;
      4. It is the parent’s/guardian’s or child’s responsibility to inform Program Staff of the time medication is to be
          issued.

Staff Qualifications & Ratios
Educated and well-trained Camp Staff is committed to promoting a fun, safe, healthy, educational environment. Each
staff has been through a background check including a fingerprint clearance from the Department of Justice and FBI as
well as a Child Abuse index check. Each camp is staffed at a low 1 to 10 ratio while at camp, and a 1 to 6 ratio when on
field trips.

Inclusive Care
Oasis Summer Day Camp at Avila Hot Springs strives to meet the needs of all children. Children with developmental
disabilities as well as non-ambulatory children can be accommodated. Well-trained aides will be provided; if a child
needs special care, please contact the Camp Director in advance.

Camp Shirts
Each child will be issued a Camp Shirt on their first day at Camp. Additional shirts may be purchased at Camp for $10.
Campers MUST wear a Camp Shirt on all field trips

Sun block
Sun block is not provided, nor is it applied to Campers. Families are responsible for providing sunscreen and applying it.
If sunscreen is sent to camp, the Camper must be capable of applying without assistance. It is encouraged that all
campers arrive to camp with sunscreen already applied. Staff will encourage use of sunscreen/sun block, but will not
apply it.

Child Abuse
Any suspected child abuse will be reported to the appropriate authorities immediately.
                                      OASIS SUMMER CAMP
                                       2009 Enrollment Forms




CAMP SCHEDULE OF ACTIVITIES

Relaxed Daily Schedule
AM

6:45              Staff: Prep for opening
7:00              Aloha! Campers begin to arrive
7-8:30            Campers choice
8:45- 9:30        Counselor-led activities
9:45              Snack
10 - 10:15        Group Time / Highlight
10:15 - 11:15     Activities / Polar Bear Plunge
11:15 12:00       Leader spotlight / Growth groups


MID-DAY

12:15 – 1:30      Lunch / Free time


PM

1:30-4:30        Swimming!!! (Remember sunscreen) / Snack / Arts and Crafts
4:30             Camp fire / RRR
5:00             Clean up / Campers Choice
6:00             Camp Sleeps




WEEKLY SCHEDULE
Every Monday: Avila Beach Trip (except first Monday)

Week 1: June 15 - 19          Mixer Summer Celebration
Week 2: June 22 - 26          Hike/Atascadero Zoo
Week 3: June 29 - July 3      Luau
Week 4: July 6 - 10           Bowling
Week 5: July 13 - 17          Carnival!!!
Week 6: July 20 - 24          Boomers
Week 7: July 27 - 31          Movie day
Week 8: August 3 - 7          Morro Bay Estuary / Aquarium
Week 9: August 10 - 14        Children’s Museum
Week 10: August 17 - 21       Bar- B- Que Splash-tacular

				
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