little learners/camp calabasas summer camp 2015 credit card form

Camp Calabasas
Summer Camp 2015
For Boys and Girls Ages 5-10
Nestled in the foothills of the Santa Monica
Mountains at DE ANZA PARK
SPECIAL EVENTS THIS SUMMER INCLUDE: JAMBA JUICE, HOT LUNCH DAYS, GLITTER TATTOOS
INFLATABLES, SPECIAL THEMED WEEKS/DAYS, SPECIAL VISITORS AND MUCH MORE!!
FULL DAY CAMP BEFORE AND AFTER SUMMER: June 11-12 and August 17-18 **Special $40 per day**
Session & Dates
FULL
Time
Rate
Part Time
Rates
Scheduled Trips
Ages 5-7
Scheduled Trips
Ages 8-10
Session 1
June 15-19
$240.00
M,T,TH, or F
$55.00 day
Wed. $60.00
Underwood Farms Berries
Leave-10:00am/Back-5:30pm
Campers Must Bring a Lunch
Raging Waters
Leave-7:30am/Back-6:30pm
Campers Must Buy Lunch
Session 2
June 22-26
$240.00
M,T,TH or F
$55.00 day
Wed.$60.00
Lake Casitas Water Park
Leave-9:30am/Back-6:30pm
Campers Must Bring a Lunch
Magic Mountain
Leave– 9:00am/Back 6:30pm
Campers Must Buy Lunch
Session 3
June 29-July 3
$240.00
M, T, Th or F
$55.00 day
Wed.$60.00
Session 4
July 6-10
$240.00
M,T,TH, or F
$55.00 day
Wed. $60.00
Adventure City
Leave-9:00am/Back-6:30pm
Campers Must Bring a Lunch
Knott’s Berry Farm
Leave-8am/Back-6:30pm
Campers Must Buy Lunch
Session 5
July 13-17
$240.00
M,T,TH, or F
$55.00 day
Wed. $60.00
Zuma Beach
Leave-9:00am/Back-6:00pm
Campers Must Bring a Lunch
Zuma Beach
Leave-9:00am/Back-6:00pm
Campers Must Bring a Lunch
Session 6
July 20-24
$240.00
M,T,TH, or F
$55.00 day
Wed. $60.00
Monarchs Gym and Lunch
Leave-8:30am/Back 6:30pm
LUNCH PROVIDED
Soak City
Leave-8:00am/Back-6:30pm
Campers Must Buy Lunch
Session 7
July 27-31
$240.00
M,T,TH, or F
$55.00 day
Wed. $60.00
Discovery Science Museum
Leave-9:30am/Back 6:30pm
Campers Must Bring a Lunch
Hurricane Harbor
Leave-8:30am/Back-6:30pm
Campers Must Buy Lunch
Session 8
Aug 3-7
$240.00
M,T,TH, or F
$55.00 day
Wed. $60.00
Santa Barbara Zoo
Leave– 8:30am/Back 6:30pm
Campers Must Bring a Lunch
Mountasia & Laser Tag
Leave-9:00am/Back-6:30pm
Campers Must Buy Lunch
Session 9
Aug 10-14
$300.00
M,T,TH, or F
$55.00 day
Wed. $100.00
DISNEYLAND
Leave-6:45am/Back-6:30pm
Campers Must Buy Lunch
DISNEYLAND
Leave-6:45am/Back-6:30pm
Campers Must Buy Lunch
Scooters Jungle & Chuck-E-Cheese Scooters Jungle & Chuck-E-Cheese
Leave– 9:00am/Back 6:30pm
Leave– 9am/Back 6:30pm
Lunch Provided
Lunch Provided
COST OF CAMP INCLUDES SWIMMING ON NON-FIELD TRIP DAYS and A MORNING/AFTERNOON SNACK
Activities Include: Daily Arts
and Crafts, Sports, Weekly
Science, Weekly Cooking
and Much More!!
SIBLING DISCOUNT FOR
FULL TIME PARTICIPANTS
Register Now for Summer Camp Calabasas
818-878-0162 or 818-880-6461
Email us at campcalabasas@aol.com
Visit us at www.campcalabasas.org
CAMP HOURS
9am-4:30pm
~FREE EXTENDED CARE~
7am–9am & 4:30-6:30pm
Summer Camp Calabasas 2015 Registration Form
Campers Name_______________________________________ Age_________ Date of Birth________________ Sex M F
Father’s Name ______________________________Work/Cell Numbers___________________/____________________
Mother’s Name ______________________________Work/Cell Numbers__________________/____________________
Home Address_______________________________________ City______________________________ Zip______________
Home Phone ____________________________________email___________________________________________________
School Camper Attends______________________________
Child Lives With: Both Parents
Shared
Grade of Camper (Starting in September)_____________
or___________________________________________________________
Circle the full time or part time days that your child will be attending. For part time days please mark each day
below the session. There is a price break if you sign up and pay for full time camp on Monday morning otherwise
you will be charged the daily rate. FEES MUST BE PAID AT DROP OFF IF YOU ARE NOT PUTTING A CREDIT CARD ON
FILE. If needed after you send in this form you may add days if space is available. CHANGES TO REGISTRATION
MUST BE MADE IN WRITING and emailed to campcalabasas@aol.com FIVE BUSINESS DAYS PRIOR TO THE START
OF THE SESSION YOU WISH TO CHANGE. Making up or transferring missed days is not permitted regardless of the
circumstance. By signing below you acknowledge the above information and policies.
Signature_____________________________________________________________________________________
Session
&
Dates
1
June
15-19
2
June
22-26
3
June 39July 3
4
July
6-10
5
July
13-17
6
July
20-24
7
July
27-31
8
Aug
3-7
9
Aug
10-14
Full
Time
$240.00
$240.00
$240.00
$240.00
$240.00
$240.00
$240.00
$240.00
$300.00
Mon.
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
Tues.
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
Wed.
$60.00
$60.00
$60.00
$60.00
$60.00
$60.00
$60.00
$60.00
$100.00
Thurs.
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
Fri.
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
$55.00
OFFICE
USE
ONLY
Summer Camp 2015
Information/Emergency Form
Campers Name_______________________________________ Age_________ Date of Birth________________ Sex M F
Father’s Name ______________________________Work/Cell Numbers___________________/____________________
Mother’s Name ______________________________Work/Cell Numbers__________________/____________________
Home Address_______________________________________ City______________________________ Zip______________
Home Phone ________________________________Child Lives With: Both Parents
Shared
or_____________________
Email:________________________________________________________
IMPORTANT MEDICAL INFORMATION
Child’s Doctor____________________________________________ Phone Number__________________________________
Child’s Dentist___________________________________________ Phone Number__________________________________
Medical Plan# ___________________________________Allergies_______________________________________________
Does your child have any special needs or currently taking any medication?
_____________________________________________________________________________________________________
Please list, in order of importance, who we should contact first in the event of an emergency other than parents.
These persons are also authorized to pick-up your child from camp. We must have written authorization for others to pick-up
your child from camp. This includes family members and friends that we might know.
Name__________________________________ Phone 1______________________ 2______________________
Name__________________________________ Phone 1______________________ 2______________________
Name__________________________________ Phone 1______________________ 2______________________
Name__________________________________ Phone 1______________________ 2______________________
Name__________________________________ Phone 1______________________ 2______________________
Name__________________________________ Phone 1______________________ 2______________________
The undersigned hereby agrees to defend, indemnify, and hold harmless the City of Calabasas and its officers,
employees and agents against any loss, liability charges and expenses (including attorneys’ fees) and costs which may arise by reason of
participation in any program. (The City does not provide accidents, medical, liability, workers’ compensation insurance for program
participants). As parent/guardian, I hereby consent to emergency treatment of my minor child as a result of accident or injury. I further
agree to pay any and all costs incurred as a result of said treatment. I agree to carefully inspect and satisfy for me that the facilities
provided are reasonably safe for their use. Once having conducted the inspection, I agree to expressly assume the risk of participating at
the premises. I understand the City retains the right to use photos taken during activities for public purposes.
Parent Signature___________________________________________________________________Date_____________________________
SUMMER CAMP CALABASAS 2015
CAMP AGREEMENT
Campers Name
LITTLE LEARNERS, LLC
RELEASE, ASSUMPTION OF RISK, AND INDEMNITY
RELEASE: The undersigned is the parent or legal guardian of the minor camper, identified above. In
consideration for Little Learners providing to the camper identified above a camp Experience at Camp
Calabasas, I HEREBY, ON MY OWN BEHALF AND ON BEHALF OF THE CAMPER, RELEASE AND DISCHARGE
LITTLE LEARNERS, LLC, THE OWNER AND OPERATOR OF CAMP, AND THE CITY OF CALABASAS AND BOTH OF
THEIR OFFICERS, DIRECTORS, EMPLOYEES, VOLUNTEERS AND AGENTS (called herein the “Releasees”) FOR
AND FROM ANY AND ALL CLAIMS ARISING OUT OF THE CAMPER’S PARTICIPATION IN THE CAMP, INCLUDING
CLAIMS ARISING OUT OF THE NEGLIGENCE OF THE RELEASEES OR ANY OTHER CAMPER THAT CAUSES, OR IS
CLAIMED TO CAUSE, INJURY OR DEATH TO THE CAMPER IDENTIFIED ABOVE, PROPERTY DAMAGE, OR OTHER
DAMAGES. I ALSO PROMISE NOT TO SUE ANY OF THE RELEASEES FOR ANY OF THE CLAIMS BEING RELEASED.
ASSUMPTION OF RISK: I understand and acknowledge that participation in camp activities
involves risk of injury. I fully appreciate the risks involved in my camper’s participation in these
activities and voluntarily assume, on the camper’s behalf, those risks.
PROMISE TO DEFEND, IDEMNIFY, AND HOLD HARMLESS: In consideration of the above camper being
permitted to participate in Little Learners camp, I agree to defend, indemnify, and hold harmless the
Releasees from and against all claims arising out of the camper’s participation in the camp.
EMERGENCY TREATMENT: I hereby consent to allowing emergency medical personnel to be summoned
for the camper if needed and consent to emergency treatment of the camper as may be required as the result
of accidental injury or otherwise. I further agree to pay any and all costs incurred for such treatment.
PHOTOGRAPHS: I agree to allow the camper to be photographed while participating in camp
activities and understand that Little Learners and the City retain the right to use any photographs taken during
camp activities for promotional and other purposes.
I HAVE READ THIS AGREEMENT AND UNDERSTAND IT INCLUDES A RELEASE OF ALL CLAIMS, VOLUNTARY
ASSUMPTION OF ALL RISKS INVOLVED IN CAMP ATTENDANCE AND AN AGREEMENT TO DEFEND, INDEMNIFY
AND HOLD HARMLESS THE RELEASEES. BY SIGNING THIS AGREEMENT I VOLUNTARILLY ACCEPT ALL OF THE
TERMS AND CONDITIONS OF THIS AGREEMENT.
PARENT OR LEGAL GUARDIANS SIGNATURE
PARENT OR LEGAL GUARDIANS PRINTED NAME
RELATIONSHIP TO CAMPER
DATE
Camp Calabasas Summer Camp 2015 Important Information and Admission Agreement
Registration: There are four easy ways to register. You can mail-in, walk-in or fax-in, or email your registration
forms.
Payments are to be made out to Little Learners.
Fee - Includes all activities, field trips, transportation, special events, swimming, one camp t-shirt,
morning and afternoon snack.
Camp Times: *Camp Calabasas activities are scheduled from 9:00am to 4:30pm daily.
*Extended care is offered at no extra charge from 7:00am to 9:00am and 4:30pm to 6:30pm.
Parents running late will be charged $1.00/minute after 6:30pm and it must be paid to supervising
staff, for every minute that you are late.
Camp Dress: *Campers are required to wear closed-toed shoes each day they attend camp. CROCS ARE OKAY
*Flip flop style sandals are only allowed to be worn while at the pool or at the beach.
Campers with open toe shoes will be sent home or must have a pair of closed toe shoes brought to
them at camp. REFUNDS WILL NOT BE GIVEN IF YOUR CHILD IS SENT HOME FOR WEARING THE
WRONG TYPE OF SHOES!
*Camp Shirts are given to each camper and they must wear them on Field Trips.
*Supervision is very important to us, so the proper use of the camp shirt is essential.
*ALTERING THE APPEARANCE OF CAMP SHIRTS IS PROHIBITED (making sleeveless)
*Additional or Replacement shirts are available for $10.00
What to Bring: *Campers are to bring a sack lunch with a drink each day they attend camp unless they plan on
purchasing lunch from the Swim Center. If purchasing a lunch please send snacks and a drink to have
during the time we sit for lunch before going to the pool.
*Campers may bring or buy lunch on certain field trip days please refer to the camp trip calendar for
specific trip information regarding meals.
*Bring a swim suit, towel, sunscreen, goggles, pool shoes on Mon, Tues, Thurs and Fri.
*We recommend putting sunscreen on your child prior to them arriving at camp and we will reapply
with the sunscreen that you provide.
*LABEL ALL BELONGINGS WITH A PERMANENT MARKER
Swimming:
We will be swimming 4 days per week at the Calabasas Tennis and Swim Center. Campers will be
bussed over to the Tennis and Swim Center by Durham Transportation at 12:30pm and will return to
De Anza Park at approximately 3:45pm.
Field Trips:
Campers will have the opportunity to attend field trips based on their age group. Trip locations for
each age group are listed on the main camp flyer. If your child wishes to attend a trip for the
opposite age group you must have prior permission by a camp director for your child to switch trips.
All campers must come to camp wearing their shirt EVERY WEDNESDAY. Your child will get their
shirt on the first Wednesday of camp that they attend. If kids do not attend Wednesdays or they
need a replacement shirt they can be purchased for $10. THERE WILL NOT BE AN OPTION TO STAY
AT THE PARK ON WEDNESDAYS.
Illness:
If your child is not feeling well during their time at camp we will take their temperature and if they
are running a fever you will be called to pick them up. If we are unable to reach you those listed as
emergency contacts will be called. If your child is running a fever they need to be picked up as soon
as possible as to limit exposing others to their possible illness.
Camp Calabasas Summer Camp 2015 Important Information and Admission Agreement P.2
Refunds:
All refunds and cancellations of days must have FIVE BUSINESS DAYS NOTICE emailed to us at
campcalabasas@aol.com prior to the session start date in order to avoid being charged. Excessive changes will result in
an administrative fee of $10.00. There will be no refunds or transfers due to illness or non-attendance for registered
days. You are financially responsible for all days registered unless we are notified via email or in writing within the
required time period about such changes. If you email us we will respond letting you know we received your notice. For
those who do not register in advance please be advised that we might not have spots for all of the drop-in’s. If you know
your child wants to attend specific trip you must pre-pay to hold your spot. If you do not tell us on Monday that your child
will be attending full time then you will be charged the daily rate and won’t get the full time attendance price break.
Making-up or transferring missed days is not permitted regardless of the circumstance.
Discipline:
We strive to provide a well-rounded and safe program for all participants. Discipline will be handled in the following
manner and depending on the infraction:
(1) Child will be spoken to and/or redirected to another activity (2) Child will be suspended from the
program (3) A written report will be completed by the staff and a meeting will be set up with the parent to discuss an
appropriate outcome. <Children with three warnings will be asked to leave the program.>
Dismissal Policy: Expulsion from the Camp Calabasas and Little Learners Program results from one or more of the
following situations:
(1) Physically or verbally abusing another participant or staff member
(2) Refusal to correct documented problematic behavior (3) Theft (4) Parent Payment Negligence
(5) Disruption on busses, on field trips, at the pool or in general at camp.
Sign In/Out: Children arriving and departing camp must be signed in and out by an adult on a daily basis. Parents or those authorized to
pick up your child must sign them out before leaving at the end of the day. Dropping your child off to walk into camp alone is not
permitted for safety reasons and in case there is something we need to discuss with you regarding camp or your child.
Snack: We will provide a morning and afternoon snack for all campers. Children may also bring snacks for the morning and afternoon.
Activity Plans: Weekly activity plans will be available to each registrant. These plans will show what activities we are doing in camp as well
as notifying you of the times we leave for field trips and arrive back at the park.
Payments:
All payments to Little Learners must be made by credit card, check: payable to Little Learners, money order or cash.
Checks returned to us for NSF or any other reason will be required to be replaced with cash or a credit card. If there are
any problems collecting the owed money for returned checks the information will be turned over to the District Attorneys
Check Restitution program. A fee of $25 will also be charged for any returned check.
****************************************************************************************************
Please return this page to Little Learners/Camp Calabasas.
I HAVE READ AND AGREE TO ABIDE BY THE 2015 SUMMER CAMP ADMISSION AGREEMENT POLICIES AND PROCEDURES SET FORTH BY
THE CITY OF CALABASAS AND LITTLE LEARNERS.
Child’s Name:_________________________________
Parent’s Signature: _________________________________________________Date:_____________
Summer 2015 Swimming/Water Field Trip
Permission Slip & Waiver and Release
Name of Child (please print): ___________________________________________________
Name of Parent/Guardian: _____________________________________________________
Swimming and/or water related activities are one of the optional activities available to campers enrolled in our summer camp programs. Certain
field trips (dependent on age group) also include outings to water parks and the beach. Each location has lifeguards and/or other safety personnel
on duty provided by the facilities. Example facilities include but are not limited to:
the Calabasas Tennis and Swim Center, Lake Casitas Water Park, Soak City Water Park, Hurricane Harbor Water Park, Raging Waters, LA
County Beaches and in water play during campers’ time at DeAnza Park.
Before the child of whom you are the parent/guardian can participate in these types of field trips involving swimming and/or water related
activities, you, the parent/guardian, must complete and sign this Summer 2015 Field Trip Permission Slip & Waiver and Release. This form
must be completed, signed, and returned to Little Learners before the day of the field trip. Failure to complete this form before the day of the
field trip, will result in the child of whom you are the parent/guardian to remain onsite at camp where they will join a group close to his/her age
for an alternate activity if that is an option/or else they will need to be picked up before such excursions.
WAIVER AND RELEASE
By indicating your acceptance, you understand, agree, warrant and covenant as follows: In consideration of the opportunity for the child of
whom I am the parent/guardian to be a participant in Little Learners’ swimming/water related field trips, I hereby freely and voluntarily agree to
the following representations, waivers, and agreements:
I do hereby for myself and my dependents, heirs, executors, administrators, agents and assigns, agree to waive, hold harmless, indemnify,
covenant not to sue, release and forever discharge Little Learners and its officers, employees, members, agents, successors and assigns
(“Releasees”) for and from any and all responsibility, liability, and causes of actions, claims, and/or damages whatsoever which I or the child of
whom I am the parent/guardian or those claiming under may have, suffer, or incur now or in the future resulting from or arising out of
participation in said trip/activity/outing and any direct or indirect event and occurrences in connection therewith occurring before, during and/or
after said trip/activity/outing, including but not limited to claims for death, personal injury, property damage, or loss.
I further agree to indemnify and hold harmless said Releasees of and from all liabilities described about, arising out of or connected with the
participation of the child of whom I am the parent/guardian in said swimming and/or water related field trips, including any claims of third
persons, relating to the matters, whether by subrogation, right of recovery or otherwise.
Severability. I further expressly agree that this Waiver and Release is intended to be as broad and inclusive as is permitted by the laws of the
State of California and that if any provision of this Waiver and Release shall be found to be unlawful, void, or for any reason unenforceable,
then that provision shall be deemed severable from this Waiver and Release and shall not affect the validity and enforceability of any remaining
provisions.
By indicating your acceptance and grant of permission for the child of whom you are the parent/guardian to participate in swimming and/or
water related field trips, you are affirming that you have read and understand this document. You understand that you are giving up substantial
rights, including the right to sue and any rights of recovery and/or subrogation.
Please read any waiver carefully. It includes a release of liability and waiver of legal rights and deprives you of the ability to sue certain parties
and/or for third party recovery of amounts paid on your behalf. Do not sign this document unless you have read and understood it in its
entirety.. You also understand and agree that swimming and/or water related activities carry certain inherent dangers and risks which may or
may not be readily foreseeable, including without limitation personal injury, property damage or death. Your child’s ability to participate in the
activities is/are subject to your agreement to waiving such rights.
Swim/Water Activities Permission – I understand that swimming and/or water activities are a part of the field trip. My child’s swimming
ability is (check one): Beginner _____ Intermediate _____ Advanced _____
By signing below, I, the undersigned, acknowledge that I have read the above and willingly consent to allow participation of the child of whom I
am the parent/guardian under the above stated conditions.
Signature of Parent/Guardian: _____________________________________________________________________________
Date of Signature: ____________________________________________________________
LITTLE LEARNERS/CAMP CALABASAS
SUMMER CAMP 2015 CREDIT CARD FORM
I, __________________________________________, hereby authorize
Little Learners to automatically charge my Credit Card for Summer Camp fees.
Participants Name:___________________________________
Fees: (Please circle one)
$________________ (one time use) OR
Reoccurring Camp Fees Based on Registration
Please charge this amount to my credit card.
Card Number:___________________________________________________
Expiration Date: _________________________
Name that appears on card: ________________________________________
Billing Address: _________________________________________________
_________________________________________________
Authorized Signature: __________________________Date ______________