Of Burbank

1. Week of 7 – 117 – Swimming8 – Ice Skating9 – Horseback Riding10 – Bowling11 – Hurricane Harbor/Swimming Week of June 9 – 139 – Swimming10 – Beach 11 – Batting Cage 12 – Miniature Golfing13 – Universal Studios/Swimming Week of 4 – 84 – Swimming5 – Long Beach Aquarium6 – Kid Space7 –Tennis at UCLA(See Jay)8 – Knott’s Berry Farm/Swimming Summer 2008 Field Trips - Please check the trips that you will be sending your child on. Please note that all field trips are on a “First Come First Serve Basis.” Week of 14 – 1814 – Swimming15 – Beach16 – Batting Cage17 – Miniature Golfing18 – Swimming Week of 16 – 2016 – Swimming17 – LA Zoo18 – Cal. Science Center19 – Skate Park20 – Swimming Week of 11 – 1511 – Swimming 12 – Beach13 – Batting Cage 14 – Bowling15 – Swimming Week of 21 – 2521 – Swimming22 – LA Zoo23 – Career Day Field Trip 24 – Skate Park25 – Magic Mountain/Swimming Week of 18 – 2218 – Swimming 19 – Out to the Movies20 – Horseback Riding21 – Ice Skating22 – Summer BBQ/Talent Show Week of 23 – 2723 – Swimming24 – Out to the Movies25 – Horseback Riding26 – Valley Fair27 – Disneyland/Swimming Of Burbank Week of 28 – August 128 – Swimming29 – Out to the Movies30 – Horseback Riding31 – Cal. Science Center1 – Swimming Week of June 30 – July 430 – Swimming1 – LA Sparks (See Jay)2 – Kid Space3 – Long Beach Aquarium4 – Club Closed Boys & Girls Club of Burbank2244 N Buena Vista StreetBurbank, CA 91504(818) 842-9333Day Camp – 7AM – 7PM * Please Note - There are two groups for swimming, GROUP A on Mondays and GROUP B on Fridays. Your child will swim on which ever day he/she is signed up for.

2. *Prices* Membership Fee: $75/Annually Weekly Fee: $80Field Trip Prices Horseback Riding: ____ x $19= _______ Out to the Movies: ____ x $9 = _______ LA Zoo: ____ x $6 = _______ Beach: ____ x $5 = _______ Batting Cage: ____ x $15 = _______ Ice Skating: ____ x $8 = _______ Kid Space: ____ x $6 = _______Cal. Science Center: ____ x $8 = _______Miniature Golfing: ____ x $6 = _______ Skate Park: ____ x $3 = _______ Swimming: ____ x $11 = _______ Long Beach Aquarium: ____ x $11= _______ Bowling: ____ x $6 = ________Amusement ParksKnott’s Berry Farm: $28 _______ Universal Studios: $40 _______ Hurricane Harbor: $20 _______ Disneyland: $52 _______Magic Mountain: $30 _______ Total: ________ Emergency/Medical InformationChilds Name: ___________________________ D.O.B. _____________________ Age: ______1st Contact: __________________________Emergency #: __________________________2nd Contact: __________________________Emergency #: __________________________Participation ConsentI hereby authorize my child’s full participation in the programs conducted by the Boys & Girls Club of Burbank. I agree not to hold the Boys & Girls Club of Burbank, its staff, volunteers, or Board of Directors responsible for the conduct or any loss, damage, or personal injury to my child. Further I understand I am required to pick up my child by the stated closing time or I must pay the applicable fees as defined by the Boys & Girls Club of Burbank, Inc. $5 for every 15 minutes after scheduled closing time. Medical Treatment ReleaseIn case of an accident or emergency, I authorize a staff member of the Boys & Girls Club of Burbank to call for medical attention. Further I agree that the club may personally transport my child to the nearest known hospital and to hold the club harmless of any consequences related to such transportation. Additionally, I will accept full responsibility for the emergency treatment or measures that are deemed necessary for the safety and protection of my child. I release the Boys & Girls Club of Burbank, its staff, and board of directors of any and all liability involved in this emergency procedure. Medical InformationDoctor: _________________________________Medical Insurance Company: ___________________Medical Conditions: __________________________________________Parent Signature: ________________________ Of Burbank Summer Day Camp2008 2244 N Buena Vista St.Burbank, CA 91504Bus. 818-842-9333Fax. 818-842-0694web. www.bgcburbank.org