Camp VIP Application Form

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2008 Camp VIP Application Form
A Summer of Enrichment Activities for Students Grades K - 8,
at Pacific School running from July 7, through August 1, 2008
(All Net Proceeds Will Benefit Programs And Services For MBUSD Students Grades K - 12)

• Registration
• Emergency
• Class Selection

© 2008 by MBAF
Manhattan Beach
Athletic Foundation
PO Box 1585
Manhattan Beach CA
90267-1585
tel: 310.415.5827
MBAF TAX ID:
#02-0603467

Note: If you wish to apply by mail rather than use the on-line application below, then request application materials from Camp VIP, Manhattan Beach Athletic Foundation, PO Box 1585, Manhattan Beach CA 90267-1585. Or email Camp VIP Information. Checks will be accepted with mail-inapplication. No confirmation will be made over the phone.

Enrollment information:
Grade level is determined by the student’s grade in September.
Registration is on a first come basis.
Activities will be offered subject to enrollment, and may be cancelled due to insufficient enrollment.
Most activities will accommodate 10-25 students.
Enrollment will continue as long as space is available.
Requests for changes will be granted only if space permits.

Refund Policy: Full refund less $25 processing fee before
June 19. After June 23: 50% refund. No refunds after July 8.

You MUST fill out this application in order to register for an sctivity class. After completing the form, click on "Submit Application". A web page will then automatically appear which will allow you to pay for a class (or classes). If you encounter problems, email us at Camp VIP Information.

(Fields with * MUST be filled in!)

Student's Name (last, first, middle)* :

Sex* : Date of birth (mm/dd/yy)* :

Street Address* :

City* :State* : Zip* :

Student Phone* : E-mail* :

Current School Attending*:

Currrent Grade Level*

School Attending Fall 2008*:

Grade Level Fall 2008*

If possible, please place my child in an activity group with

Parent or Guardian (Dr./Mr./Mrs./Ms.)* :

Best Parent E-Mail:

Where can the student’s parents or guardian be contacted during school hours? If employed during school hours, please provide all pertinent information; employer, telephone numbers including cell and pager, department supervisor, etc.

Mother/Guardian*: Daytime Phone: Cell/Page:

Father/Guardian*: Daytime Phone: Cell/Page:

Is there any medication student MUST take during school hours?

Are there current health problems or allergies to drugs or foods (specify)?

Date of last tetnus booster?

Any other information that program staf should be aware of in order to best care for your child:?

In the event I cannot be reached, permission is hereby given for the physician or hospital designated below to provide emergency care for my child should serious illness/injury occur during camp hours. I also authorize the Camp Director or member of Camp VIP staff to offer consent to medical attention by calling 911 and/or to offer consent as needed.

*

Physician Name, Address, Phone*:

Hospital Name, Address, Phone*:

My child may walk/bike home without parent supervision:

I agree to taking of photographs of my child during Camp VIP activities for the use of promotional purposes for Camp VIP and Manhattan Beach Athletic Foundation only.

Information submitted by*:

E-mail Address*: Date (mm/dd/yy)*:

We have read and discussed the Student Code of Conduct (on the Camp VIP Information web page) and accept the values and standards set forth. It is understood that inappropriate behavior that disrupts classroom learning or prevents others from enjoying an outing, is grounds for dismissal from the program.

*

PLEASE CAREFULLY REVIEW APPLICATION BEFORE SUBMITTING!
After submitting, within seconds, an on-line e-payment form will automatically be forwarded to you.
Note! You are NOT registered until your e-payment form is completed and sent. You will then receive an online
receipt of payment but not specific confirmation of classes.
Camp VIP class confirmation notices will be mailed as the schedule is finalized.

If you encounter problems, e-mail us at Camp VIP Information