2016 VENTURA COUNTY JUNIOR LIFEGUARD PROGRAM HELD ON SILVER STRAND BEACH IN OXNARD
|
|
|
- Bonnie Shelton
- 9 years ago
- Views:
Transcription
1 2016 VENTURA COUNTY JUNIOR LIFEGUARD PROGRAM HELD ON SILVER STRAND BEACH IN OXNARD Dear Junior Lifeguard Families and prospective Junior Lifeguards: Enclosed is your 2016 PROGRAM OUTLINE. Please retain it for the duration of the Junior Lifeguard Program year. You may find this program outline useful and refer to it for questions about: Tryout testing standards Program dates and times Refunds Behavioral expectations of Junior Lifeguards Disciplinary procedures Program activities ENROLLMENT Enrollment for the Junior Lifeguard Program is first come first served. Due to the popularity of the program, enrollment is expected to fill to capacity very quickly. Students are considered enrolled in the program when the Harbor Patrol Office receives all completed forms and full payment of tuition fees. NOTE: It is necessary to submit the program fees with the application and signed and initialed waiver forms to insure your child s place in the Junior Lifeguard Program. PROGRAM FEES: $ for the first child from a family $ for each additional child from the same family $ enrollment in both sessions $50.00 Anacapa Trip (trip optional, space limited, fee must be paid with tuition) Make checks payable to the County of Ventura Harbor Department AGE REQUIREMENTS: 8 through 15 years of age at 1st day of instruction. New participants will be required to show a birth certificate or passport. TRYOUTS: Tryouts will be held in the pool at the Oxnard High School Aquatic Center, 3400 West Gonzales, Oxnard, CA on May 28 th, June 11 th, & July 9 th, 2016 from 10:00 a.m. to 12:00 p.m. Tryouts are required for first year Jr. Lifeguards only. Parent/Guardian must be present during tryout. Please contact the Harbor Patrol at prior to the tryout dates to assure the location and or times have not been changed. SESSION ONE (1) PROGRAM DATES: June 20, 2016 through July 15, An awards barbecue will be held on the last day of the program at Silver Strand Beach. SESSION TWO (2) PROGRAM DATES: July 18, 2016 to August 12, An awards barbecue will be held on the last day of each program at Silver Strand Beach PROGRAM TIMES: Monday through Friday, 9:00 a.m. until 2:00 p.m.
2 2016 VENTURA COUNTY JUNIOR LIFEGUARD PROGRAM TESTING STANDARDS TRYOUTS: Tryouts will be held in the pool at the Oxnard High School Aquatic Center, 3400 West Gonzales, Oxnard, CA on May 28 th, June 11 th, & July 9 th, 2016 from 10:00 a.m. to 12:00 p.m. Tryouts are required for first year Jr. Lifeguards only. Parent/Guardian must be present during tryout. Please contact the Harbor Patrol at prior to the tryout dates to assure the location and or times have not been changed. The following requirements must be met in order for the applicant to successfully be admitted into the program: Applicant must complete a 150 yard swim within 4 minutes. Applicant must be able to float or tread water for 2 minutes. Applicant must be able to dive underwater to a depth of 7 feet. Application Check off List 2016 Student Application Authorization to Treat a Minor Form (Note: If your child is new to the program, tryouts are required and the dates are listed on this page.) Parent Participant Survey Form To be completed at the beginning of the Junior Lifeguard program A copy of Birth Certificate (If child is new to the program) If you would like to Pre-Order Boys and/or Girls board shorts for $30.00, please include it in your check/money order and indicate what size and style (Boy/Girl) you are ordering. Check/Money Order
3 VENTURA COUNTY HARBOR DEPARTMENT JUNIOR LIFEGUARD PROGRAM 2016 STUDENT APPLICATION HELD ON SILVER STRAND BEACH IN OXNARD Student s Name: _ Last First Middle Address: Number Street City Zip Home Phone: ( ) I want my name, zip code and telephone number published to assist me and other parents in forming carpools. SEX: Male Female Date of Birth: / / Age 1 st day of program: Session one June 20, 2016 July 15, st Session Island Trip July 7, 2016 Session two July 18, 2016 August 12, nd Session Island Trip August 2, 2016 AMOUNT ENCLOSED $ (See PROGRAM FEES in Parent Letter) Child s Physician or HMO: Phone: ( ) List any restrictions to medical treatment: _ Allergies to foods/drugs: Any special medications, pertinent information or special instructions: EMERGENCY CONTACTS Please list emergency contact numbers in the order in which they should be called. Contact Name # 1 Phone Numbers Contact Name # 2 Phone Numbers Contact Name # 3 Phone Numbers MAIL COMPLETED APPLICATION AND FEES TO: Ventura County Harbor Department 3900 Pelican Way Oxnard, CA Attn: Gary Hirtensteiner Phone: (805) Fax: (805) Office Use Only: check # lifeguard aide tryout receipt # island trip paid signed & initialed release amount paid board shorts paid parent participant survey board shorts received birth certificate
4 PARENT PARTICIPANT SURVEY (To be completed at the beginning of the Junior Lifeguard Program) This survey is designed to measure the effect that the Junior Lifeguard program has on the lives of its participants. It is important that ALL parents or guardians of Junior Lifeguard participants complete this survey and return it with the application. Has your son/daughter ever participated in the Junior Lifeguard program? Y N If yes, how many years have they attended? How old is your son/daughter? Age when started Program: Use the following five-point scale to answer questions Circle the number that you feel best describes your son/daughter. Please read all questions before you begin circling your answers. Strongly Agree Undecided Disagree Strongly Agree Disagree 1. My child has self-respect My child has respect for all family members My child has respect for others My child has respect for the environment My child gets good grades My child has good school attendance My child is in good physical condition
5 RELEASE FROM LIABILITY In consideration of the acceptance of the application of my child as a participant in the Junior Lifeguard Program, my child and I hereby agree to assume all risks attendant upon myself and my child while participating in the Junior Lifeguard Program. My child and I hereby waive, release and discharge any and all claims for damages for death, personal injury or property damage which my child or I may have, or which may hereafter accrue to me or my child, as a result of my child s participation in the Junior Lifeguard Program. I agree to save and hold harmless from liability the County of Ventura, any of its agents, servants or employees by reason of any accident, death, injury, or damages to persons or property which my child or I may suffer from and against any and all liability arising out of or connected in any way with my child s or my participation in the Junior Lifeguard Program, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. I further understand that serious accidents or death can occur during aquatic and marine activities, and that participants in aquatic and marine activities occasionally sustain mortal or serious personal injuries, and/or property damage, as a consequence thereof. Knowing the risk of aquatic and marine activities (swimming, surfing, lifesaving, body boarding, competition, and the like), nevertheless, I hereby agree to assume on my behalf and the behalf of my child those risks and to hold harmless all of the persons or entities mentioned above, who (through negligence or carelessness) might otherwise be liable to me or my child (or my heirs or assigns, or my child s heirs or assigns) for damages. It is further understood and agreed this waiver, release and assumption of risk is to be binding on my heirs and assigns, and the assigns of my child. I agree to assume all responsibility for any property damage or injury to any persons caused by me or my child while participating in the Junior Lifeguard Program. VIDEO-PHOTO RELEASE I understand that during the Junior Lifeguard Program or related activities, my photograph and/or the photograph of my child may be taken by the Junior Lifeguard Program, producers, sponsors, organizer, and/or assigns. I agree that my photograph and/or the photograph of my child, including video photography, film photography, or other reproduction of my likeness or the likeness of my child, may be used without charge by the Ventura County Harbor Department Junior Lifeguard Program, producers, sponsors, organizers and/or it s assigns for such purpose as they deem appropriate.
6 AUTHORIZATION TO TREAT A MINOR I, the parent or legal guardian of the child listed above, do hereby authorize and consent to any X-ray examination, anesthetic, medical, or surgical treatment rendered under the general or special supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medical Practice Act or a Dentist licensed under the provisions of the Dental Practice Act and on the staff of any acute general hospital or emergency care facility holding a current license to operate a hospital or emergency care facility from the State of California Department of Public Health. I understand that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power to render care which the aforementioned physician, in the exercise of his/her best judgment, may deem advisable for my child. Further, I understand my child will be participating in inherently dangerous activities (swimming, surfing, lifesaving, body boarding, competition, and the like) and agree to pay for my child s medical expenses. I understand that all effort shall be made to contact me prior to rendering treatment to my child, but any of the above treatment will not be withheld if I cannot be reached. This authorization is given pursuant to the provisions of the California Civil Code. This consent shall remain in effect until September 1, of the subject year. INITIAL I have read, understand and approve the RELEASE FROM LIABILITY and the VIDEO-PHOTO RELEASE. I have read, understand and approve the AUTHORIZATION TO TREAT A MINOR with any restrictions I may have listed above. I request that my child not tryout this year. He/she was in last year s Junior Lifeguard Program. I certify that my child is physically fit to participate in the Junior Lifeguard Program this summer. I understand there is a $50.00 fee for all returned checks and that my child cannot participate in any program activities until all fees have been paid in full. I accept the provisions of the Ventura County Junior Lifeguard Program refund policy as stated in the PARENT HANDBOOK. I understand that if I do not initial the boxes approving RELEASE FROM LIABILITY and the AUTHORIZATION TO TREAT A MINOR, and if I refuse to sign this document, my child s application will not be processed. Signature of Parent or Legal Guardian Date
7 NOTICE OF NONDISCRIMINATORY POLICY AS TO STUDENTS The Ventura County Junior Lifeguard Program accords students of any race, color, national and ethnic origin all the rights, privileges, programs and activities generally accorded or made available to students at the school. Ventura County Junior Lifeguard Program does not discriminate on the basis of race, color, national and ethnic origin in administration of educational policies, admissions policies, athletic and other school-administered programs. STUDENT DISCIPLINE FOR MINOR INCIDENTS For the Junior Lifeguard Program to be successful, students must exhibit behavior that is respectful of our staff, other students, our equipment and facilities. Group activities are vital to our program. A student that is disruptive to group activities and disrespectful to instructors, diminishes the enjoyment and education of the other students. The intent of discipline is to instruct the student so as to gain compliance with acceptable behavior norms. Therefore, please familiarize your Junior Lifeguard with the following expected behaviors: Respect of instructors and other staff Respect of other students; no shoving, hitting or name calling Respect of facilities, equipment and property Cooperation with others and good sportsmanship Following all safety rules and all instructions Listening quietly to directions and announcements Participation in regular program activities The progressive steps of discipline are as follows: 1. When a minor discipline situation occurs, the student will be counseled about the situation and given an explanation of what behavior change is expected. 2. If a subsequent incident occurs, the student will be asked to take a TIME OUT or TAKE A LAP. A TIME OUT is a period of five to ten minutes that the student spends quietly reflecting on the incident. A TAKE A LAP is a supervised swim or run of reasonable distance. After the TIME OUT or TAKE A LAP, the student is allowed to rejoin the group activity. 3. When a student has a series of TIME OUT or TAKE A LAP in the same day, or a series of discipline situations over several days, the lead instructor will inform the youth s parent or guardian about the situation.
8 4. When a student continually disregards the Instructors or shows little or no improvement with steps 1 through 3, the student will be suspended from the program for one day. The parent or guardian of the student will be informed that the student has been suspended. There will be no pro-rated refund of fees. 5. If, after suspension, the student s behavior is still not acceptable, the parent or guardian of the student will be informed that the student may no longer attend any of the program s activities. There will be no refund of fees. Major first time incidents may progress the student directly to step 4 or step 5 of the above procedures. Major incidents would include: Leaving the program area without permission Insubordination Fighting with another student or other persons Unlawful or non-consensual touching of another person Stealing property Vandalism of equipment or facilities Other conduct which brings disrespect on the Junior Lifeguards or the County of Ventura Any time a major behavior problem occurs, the Program Supervisor will be advised. ATTENDANCE Attendance is taken daily. We would appreciate being notified if your child will be absent. Please phone the Harbor Patrol office between 8:00 and 8:45 a.m. at REFUND POLICY (Please note the Ventura County Jr. Lifeguard Program is NOT the State of California Ventura Jr. Lifeguard Program). 1. There is a $50.00 fee for cancellations made prior to the first day of instruction. 2. Students may drop from the program at any time prior to the completion of the first week of instruction and receive a 50% refund of tuition. After commencement of the first day of instruction of the program s second week, no refunds will be made. 3. Student injuries that occur during the program that preclude the student s continuation in the program will result in a pro-rated refund based upon the remaining number of days in the program, including the day of injury. 4. There is no refund of fees for students suspended (1-3 days) or for students that are removed from all further program activities for disciplinary reasons.
9 PARTICIPATION IN ACTIVITIES Students are encouraged to participate in all regular program activities. The younger, smaller students may not have the same opportunities as the older students to utilize the kayaking equipment and other equipment, which require body weight and strength. Daily activities include strength conditioning, stretching, running, paddling, surfing and swimming. If you have questions, please see one of the lead instructors. Participants will be given boat rides with the Harbor Patrol and instructed on local marine life and habitats. UNIFORMS Boys and Girls Board Shorts Now Available Student s required uniform shirts provided on 1 st day of session Ventura County Junior Lifeguard T-shirts will be provided to all participants Boys/Girls: Navy Blue Board Shorts - $30.00 Girls: Navy Blue tank top type swim suit (not provided) Sports Chalet, Sportmart Student optional uniform items: Optional items would include sweatshirts, sun hats, sunglasses, sunscreen, towel, etc. Some items are available at the Harbor Patrol Office. Instructors: Instructors are distinguished from Assistants and students by their red Lifeguard swim trunks, suits and Ventura County Lifeguard patch.
10 PARENT SURVEY (To be completed and returned at the end of the Junior Lifeguard Program) Using the same set of questions, how do you feel your child s involvement in the Junior Lifeguard program has improved these traits. Because of participation in the Junior Lifeguard program, my child has... Strongly Agree Undecided Disagree Strongly Agree Disagree 8....shown improvement in self-respect shown improvement in respect for family members shown improvement in respect for others shown improvement in respect for environment shown improvement in grades shown improvement in school attendance shown improvement in physical condition Comments: Please relate any success stories because of involvement in this Junior Lifeguard program
FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT
FUN IN THE SUN SUMMER DAY CAMP BEHAVIORAL CONTRACT This contract is to be signed by both the participant (child) and his or her parent/guardian. This ensures that both the child and the adult understand
GATEWAY DISCOVERY CAMP
GATEWAY DISCOVERY CAMP SUMMER 2 0 1 6 REGISTRATION FORM Gateway Science Museum will host three sessions of the Gateway Discovery Camp. All sessions run 9am to 3pm and include daily snacks and lunches.
Motorcycle RiderCourse WAIVERS
Motorcycle RiderCourse WAIVERS General Instructions All pages must be completed and signed. If you have any questions, call (231) 591-5819. Mail completed forms to: Motorcycle Rider Courses, Ferris State
Math + Leadership Camp at CSUSM Registration Forms
Math + Leadership Camp at CSUSM Registration Forms CONTACT INFORMATION Math for America San Diego Email: [email protected] Phone: 858-822-6284 Registration Checklist Complete all sections of
2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES
2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES CAMP LOCATIONS CAMP DATES/TIMES June 6 July 15, 2016 James J. Eagan Center (300) 9:00am 3:00pm Koch Park (320) No camp July 4th All Prices Subject
Youth Programs Registration Form Summer of Service (SOS) 2015
Youth Programs Registration Form Summer of Service (SOS) 2015 Participant s Information PHONE GENDER: FEMALE OF BIRTH SCHOOL GRADE IN FALL 2015 MALE ETHNIC BACKGROUND AFRICAN ASIAN INDIAN LATINO NATIVE
WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes)
Robert D. Fowler Family YMCA Middle School Enrichment Program Student Registration Form 2015-16 Ivy Prep Academy Program Hours: 7am-7:45am & 4pm-7pm Transportation AM: Group leaves at 7:30am Transportation
CONTRACT FOR PRIVATE MUSIC INSTRUCTION
CONTRACT FOR PRIVATE MUSIC INSTRUCTION I. GENERAL CONDITIONS i. Lessons will be offered over the academic year in each of the instruments for which the student is registered. Students will be scheduled
2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION
These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we
Karate Adventure Summer Camp
Karate Adventure Summer Camp Our Summer Karate Camp is one of the most unique summer camps available to children. It provides an enriching selection of self defense activities as well as many fun summer
COMMUNITY FOR NEW DIRECTION PARTICIPANT REGISTRATION FORM
COMMUNITY FOR NEW DIRECTION PARTICIPANT REGISTRATION FORM Child s Name (Last) (First) (Middle Init.) Address Apt. # Zip Code Home Telephone Message Telephone Birth Age *Gender: Male Female *Race (please
Independent Contract Instructor Handbook and Proposal City of Lathrop Parks & Recreation Department
Independent Contract Instructor Handbook and Proposal City of Lathrop Parks & Recreation Department 390 Towne Centre Drive Lathrop, CA 95330 Phone (209) 941-7370 Fax (209) 941-7379 www.ci.lathrop.ca.us
INTERNATIONAL LEADERSHIP OF TEXAS
INTERNATIONAL LEADERSHIP OF TEXAS ACKNOWLEDGMENT OF RISK, INDEMNITY, WAIVER AND RELEASE OF LIABILITY AGREEMENT, NOTICE OF FINANCIAL RESPONSIBILITY, AND MEDICAL AUTHORIZATION & INFORMATION FORM IN WITNESS
Emerald Hills Junior Golf Camp - Summer 2016. 938 WILMINGTON WAY REDWOOD CITY, CA 94062 www.playemeraldhills.com E-Mail - jrgolf.ehgc@gmail.
OUR CAMPS ARE FOR GIRLS AND BOYS (AGES 5 THRU 14) Visit our website at Junior Golf Camp (9:00am 12:30pm) We start camp early (8:45am) on Monday for check-in and orientation. The camp is designed for beginners
CHALLENGER WORLD TOURS (CWT)
CHALLENGER WORLD TOURS (CWT) TRAVELER REGISTRATION DOCUMENT & TERMS AND CONDITIONS Mail, Fax or Scan/Email To: Challenger World Tours Attn: Gareth Hughes 8263 Flint, Lenexa, KS 66214 USA Phone: 800 878
Field Trip, Offsite Tutoring and Transportation Policy
Field Trip, Offsite Tutoring and Transportation Policy This policy is intended to protect the safety of School on Wheels, Inc. (SOW) students and volunteers while participating in field trips, offsite
Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC
Registration Packet Summer Academy June 3 rd to August 30 th Z M G www.zmgtennis.com HP and TTT Registration Form 1, LLC Enrolment Process prides its self on offering everything essential in the development
YOUTH MENTORING PROGRAM. Mentee Application (To Be Completed by the Parent/Guardian)
Personal Information YOUTH MENTORING PROGRAM Mentee Application (To Be Completed by the Parent/Guardian) Youth s Name: Date: Parent/Guardian Name: Relationship to Youth: Mother Father Other, specify: Street
Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823
Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Participant Last Name: Participant First Name: Grade: Age: Gender: Male
2013 Mid-West Collegiate Championships February 9, 2013
2013 Mid-West Collegiate Championships February 9, 2013 Host: Purdue Judo Club Location: Purdue University Sanction: USA Judo Recreational Sports Center Indiana Judo Inc. 355 N. Martin Jischke Drive West
FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM
FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM NOTICE: ALL ATHLETES WILL BE REQUIRED TO HAVE A SIGNED CONSENT FORM BEFORE TAKING THE FIELD. Football Camps of America, LLC. Parental Release Physical Form Waiver
2016 Bowdoin Summer Art Camp Registration
2016 Bowdoin Summer Art Camp Registration Hours and Location Bowdoin Summer Art Camp will run for four weeks from June 27 th through July 22 th. The times and length of each session vary. Please refer
Amnesty International - Requirements For 2015 Regional Conferences
Amnesty International USA sponsors special enrichment events for youth leaders as a means of providing a comprehensive and diverse learning environment to further their understanding of and participation
PROJECT EXCEL MENTORING PROGRAM Creating Vision Through Mentoring / What They See is What They Will Be
Personal Information Mentee Application (To Be Completed by the Parent/Guardian) Youth s Name: Date: Parent/Guardian Name: Relationship to Youth: Mother Father other, specify: Street Address: City: State:
Chang Scholarship Student Information
Chang Scholarship Student Information The mission of the Davis Schools Orchestral Music Association (DSOMA) is to support music students and the music program in general. Our music teachers believe that
Aquaculture and Conservation Biology Summer Camp 2014 Registration Form
All forms and payment are due no later than June 1, 2014 Participant s Name (First, Last) Age Grade in Fall 2014 Sex Street Address Apt.# City, State Zip Code Guardian Name Cell Phone Number E-Mail Address
Cherry Blossom Open XXII
Cherry Blossom Open XXII Saturday, February 13, 2016 National Ranking Points: Bantam, Intermediate, & Juvenile A & B only - 2 for 1st, 1 for 2nd, and.5 for 3rd Hosted by: Tomodachi Judo Club & Ki-Itsu-Sai
8 th Grade Event Packet Contents
8 th Grade Event Packet Contents 1) Letter Home About Upcoming Events and Donations please read and mark the appropriate box at the bottom of the page 2) Interested in Chaperoning? check the box and include
2015 FUMC Hurst Youth Missions: SAN ANTONIO Permission, Liability Waiver, and Medical Release Form
Permission, Liability Waiver, and Medical Release Form I give permission to participate in activities of the Youth or Children s Division of the First United Methodist Church, Hurst, Texas for the dates
2015 Summer Sibling Camp Weekend August 14-16th
Dear Parents and Siblings, 2015 Summer Sibling Camp August 14 th -16 th We are excited to invite siblings to participate in Camp Sunshine's Sibling Camp Weekend to be held August 14-16th. The weekend will
Sign-up students NOW!
Formally known as SEMAA MAA is a K-12 Hands-on, Minds-on STEM (Science, Technology, Engineering, and Mathematics) engagement at its best! Sign-up students NOW! Tri-C MAA offers fun STEM education activities
PCI NVA NSBE, Jr. Pre College Initiative Program
PCI NVA NSBE, Jr. Pre College Initiative Program Nubian Village Academy ational Society of Black Engineers Application Packet NVA-NSBE, Jr. Pre-College Initiative WHAT IS NSBE, JR. PCI? NSBE, Jr.-PCI is
Community House High School Programs Standing with families since 1969
Dear Parents/Guardians, Founded in 1969, Community House is devoted to standing with Princeton families by providing tools for academic success and social- emotional wellness through programs that bolster
Extracurricular Activities Handbook
Extracurricular Activities Handbook Board Approved July 16, 2007 EXTRA-CURRICULAR STUDENT ACTIVITIES HANDBOOK Philosophy and Definition Extra-curricular activities are school-sponsored activities that
2014 High School Police Academy Application Packet. Session 1: July 7 th 11 th Session 2: August 11 th 15 th
2014 Application Packet Session 1: July 7 th 11 th Session 2: August 11 th 15 th The Charlotte-Mecklenburg Police Department is offering high school students in Mecklenburg County the opportunity to experience
SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS
SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS I, ( ), the undersigned student, wish to participate in a study abroad Program offered by Saint
All Students - Please complete items 1-5 All paperwork must have original signatures and be readable. No partial submissions will be accepted.
Independent Study Physical Education (I.S.P.E.) The following items must be on file before your Independent Study application is complete. (1) Complete the online I.S.P.E. contract (keep a copy for your
SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS
SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS I, ( ) the undersigned student wish to participate in a study abroad Program offered by Saint Louis
Youth Camp Civic Center
Youth Camp Civic Center Household ID # Please circle the session(s) that your child(ren) will attend Session One June 8- June 12 Session Two June 15 June 19 Session Three June 22 June 26 Session Four June
camp rules/behavior agreement
camp rules/behavior agreement Lake Metroparks camps use assertive discipline techniques that are used to strengthen good behavior by the use of positive reinforcement such as verbal praise, smiles, awards,
CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING
CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING The undersigned, in consideration of being permitted to participate
J UNE 15 - AUGUST 7 GRADES (going into) HEADSTART - 7th grade
J UNE 15 - AUGUST 7 GRADES (going into) HEADSTART - 7th grade Our day camp offers structured activities from 8:00 a.m. to 5:00 p.m., 5 days a week for an eight-week program, all at one low price. Children
THE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP
THE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP 2011 SUMMER FASHION PROGRAM STUDENT APPLICATION CHECKLIST To apply for the Summer Fashion Program, please submit the required documents to The Center for Global
Taishi Judo Club 5 th Annual Invitational Tournament
Taishi Judo Club 5 th Annual Invitational Tournament Date/Time: Location: Sunday, March 22, 2015. Tournament will start promptly at 10:00AM Northview High School 1016 W. Cypress St. Covina, CA 91722 Sanction:
The Merritt Kids College Program - A Review
Parent s Name: Address: Email Address: Cell Phone: Emergency Contact Name: Registration Form Home Phone: Number: Child s Name: Grade: Age: School Name: Gender: Male: Female: T-Shirt Size: Small: { } Medium:
To apply please complete application and return to: Harris Towers Attn: Volunteer Coordinator 233 Peachtree Street; Suite 1700 Atlanta, Georgia 30303
To apply please complete application and return to: Harris Towers Attn: Volunteer Coordinator 233 Peachtree Street; Suite 1700 Atlanta, Georgia 30303 For more information please call 404-546-6788 Front
IELS Manual of Rules, Regulations and Procedures for Minors / Young Learners
IELS Manual of Rules, Regulations and Procedures for Minors / Young Learners 1. Mission Statement: Our mission at IELS Malta is to provide a fun, educational and safe environment for students to learn
2016 Summer Camp Registration Form
2016 Summer Camp Registration Form 1 of 6 2016 Summer Camp Registration Form All forms can be found online: http://go.dtcc.edu/swcamps q New Camper q Returning Camper Office Use Only: Identification Number
Georgia Tech North Ave. NW Atlanta Ga. 30332
Welcome to Fun Weird STEM Saturdays 2014 The functioning objective of Fun Weird Science STEM Saturdays is to: 1. Provide students with hands-on STEM experience; and 2. Engage students in the exciting ways
FURMAN UNIVERSITY SPORTSMEDICINE CENTER
IMPORTANT INSURANCE INFORMATION Dear Parents: Furman University provides an excess coverage policy for our intercollegiate athletes. Incurred medical charges are to be filed with your insurance first.
Summer College & Career Exploration Camps Parental Consent Form
Summer College & Career Exploration Camps Parental Consent Form This form must be completed, signed and returned to TCC one week prior to the camp start date. Email the completed form to [email protected]
Teen Academy one week program no cost June 22 to June 26, and July 20 to July 24
Teen Academy The Teen Academy is a one week program designed to give the teens of Rowlett a working knowledge of the Rowlett Police Department. There is no cost to anyone who enrolls. The classes will
RARITAN BAY AREA YMCA
Dear Applicant, Enclosed please find the Youth Leaders & Junior Counselor In Training Application and the Camp Registration Packet. Please complete the application and return all documents with your $100.00
Souderton Area. Internship Contract
Souderton Area S c h o o l D i s t r i c t Internship Contract Student Information Student s Name: Street Address: City: State: Zip: Home Phone: Cell Phone: Company Information Company Name: Location Address:
ARCADIA YOUTH RODEO ASSOCIATION, INC. 124 Heard Street, Arcadia, Florida 34266 863-494-2014 2015-2016 SEASON MEMBERSHIP APPLICATION
2015-2016 SEASON MEMBERSHIP APPLICATION MEMBER INFORMATION: BACK TAG # ISSUED: MEMBER NAME: ADDRESS: CITY: STATE: ZIP: HOME PHONE: CEL #: E-MAIL ADDRESS: (Please send newsletter via: Mail E-Mail ) DATE
Duke GEO Summer Program Participation Agreement
Duke GEO Summer Program Participation Agreement Summer Program Name: Term/Year: Student Full Name: Parent/Guardian Full Name: Student enrollment in Program is not granted until Student and a Parent/Guardian
CENTRAL MAINE CHRISTIAN ACADEMY 390 Main Street Lewiston, Maine 04240 207.777.0007 www.centralmainechristianacademy.org
CENTRAL MAINE CHRISTIAN ACADEMY 390 Main Street Lewiston, Maine 04240 207.777.0007 www.centralmainechristianacademy.org REGISTRATION FORM (Please Print) STUDENT INFORMATION Student s last name: First:
PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I, the undersigned, on behalf of my minor child: ( Participant ), hereby acknowledge that Participant has
2016 Summer Art Camp Scholarship Application Parental Consent Form
QUINLAN VISUAL ARTS CENTER April 17, 2016 Georgia Schools Attn.: Art Instructors, Principals Re: 2016 Summer Art Camp Scholarship Application Parental Consent Form Dear School Art Instructor and School
CTE SUMMER INTERNSHIP PROGRAM
CTE Applications Due: Thursday, May 15, 2014 PROGRAM DESCRIPTION Learn the both the art of culinary as well as how to develop your own business! This summer experience includes a combination of in-class
5k Run/Walk hosted by the Rochester Hills Government Youth Council
5k Run/Walk hosted by the Rochester Hills Government Youth Council to benefit the Saturday, June 13, 2015 Bloomer Park Rochester Hills, Michigan 8:30 a.m. 10:30 a.m. Registration Brochure Blessings in
Hayward Area Recreation and Park District. Summer Swim League. Parent Handbook
Hayward Area Recreation and Park District Summer Swim League Parent Handbook 1 Coaching Staff & Team Structure Coaching Staff All HARD Summer Swim League coaching staff have been chosen to coach due to
Camp Culinaire. Camp Dates June 22-24, 2016 12:30 5:30 p.m. each day
Camp Culinaire Camp Dates June 22-24, 2016 12:30 5:30 p.m. each day For more information contact Jessica Hoffman Email: [email protected] or Phone: 317-921-4292 Ivy Tech Community College Central
Any questions may be directed to Master Officer Jason Stone or Master Officer Matt Mellenberger (919) 362-8661
Thank you for your interest in the Apex Police Department Law Enforcement Explorer Program. Please complete the following steps so we are able to process your application. Fill out the application completely
FORREST COLLEGE CHILD CARE. Handbook
FORREST COLLEGE CHILD CARE Handbook MISSION STATEMENT We are privileged at Forrest College to provide free child care for the children of our fulltime students. It is our aim to provide a safe and structured
DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP:
Get Noticed Beach Volleyball Waiver WAIVER AND RELEASE, EXPRESS ASSUMPTION OF RISK, INDEMNITY AND HOLD HARMLESS AGREEMENT, AND GRANT OF RIGHTS NAME OF PLAYER: PLAYER AGE DATE OF BIRTH: PLAYER GRADE as
Citizens Academy Overview
If you reside, own property, or a own a business in the City of Sarasota, you are invited to apply for the Citizens Academy by downloading an application which is available on the Neighborhood and Development
Compass Road to College Summer Tour Application
Compass Road to College Summer Tour Application Student Information Name: Email Address: Sex: F M Birth Date: Primary Language Spoken at Home: English Spanish Other: Current School: School You ll be Attending
GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR
GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR Welcome Child s Enrollment Form Parent Pick-Up Authorization Emergency Information, Waiver & Medical
TOWN OF POUGHKEEPSIE POLICE DEPARTMENT
TOWN OF POUGHKEEPSIE POLICE DEPARTMENT INFORMATION PACKET OVERVIEW The Town of Poughkeepsie Police Department is seeking to provide an innovative program for youth residing in the Town of Poughkeepsie.
REGISTRATION FORM. Registration Forms & $200 Deposit due -> October 9, 2016
Northwest University College of Business T H E I M P E R I A L C I T I E S Budapest, Vienna and Prague I N T E R N A T I O N A L B U S I N E S S T O U R M a y 9-1 9, 2 0 1 6 REGISTRATION FORM REGISTRATION
Application Summer Study - Pre-College New York Summer Study 2016
Application Summer Study - Pre-College New York Summer Study 2016 First Name Birth Date (Month/Day/Year) Address Last Name Male Female City State Zip/Country code Country Home Tel. E-mail Current School
Midwest Cheer Elite All-star Hip Hop Information 2015-2016
Midwest Cheer Elite All-star Hip Hop Information 2015-2016 Welcome to Midwest Cheer Elite, Inc. We are delighted that you have chosen to become a part of one of the top All-Star programs in the Midwest!
Ambassador Application
Ambassador Application Dear Applicant, Thank you for your interest in Dallas Medical Center s Ambassador Program! Your willingness to invest a few hours each week is greatly appreciated. I believe you
OKLAHOMA SCHOOL FOR THE DEAF DEAF AND HARD OF HEARING SUMMER CAMP HIGH SCHOOL JUNE 14-19, 2015 ELEMENTARY SCHOOL JUNE 21-24, 2015 REGISTRATION DAY
OKLAHOMA SCHOOL FOR THE DEAF DEAF AND HARD OF HEARING SUMMER CAMP HIGH SCHOOL JUNE 14-19, 2015 ELEMENTARY SCHOOL JUNE 21-24, 2015 REGISTRATION DAY WHEN: JUNE 14 th (High School) JUNE 21 nd (Elementary)
West Virginia University 2015 Forensic Science Summer Camp
Thank you for registering for the! This packet contains the following forms that must be completed and returned before the student will be allowed to attend camp: Participant Information Form Event Participant
