Camp VIP Application Form

PSmanhattan Home Page | The Manhattan Beach Athletic Foundation | Camp VIP | Manhattan Beach After School Programs

CAMP VIP: Application

A Summer Of Enrichment Activities For Students Grades K - 8
(All Net Proceeds Will Benefit Programs And Services For MBUSD Students Grades K - 12)
Four one-week sessions: 9:00 a.m.—12:10 p.m. daily
Week #1, July 5 - 9
Week #2, July 12 - 16
Week #3, July 19 - 23
Week #4, July 26 - 30
Two additional afternoon sessions: 1:15 a.m.—4:25 p.m. daily
Week #2, July 12 - 16
Week #3, July 19 - 23

© 2010 by MBAF
Manhattan Beach
Athletic Foundation
PO Box 1585
Manhattan Beach CA
90267-1585
E-mail (preferred):
kathy@wvcpas.com
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 18. After June 18: 50% refund. No refunds after July 2.

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*:

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:

Please list two contacts (friends, neighbors, relatives) that child may be released to if parent cannot be reached
or that child may go home with under normal circumstances:

NAME 1 ADDRESS PHONE

NAME 2 ADDRESS PHONE

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.

Current School Attending*:

Currrent Grade Level*

School Attending Fall 2010*:

Grade Level Fall 2010*

WEEK ONE 9:00 A.M. TO 12:10 PM FIRST CHOICE:

WEEK ONE 9:00 A.M. TO 12:10 PM SECOND CHOICE:

WEEK TWO 9:00 A.M. TO 12:10 PM FIRST CHOICE:

WEEK TWO 9:00 A.M. TO 12:10 PM SECOND CHOICE:

WEEK TWO 1:15 P.M. TO 4:25 PM FIRST CHOICE:

WEEK TWO 1:15 P.M. TO 4:25 PM SECOND CHOICE:

WEEK THREE 9:00 A.M. TO 12:10 PM FIRST CHOICE:

WEEK THREE 9:00 A.M. TO 12:10 PM SECOND CHOICE:

STARTING WEEK THREE 9:00 A.M. TO 12:10 PM
SKILLS, REVIEW, ACADEMIC SUPPORT

WEEK THREE 1:15 P.M. TO 4:25 PM FIRST CHOICE:

WEEK THREE 1:15 P.M. TO 4:25 PM SECOND CHOICE:

WEEK FOUR 9:00 A.M. TO 12:10 PM FIRST CHOICE:

WEEK FOUR 9:00 A.M. TO 12:10 PM SECOND CHOICE:

We have read and agree to follow the Code of Conduct (on the Camp VIP Information web page) and understand that behavior exhibited which is in conflict with this code may result in being excluded from Camp VIP activities.

*

Information submitted by*:

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

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.
Refund Policy: Full refund less $25 processing fee before
June 18. After June 18: 50% refund. No refunds after July 2.

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