WELCOME TO SUMMER DAY CAMP 2016!
You have enrolled your child: ________________________________________________
(Full Name)
in our Day Camp Program from _________________ to _________________ (Dates)
Dear Day Camper Families:
Welcome to our 2016 Summer Program. We are looking forward to providing your child with
the best summer experience.
Camp hours are 8 a.m. - 3 p.m. The Babysitting program will open with extended hours this
year from 3 p.m. to 6 p.m. The fee for extended care is $8 per program day. There is a late fee of
$5 for every 15 minutes if you do not pick up your child by 3 p.m. (6 p.m. for babysitting.) After
three late pick-ups, your child’s participation in the program may have to be terminated.
Camp session fees are not refundable, pro-ratable or transferable. Fees may be billed to your
Club account (subject to credit limit). The program fee does not include extended babysitting
care. No credit will be given for missed camp. Please let us know when you will be taking a
vacation or if your child will be out for more than one day.
Each day your child is required to bring:
•
A sack lunch
•
Swimsuit, brush or comb, and a backpack.
Make sure everything is labeled with your child’s name.
If you have further questions after you read the enclosed information, please call Program
Coordinator Skye Conant, (213) 625-2211 ext. 3366.
Once again, thank you for choosing the Los Angeles Athletic Club. I can assure you that we will
do our best to provide a safe and enjoyable program for your child.
Sincerely,
Marlene Wiscovitch
Athletic Director
1
Rev. 03-24-16
A TYPICAL DAY
8:00 - 9:30 a.m.
Drop off (ninth floor babysitting room)
9:30 - 9:45 a.m.
Friendship Circle/Movie
9:45 - 10:45 a.m.
Pool Time
10:45 - 11:00 a.m.
Snack
11:00 - 11:45 a.m.
Warm-up and Fitness Games
Noon - 12:30 p.m. Lunch
12:30 - 1:00 p.m.
Quiet Time
1:00 - 2:00 p.m.
Arts & Crafts
2:00 - 2:45 p.m.
Lesson Focus for the Day
1. Focus on the theme of each session.
2. Give the child a new activity to emphasize the theme.
3. Play a game involving the skill that was worked on within
the context of the theme for that session.
2:45 - 3:00 p.m.
Friendship Circle/Movie (ninth floor babysitting room)
Songs, group skits, collect belongings, announcements, and
dismissal
Babysitting
3:00 - 3:30 p.m.
Board Games
3:45 - 4:45 p.m.
Free Swimming Period
5:00 - 6:00 p.m.
Movies
Snack/Nutrition
One of the following will be chosen each day: fruit, granola bars, juice,
trail mix, cereal bar, wafers, Animal Crackers, Cheeze-Its, cookies or
pudding.
Check out
Make sure you sign out your child with the instructor.
This is for your child’s safety.
2
Rev. 03-24-16
Summer Camp Program
Policies and Procedures
I. Admission Criteria
Prior to your child’s participation in the program, signed copies of the following must be on
file at The Club:
A.
B.
C.
D.
E.
F.
Enrollment Form
Summer Policies and Procedures
Emergency and Identification Information Sheet
Consent for Medical Treatment
Child’s Health History - Parent’s Report
Liability Waiver, Release and Indemnity Agreement
II. Sign in/out Procedures
1.
2.
3.
4.
5.
6.
Each child must be signed in and out of the program by an authorized adult, with a full
and legible signature.
All children must be at camp no later than 9:30 a.m.
Children must be picked up by an authorized adult no later than 3 p.m. (6 p.m. if
enrolled in babysitting)
There is a late fee of $5 for every 15 minutes your child is not picked up on time.
The program fee for the day camp is not refundable, pro-ratable or transferable.
Absences will not be credited.
III: Behavior — Discipline Procedures
1. Preventative discipline shall be used by staff whenever possible. We believe that
reinforcing positive behavior and the five LAAC house rules will many times prevent a child
from indulging in negative behavior.
2. As in any group activity, the inappropriate behavior of a few children can spoil the
experience for the whole group. Therefore, the following steps of discipline apply to all
children and will be used when necessary.
a.
b.
c.
d.
Discussion on a one–on-one basis with parent or guardian.
Restrictions from continuing activity.
Discussion with the Program Director.
Discussion with the parent and staff.
3.
The Los Angeles Athletic Club strongly believes that children should not be allowed to
hurt themselves or others. If this type of behavior occurs it will be considered severe and any
or all of the following steps will be taken:
3
Rev. 03-24-16
a.
b.
c.
d.
Parent and Program Coordinator will have a conference.
Child will be placed on a behavior contract.
Child will be suspended from the program.
Child will be discharged from the program.
4.
Your help in keeping us informed on significant changes or events in your child’s
life that might impact his/her behavior would be appreciated. Please keep your emergency
phone numbers and information up to date.
5.
Feel free to ask for a conference with the Program Coordinator. We welcome a
conference for joint learning that can benefit your child(ren), you, and our Summer Program.
I acknowledge that I have read and agree to the above Policies and Procedures for the 2016 Summer
Program of the Los Angeles Athletic Club. I understand that failure to comply with the Policies and
Procedures may result in termination of my child’s participation by The Club.
_______________________________________
Signature of Parent or Guardian
Date: ________________________
_______________________________________
Print Name
4
Rev. 03-24-16
2016 Summer Camp Enrollment Form
Child’s Name________________________________________________ Age _____ Sex _______
Parent’s Name__________________________________ Membership No.____________________
Address______________________________________________ e-mail______________________
City __________________________ State _______ Zip____________ Phone_________________
CHECK
SESSIONS
______
Session 1
June 20 – July 1
______
Session 2
July 5 – July 15 (Closed on the 4th)
______
Session 3
July 18 – July 29
______
Session 4
August 1 – August 12
*Field Trips will be on the second Thursday of every session at additional fees
(Information will be given to those enrolled on by June 10th)
1.
Payment in full for any day that your child will attend must be received at The Club by the first
day your child comes in to camp.
2.
Members may charge all fees to their LAAC account (subject to credit limit).
3.
Camp fees are not refundable, pro-ratable or transferable. Fees per session:
Program fee: $325 for 2-weeks $190 per week Members
Extended Babysitting:
$75 for 2-weeks $38 per week Members
Program fee: $405 for 2-weeks $250 per week Non-members
Extended Babysitting:
$75 for 2-weeks $38 per week Non-member
Amount
Program Fees
$_________
Babysitting Fees $_________
Total
$_________
(Staff use only)
Date Received
Staff Initials
___________________
__________
I wish to enroll my child in the 2016 Summer Camp listed above. I agree to pay the fee(s) set forth
above.
________________________________________________
Signature of Parent or Guardian
5
Date: _____________________
Rev. 03-24-16
Emergency and Identification Information
A. Family Information:
Child’s Name: _________________________________________________________________
Last
First
Middle
Date of Birth: _________________________________________ Sex: _____ M _____ F
Month
Day
Year
Mother/Guardian Name: ___________________________________________________________
Home Address: __________________________________________________________________
Home Phone: ___________________________ email: __________________________________
Business address: ________________________________________________________________
Work phone: ___________________________ Cell Phone: _______________________________
Father/Guardian Name: ____________________________________________________________
Home Address (if different from above): _________________________________________________
Home Phone (if different from above):_____________________ email: ________________________
Business address: _________________________________________________________________
Work phone: _____________________________ Cell Phone:_____________________________
B. Names of persons authorized to take your child from The Club. (Your child
will not be allowed to leave The Club with any other person without prior
written authorization from a parent or guardian.)
1. ___________________________________________________________________________
Full Name
contact phone #
relationship
2. ___________________________________________________________________________
Full Name
contact phone #
relationship
3. ___________________________________________________________________________
Full Name
contact phone #
relationship
4. __________________________________________________________________________
Full Name
contact phone #
relationship
6
Rev. 03-24-16
C. Child’s Physician
Name: ___________________________________________Phone #:______________________
Address: ______________________________________________________________________
D. Medical Insurance
Medical Insurance Provider: ______________________________________________________
Primary Named Insured: _________________________________________________________
Policy #: ________________________________ Group #: ______________________________
E. Consent for Medical Treatment
In the event of illness or injury to my child, I authorize staff members of the Los Angeles
Athletic Club to do any or all of the following: administer first aid, contact the above named
Physician, summon paramedics, transport my child to a nearby hospital or clinic for such
treatment and measures as deemed prudent for the health and safety of my child, at my
expense, and without liability. Such authority shall include the power to consent to any X-ray
examination, anesthesia, medical or surgical diagnosis or treatment and hospital care under
the supervision of a licensed medical or dental practitioner. This authorization is irrevocable
for the duration of my child’s participation in the summer camp program.
_____________________________________________
Signature of Parent or Guardian
____________________________
Date
_____________________________________________
Print Name
7
Rev. 03-24-16
SUMMER CAMP 2016
Child’s Health History — Parent’s Report
Child’s Name: __________________________________________________________
Date of Birth: ________________________
Does your child have the following?
Sex: ____ Male
____ Female
Details/Limitations
Seizures
_____No _____Yes ___________________________________
Heart defect or disease
_____No _____Yes ___________________________________
Diabetes
_____No _____Yes ___________________________________
Bleeding / clotting disorder
_____No _____Yes ___________________________________
Asthma
_____No _____Yes ___________________________________
Serious allergies: Insect stings
_____No _____Yes ___________________________________
Penicillin
_____No _____Yes ___________________________________
Other drugs
_____No _____Yes ___________________________________
Food
_____No _____Yes ___________________________________
Other
_____No _____Yes ___________________________________
Muscle, bone or joint problems _____No _____Yes ___________________________________
Previous injury still affecting
_____No _____Yes ___________________________________
Loss of consciousness
_____No _____Yes ___________________________________
Physical limitations
_____No _____Yes ___________________________________
Surgery in the last year
_____No _____Yes ___________________________________
Special fears or conditions
_____No _____Yes ___________________________________
Note: If you answered, “Yes” to any of the above, you must provide a doctor’s release before your
child will be allowed to participate in summer camp.
Is there anything else we should know about your child? _________________________________
_______________________________________________________________________________
I certify that the above information is true, correct and complete. I represent that my child is able to
safely interact with other children and participate in summer camp activities.
_______________________________________
Signature of Parent or Guardian
___________________________
Date
___________________________________________
Print Name
8
Rev. 03-24-16
LIABILITY WAIVER, RELEASE AND INDEMNIFICATION AGREEMENT
Please Read Carefully
I am a parent having legal custody or person having legal custody or guardian of the following
Minor: _______________________________________________ (print full name of child). In
consideration of the Minor’s use of the facilities and participation in activities of the Los Angeles
Athletic Club (“LAAC”), I acknowledge and agree as follows, for myself, the Minor, and the Minor’s
heirs, personal representatives and assigns:
1. Assumption of Risk. Use of LAAC’s facilities and participation in summer camp activities on or off
LAAC premises is completely voluntary and for the Minor’s recreational enjoyment. Risks exist in the
various activities and facilities offered by LAAC, including but not limited to, the risk of illness, serious
personal injury, disability or death. I assume all risks, including unforeseen risks.
2. Liability Waiver & Release. To the fullest extent permitted by law, I waive all claims and forever
release LAAC from any claims, damages, liabilities, losses, suits, costs and expenses including attorney
fees, for personal injury to the Minor or any other person, or loss of any property, arising from the
Minor’s use of LAAC’s facilities or participation in any activities on or off LAAC’s premises, including
claims arising from any active or passive negligence of LAAC.
3. Indemnification. I further agree to hold harmless and indemnify LAAC against all third party claims,
damages, liabilities, losses, suits, costs and expenses including attorney fees suffered or incurred by
LAAC and arising from the Minor’s participation in any activities or use of LAAC’s facilities.
4. Insurance. LAAC is not the insurer of the Minor or me. I will maintain insurance to protect the
Minor, including health insurance, and myself and to the extent I deem prudent, liability coverage.
5. Representations. I represent that the Minor is healthy enough to safely undertake the activities
offered by LAAC, comprehend instructions, and follow directions. I will abide by the decisions of
LAAC staff if they find it necessary to discipline or dismiss the Minor. I will be responsible for any
charges incurred on account of the Minor.
6. Interpretation. LAAC is defined as the Los Angeles Athletic Club, its owners, affiliates and the
partners, directors, officers, employees, agents and representatives of any of them. This Agreement
contains all of the understandings between LAAC and me regarding the subject matter hereof, and may
be modified only in a writing signed by the parties. I am not relying upon any promise, representation
or inducement not contained herein. The waiver, release and indemnity provisions herein are continuing
obligations and intended to be as broad, comprehensive and inclusive as permitted by law, but are not
intended to assert any claim or defense that prohibited by law. The provisions of this Agreement shall
be interpreted in such a way so as to render them valid whenever possible, and any ambiguity shall not
be strictly construed against LAAC. If a court or arbitrator having jurisdiction holds any part of this
Agreement invalid, the remainder shall continue in full force and effect.
By signing below, I certify that I have carefully read the above and understand that this is a binding
contract that releases LAAC from liability, among other things, and I enter into it of my own free will.
______________________________________________
Date: ___________________
Signature of Parent or Guardian
Print Name ______________________________________
9
Rev. 03-24-16
10
Rev. 03-24-16