One Sign Up Sheet Per Member
Current Phone Number ________________________________________________
Date of Birth _________________________________________________________
Summer Break 2016 Science Camp
William N. Pennington Facility ●
360-2469
Program Reminders
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Hours of Operation: 7:00am-6:00pm.
Children must be picked up by closing time. There is no grace period.
Refunds or credits will not be issued for suspensions of any kind.
All field trips fees must be paid by closing on the Friday prior to the trip.
Weekly fee is required; field trips are optional.
Field trip box on form must be marked for child to attend the field trip.
Membership cards must be presented to attend field trips.
Field trip shirts must be worn for designated outings.
All field trips leave after lunch and return by 5:00pm unless stated otherwise.
On Friday,
Dress in your rodeo
gear.
Field Trips (Additional/optional Fee)
Monday
Coconut Bowling
1:00pm-5:00pm
Socks required
Tuesday
Not eligible due to camp
Wednesday
Raceway & Mini Golf
$6
$10
1:00pm-5:00pm
Thursday
Not eligible due to camp
Total: _________
Parent/Guardian Signature ______________________________
By signing above, I agree that I have read this form in its entirety and agree to adhere to the
rules set forth by BGCTM.
Office Use Only
Date: _____/_____/2016 Entered By:___________
Cash
Credit Card
Check
JUNE 20-24
Keepin’ it
Country Week
Ages 7-12
9:00a-12:00p, Monday-Thursday.
Capacity: 20 members; first come, first served.
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· In consideration of my child’s membership and participation in the activities, special programs and/
or special events of the Boys & Girls Club, I hereby fully waive, release, and hold harmless the Boys &
Girls Club, together with all its agents, employees, representatives, officers, and directors from any
and all claims, causes of actions, damages, costs, expenses, and other liabilities in any way arising out
of or resulting from such membership or participation, including, but not limited to, any personal
injury, accident, illness, property damages or any loss, injury or harm of any nature whatsoever.
· I attest and verify that I have full knowledge of any and all risk involved in such membership and
participation, and that I will, on behalf of the named member(s), assume full responsibility for such
risks and pay any and all medical, emergency, and other costs and expenses in the event of injury,
accident, illness, casualty or other incapacity regardless of whether I have authorized such expenses. I
acknowledge that my child is in good health, physically fit, and sufficiently trained to participate in
membership and in programs, activities, and events of the Boys & Girls Club.
$100
YOUTH SUMMER Week 2
Member First and Last Name ___________________________________________