2012—2013 Winter Camp Registration Form

Submit completed registration form to the Registration Office, 455 N. Rexford Dr. Room

260, Beverly Hills, CA 90210 or fax to 310.274.9571. Refunds and RETURNED CHECKS

are subject to service charges. Outstanding balances with the Community Services Depart-

ment will be applied against any and all registration fees.

Participant’s Name

Grade Age School

Address

Home Phone e-mail

Parent’s Name(s)

Day Phone Cell Phone

Medical Conditions/Allergies

Method of Payment: Check (Checks made payable to the City of Beverly Hills)

Master Card Visa

AMEX Discover

Credit Card # Exp. Date

Cardholder’s Name

Cardholder’s Signature

Amount Enclosed $

Course Name & Number:

Course Name & Number:

Emergency Contacts (other than parents)

Name

Phone

Name

Phone

Please read and sign the following I hereby agree to indemnify, defend and hold harmless the City of Beverly Hills, and its officers, em-

ployees, agents and volunteers, from and against any and all damages, loss liability, charges and ex-

penses in any way arising out of my (or my children’s) participation in the program for which I am

registering. I hereby consent to the photographing, recording and reproduction in any other manner (including use of video and audio) of the likeness, voice and/or activities of the participant and further

authorize the City of Beverly Hills, its agents or assigns, to make unlimited use of such reproductions

over radio, television and on the Internet. I understand that I will not receive any monetary compensa-tion now or in the future for participating. I do hereby release and hold harmless the City of Beverly

Hills, its officers and employees from any claims. I have read and acknowledge the refund policy.

X Date Parent/Legal Guardian Signature

City of Beverly Hills—Community Services Department

Winter Break Camps

Not sponsored by BHUSD

December 24—January 4

To Register: www.beverlyhills.org/BHRegOnline

310.274.9571 (fax)

For information: 310.285.6810

BevWood Basketball Camp SmART Space Art Camp

Brit West Soccer Camp Camp Beverly Hills

AK Soccer Academy

Camp Beverly Hills [ages 5-10] Join us for smiles, laughter, new experiences, and fun at Camp Beverly Hills. Our Recreation Leaders provide a safe, fun camp environment with games, sports, arts and crafts, and special events. Campers will build social skills as well as confidence with our enriching activities.

Week 2 (12/31—1/4) No camp Tuesday 1/1 19303 Monday (12/31) 8:00am—4:00pm Wednesday, Thursday, Friday 8:00am—6:00pm $180/$225 La Cienega Community Center

Brit West

Soccer Camp [ages 5-14] Brit West is dedicated to providing quality soccer instruction while promoting sportsmanship and fun. Camp activities have been designed to develop a player’s skill and technique. Brit West’s program includes many different aspects of the game including ball familiarity, passing and shooting.

Week 2 (12/31—1/4) No camp Tuesday 1/1 19302 Monday, Wednesday, Thursday, Friday 9:00am–12:00pm $135/$169 La Cienega Park, Field #3

SmART Space Camp [ages 5-10] PAINT, DRAW, STRETCH, COLLAGE, SCULPT, IMAGINE...At SmART Space! Inspired by the theme ―Winter Wonderland,‖ young artists will explore the exciting world of creativity through a variety of hands-on art activities. Camp workshops include inspired lessons designed to encourage open-ended creativity. Activities such as painting, 3D sculpture, pastels, paper-mache, mask-making, mixed media and clay-working will be scheduled, as well as imagination games, drama exercises and outdoor play. All SmART Space camps are taught by our professional teaching artists. Campers will be grouped by age for art workshops. Please pack a healthy snack and lunch each day. An additional material fee of $30 due to Smart Space on the first day of camp.

Week 1 (12/24–12/28) No camp Tuesday 12/25 19301 Monday, Wednesday, Thursday, Friday 9:00am–2:00pm $200/$250 LCCC

BevWood All-Stars

Basketball Camp [ages 5-14] Get ready to run, pass and shoot! Players will receive general instruction, as well as individual practice drills and learn team offense and defense concepts. To ensure each camper receives the appropriate level of coaching, players are grouped according to age.

Week 2 (12/31—1/4) No camp Tuesday 1/1 19300 Monday, Wednesday, Thursday, Friday 9:00am–3:00pm $180/$225 El Rodeo School

LOCATIONS:

El Rodeo School 605 Whittier Dr., BH 90212

La Cienega Community Center 8400 Gregory Way, BH 90211

La Cienega Park, Field #3 8400 Gregory Way, BH 90211

Field just east of the parking loop

For more information: 310.285.6810

AK Soccer Academy (ages 4-12) The City of Beverly Hills, Beverly Hills AYSO Region 76 and AK Soccer Academy are teaming together to offer an intense but fun camp for players that are serious about their soccer game. Rotating skills stations, strategizing game play, and high energy fun will prepare you to excel. Coach Asaf will lead the Camp and is well known for providing the excellent Monday night AYSO Skills Clinics. Camp will be divided into age groups. Register early! Spaces are limited by age group for this specialty camp.

Week 1 (12/26—12/28) No camp Monday 12/24 or Tuesday 12/25. 19680 Ages 4-6 19681 Ages 7-8 19682 Ages 9-10 19683 Ages 11-12 Wednesday, Thursday, Friday 9:00am—1:00pm $165/$206 La Cienega Park, Field #3