Summer 2006 at the

Boys and Girls Clubs

of Burbank

June 2006Week of June 19 – 2319 – Horseback Riding 20 – Swimming21 – Out to the Movies22 – Swimming23 – Universal Studios

June 2006Week of June 26 – 3026 – Santa Monica Pacific Park 27 – Swimming28 – Ice Skating29 – Swimming30 – Bowling July 2006Week of July 3 - 73 – LA Zoo4 – Club Closed5 – California Science Center/IMAX6 – Swimming7 – DisneylandJuly 2006Week of July 10 - 1410 – Long Beach Aquarium11 – Swimming12 – Beach13 – Swimming 14 – Burbank History Museum

July 2006Week of July 17 - 2117 – Natural History Museum 18 – Swimming19 – LA Maritime Museum

20– Swimming/LA Galaxy 21 – Hurricane HarborJuly 2006Week of July 2424 – Horseback Riding25 – Swimming/Cal. African American Museum 26 – Out to the Movies 27 – Swimming/Countrywide Tennis Classic (See Jay) 28 – Burbank Recycle Center July/August 2006Week of July 31 –August 431 – Santa Monica Pacific Park 1 – Swimming 2 – Ice Skating3 – Swimming 4 – Magic Mountain August 2006Week of August 7 - 11 7 – LA Zoo 8 – Swimming 9 – Cal. Science Ctr. / SPARKS (See Jay) 10 – Swimming 11 – Bowling

August 2006Week of August 14 - 1814 – Long Beach Aquarium 15 – Swimming16 – Beach 17 – Swimming 18 – Knott’s Berry Farm August 2006Week of August 21 - 2521 – Natural History Museum 22 – Swimming 23 – LA Maritime Museum 24 – Swimming 25 – Summer BBQ

Boys & Girls Club of Burbank

2244 N. Buena Vista StreetBurbank, CA 91504

(818) 842-9333

Day Camp – 7AM – 7 PM

Monday through Friday

$80.00/Week

Please place a check by the trips that you will be sending your child

on. Please note all field trips are on a “First Come First Serve Basis.”

Club Membership Fee: $75.00Weekly Fee: $80.00

Field Trip Prices

Unlimited Swimming:___ X $11.00

Horseback Riding: ___ x $18 = _____

Out to the Movies: ___ x $9 = _____

Santa Monica Park: ___ x $11 = _____

Ice Skating:___ x $8 = ______

LA Zoo: ___ x $6 = ______

Bowling: ___ x $8 = ______

California Science Center: ___ x $8 = _____

Long Beach Aquarium: ___ x $11 = _____

Beach: ___ x $5 = _____

LA Maritime Museum: ___ x $4 = _____

Natural History Museum: ___ x $8 = _____

Universal Studios: $38.00 ______Knott's Berry Farm: $29.00 ______Hurricane Harbor: $20.00 ______Disneyland: $40.00 ______Magic Mountain: $27.00 ______

Total: $______

Summer 2006

OF BURBANK

2244 N Buena Vista StreetBurbank, CA 91504

Phone: 818-842-9333Fax: 818-842-0694

Website: www.bgcburbank.org

Summer Camp 2006 RegistrationChilds Name: ________________________________

D.O.B.: _________________ Age: _____________ Home # ____________________________________Contact: ____________________________________Emergency # ________________________________Contact: ____________________________________Work # ____________________________________Contact ____________________________________

PARTICIPANT CONSENTI hereby authorize my child’s full participation in the

above named program conducted by the Boys and Girls Club of Burbank, I agree to not hold the Boys and Girls

Club, its staff, volunteers, or board of directors responsible for the conduct or any loss, damage or

personal injury to my child. Further I understand I am required to pick up my child by the stated closing time or I must pay the applicable late fees as defined by the Boys and Girls Club of Burbank, Inc. $5.00 FOR THE

EVERY 15 MINUTES. Medical Treatment Release

In case of an accident or emergency, I authorize a staff member of the Boys and Girls Club of Burbank to call for medical attention. Further I agree that the Club may

personally transport my child to the nearest known hospital and to hold the Club harmless of any consequences related to such transportation.

Additionally I will accept full responsibility for the emergency treatment or measures that are deemed

necessary for the safety and protection of my child. I release the Boys and Girls Club of Burbank, its staff

and board of directors of any and all liability involved in this emergency procedure.

Medical InformationDoctor: __________________ Dr. #: ______________Medical Ins. # ________________________________

Medical Conditions Allergies, Medications,Devices

Worn) _____________________________________Parent Signature: ______________________________