June 20 to August 5, 2022. For girls entering 1st thru 6th grade and at least 6 years old 1724 Santa Clara Ave. Alameda, CA 94501 (510)521-1743
Please PRINT all information below CLEARLY
A deposit of at least half of all fees are due when you receive your summer camp confirmation email. The remaining balance must be RECEIVED by June 1, 2022 If the balance is not paid, your girl cannot attend and no refund will be given. You will be assessed a $10 fee for any form turned in that is incomplete.
TRANSFER & CHANGE POLICY
All requests for transfers and changes must be submitted in writing to the Director of Elementary Programs. A $25 fee will be charged per transaction for all transfers and changes. These will be honored as long as space is available. There are no transfersbetween campers.
CAMP REFUND POLICY & PROCESSING
All cancellation requests must be made in writing to email@example.com. Verbal requests will not be accepted.
Media/Photo Release (optional)
I hereby authorize Girl Inc. of the Island City, its agents and others working for it or on its behalf to use my girl's image/likeness/voice/artwork/writing in still photos, slides video productions, radio coverage, television coverage, interviews, testimonials for promoting and representing Girls Inc. and its programs, and do hereby grant and convey unto Girls Inc. all rights, title, and interest in the above media including but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.
Social Media/Photo Release (optional)
I hereby authorize Girl Inc. of the Island City, its agents and others working for it or on its behalf to use my image/likeness/voice/artwork/writing in still photos, slides video productions on Girls Inc. of the Island daughter's City's accounts on social media sites (Facebook, Twitter, etc) including Girls Inc. website, for promoting and rep- resenting Girls Inc. and its programs, and do hereby grant and convey unto Girls Inc. all rights, title, and interest in the above media including but not limited to, any royalties, proceeds, or other benefits derived from such photo- graphs or recordings.
Liability Agreement Release - Required for Participation
I hereby authorize, as parent or legal guardian, for my girl to participate in Girls Inc. Programs. In consideration hold for this participation, I do hereby, for myself and my heirs and assigns, release and agree to indemnify and harmless Girls Incorporated of the Island City, its employees and volunteers from all liability, loss, claim, demand, action or cause of action which arises or may arise or be occasioned in any way by such participation. I also release and hold harmless Girls Inc of the Island City, its employees and volunteers from all liability, loss or claim which may occur in transporting my child for the purposes of participating in any Girls Inc. activities.
PLEASE PRINT ALL OF THE INFORMATION BELOW
In addition to the parents/guardians, the following adults (18 years and older) are authorized to take this child from the facility. These names will also serve as emergency contacts. These contacts must be reachable and available for immediate pick-up or response.
Allergies to: (If "none" please write in none)
Parent/Guardian - Please read and sign: I give permission to obtain all emergency medical or dental care prescribed by a duly licensed Physician (M.D Osteopath (D.O or Dentist (D.D.S for my child. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of the child named above.
This information will be kept anonymously and in confidence. It will be used strictly for statistical data reports to Girls Inc. National Organization and potential funders. Thank you for your help.
Please mark all appropriate boxes.