2022 SUMMER CAMP REGISTRATION

2022 SUMMER CAMP REGISTRATION
Before filling out the registration form, please review our 2022 summer camp brochure below: *
ONE REGISTRATION FORM & ONE PAYMENT PER CHILD
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
Entering Grade In 2022-2023 *
Name *

First Name Last Name
Age *
Birthdate *

Month Day Year
Date
Parent / Guardian Name *
Address *

Address

Street Address Line 2

City

Zip Code
Phone number *
E mail Address *

Confirmation Email example@example.com
How did you hear about Girls Inc.?
PAYMENT PROCEDURE

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 transfers
between campers.

CAMP REFUND POLICY & PROCESSING

All cancellation requests must be made in writing to summercamp@girlsincislandcity.org. Verbal requests will not be accepted.
- Cancellation requests made before April 18 will be subject to a $50.00 cancellation fee.
- Cancellations requests made after April 18 and up to 7 days prior to the registered camp start date will be subject to a 50% cancellation fee.
- No refunds given with less than 7 days notice of the registered camp start date.
Acknowledgement *

I understand and agree to the Payment Procedure, Transfer & Change Policy and Refund Policy listed above.
Registration for girls entering 1st - 6th grade and at least 6 years of age8am-4pm, $220 per week. *Center will be closed Monday, July 4 in observance of 4th of July Week 3 will be a special rate of *$200 *

Week 1 June 20-24 Week 2 June 27-July 1 Week 3 *July 4-8 Week 4 July 11-15 Week 5 July 18-22 Week 6 July 25-29 Week 7 August 1-5

Girl/Participant Name

First Name Last Name
Parent/Guardian Name
Girl/Participant Birth Date *

Month Day Year
Date
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.
Parent/Guardian signature

Clear
Date

Month Day Year
Date
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.
Parent/Guardian signature

Clear
Date

Month Day Year
Date
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.
Parent/Guardian signature *

Clear
Date *

Month Day Year
Date

2022 SUMMER CAMP REGISTRATION

ONE REGISTRATION FORM & ONE PAYMENT PER CHILD

EMERGENCY AND HEALTH INFORMATION

HEALTH INFORMATION

MEYERS CENTER