YS Winter 2025 Wilton Program Application Logo
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  • YS Winter 2025 Wilton Program Application

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  • PARENT/GUARDIAN INFORMATION (PRIMARY CONTACT)

  • PARENT/GUARDIAN (SECONDARY CONTACT)

    If there is no secondary parent/guardian, you may skip this section

  • ADDITIONAL PICK UP/EMERGENCY CONTACT INFORMATION

  • ACKNOWLEDGEMENTS

  • Mandated Reporting - I understand that all KYCC staff are mandated reporters by California Law, and must report suspected child abuse or neglect of a child under the age of 18 to the Department of Child and Family Services using the resources that we were taught in our trainings. The types of reportable suspected child abuse are physical abuse, sexual abuse, emotional abuse, or neglect. By law, KYCC staff are not allowed to investigate or make any kind of judgement about the particular family. Any reports made are kept confidential and only shared with members of the Supervisor team.

    Liability - I hereby grant permission for my child to use all of the program equipment and participate in all activities of the center, and grant permission for my child to leave the premises under the supervision of a KYCC staff member. I do hereby, for my child/children, myself, my heirs, executors and administrators, release and hold harmless KYCC, and all officers, directors, employees, agents and volunteers of the organization, acting officially or otherwise, from any claims, demands, actions or causes of action which in any way arise related to my child's participation in KYCC programs.

    By signing below, I certify that I am the parent and/or legal guardian of the child named in this application. I acknowledge that I have carefully read this document and understand the information therein. I agree to each of the terms and acknowledgments above, and agree to permit my child to participate in KYCC activities.

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  • MEDIA RELEASE

  • Occasionally, KYCC program activities may be photographed, videotaped, or audio taped for educational, publicity or fundraising purposes. Please indicate if you give permission for your child and/or their project work to appear in videos, photos or audio recordings without compensation (e.g., as part of brochures, slide shows or program websites).

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  • KYCC Emergency Medical Release Form 2025-2026

  • YOUTH PARTICIPANT MEDICAL INFORMATION

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  • EMERGENCY RELEASE

  • If, in the judgment of the staff of KYCC the child named above needs immediate care and treatment as a result of any injury or sickness, I do hereby authorize and consent to any x-ray examination, anesthetic, medical, or surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon or dentist and performed by or under the supervision of the medical staff of the hospital or facility furnishing medical or dental services.

    I do hereby agree to indemnify and hold harmless KYCC (including its officers, directors, members and/or volunteers) from any claim by any person whomsoever on account of such care and treatment of said child. It is understood that a good faith attempt shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatments will not be withheld if the undersigned cannot be reached. Further, it is understood that the undersigned will assume full responsibility for any such action, including payment of costs.

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  • KYCC SIGN-IN AND SIGN OUT POLICY ACKNOWLEDGEMENT

  • Here is a brief overview of our sign-in and sign-out policy:

    • All middle and high school students can sign themselves in and out of the program. I understand that KYCC is not liable for the health and safety of my child before signing in and after signing out of the program.
    • Parents and/or Guardians have the right to request information about their child's attendance (i.e. asking if their child attended program on certain days or asking for the time their child signed in/out Any questions about attendance history can be addressed to the Program Lead Staff.
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  • KYCC Winter Break Programming 2026

  • Camp Dates: January 05 - January 09, 2026

    Camp Hours: 8:30am - 6:00pm

    Location: 680 S. Wilton Place, Los Angeles, CA 90005

  • PAYMENT POLICY

    • A non-refundable registration fee of $35 is due at the time of enrollment.
    • Families may choose to: Pay in cash, check (payable to KYCC), Zelle (payments@kyccla.org / Memo: Youth Services-Winter Camp Tuition)
    • Payment and proof of income are due at registration.
    • We do not prorate tuition for missed days, including absences due to illness, travel, or personal reasons.

  • TUITION TIER CHART

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  • LATE PICK-UP POLICY

  • Our program ends promptly at 6:00 p.m.

    A 15-minute grace period is offered until 6:15pm.

    After 6:15pm, a flat fee of $18 will be charged.

    After 6:30pm, we begin charging an additional $1 per minute on top of the $18 fee.

  • STUDENT DROP-OFF AND PICK-UP PROCEDURE

  • For the safety and convenience of all families, we have established the following procedures for dropping off and picking up your child.

    Main Drop-Off and Pick-Up Location (Front Lobby - Ingraham Street):

    The primary drop-off and pick-up location are in the front lobby on Ingraham Street.

    Elementary students must be signed in and out by a parent or authorized guardian at the front desk.

    Middle school students are allowed to sign themselves in and out each day if permitted by their family.

    A sign-in/sign-out log will be available at the front desk.

  • KYCC WINTER CAMP FIELD TRIP CONSENT FORM 2026

    Applicable to 1st - 8th grade participants

  • As a participant of KYCC's Winter Break Camp, my child will attend the scheduled field trip below. I understand that KYCC will provide: 

    • Transportation to and from the field trip
    • Entrance fees for all applicable trips
    • Supervision by staff and/or volunteers throughout the entire trip
    • Various activities and/or learning opportunities throughout the trip

    I further understand that field trip fees are included in the tuition for Winter Break Camp. I also understand that I may withdraw my child's participation from the field trip below at any time. Should I choose to keep my child out of camp on field trip days, I understand that KYCC will not be able to reimburse my tuition for that day. Lastly, I understand that parent/guardian(s) will be responsible for packing snacks for my child on the day of the field trip. Lunch will be provided at KYCC upon return from the field trip.

  • For Winter Camp field trips, the student's Parent(s)/Guardian(s) will be the primary Emergency Contact.

    For the Alternate Emergency Contact, please name an individual who is NOT a Parent/Guardian. 

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  • PLEASE SIGN AFTER READING THE FOLLOWING INFORMATION.

    I give permission for my child to participate in the Winter Break Camp field trip marked above. I understand that my child will be supervised during the activity, and there will always be a designated staff person available during the activity. I also understand that it is my responsibility to provide transportation for my child to/from KYCC’s Winter Break Camp site before and after the activity.

    I do release and hold harmless KYCC, its Board of Directors, and its employees for any and/or all loss, damage, and/or injury related to my child’s participation in this activity. I also understand that if my child’s behavior is deemed unacceptable (including causing any damage), I will be held liable and may be required to immediately retrieve him/her from the activity site.

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  • Parents are more than welcome to join us on our field trips as a chaperone. Parents will have to provide their own transportation to the site of field trips since we will have just enough seats on the bus for our students, volunteers, and staff.

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