2011 Tocaloma Camper Application

Tocaloma 2011 Camper Application.
Camper Name
Camper Birthdate	*
Gender	*	Male Female
Camper Grade in Fall 2011	*
School
Parent Name
Home Phone
Parent 1 Cell	*
Parent 2 Cell
Address	*
City	*
State
Zip Code	*
Email Address	*
Grouping Request: {One name only}
Please Note: To guarantee placement with your request, they must request you in return. While you may add additional requests in the "Additional Comments" field for consideration, we only guarantee one request. Camp is a great place to make new friends!

Choosing Your Camper's Schedule
Please use the check boxes below to indicate your camper's schedule. While your weeks do not need to be consecutive, we do have a 4 week minimum enrollment. 2/day a week enrollment must be Tuesday & Thursday.

Select Your Camper's Days		Monday Tuesday Wednesday Thursday Friday

Select Your Camper's Weeks		Pre Camp: 6/13 to 6/17 {Returning camper's only grade 1 and up} Week 1: 6/20 to 6/24 Week 2: 6/27 to 7/1 Week 3: 7/4 to 7/8 {Closed 7/4, day of credit} Week 4: 7/11 to 7/15 Week 5: 7/18 to 7/22 Week 6: 7/25 to 7/29 Week 7: 8/1 to 8/5 Week 8: 8/8 to 8/12

Transportation
I would like to use your shuttle service		Yes
Shuttle Area {Please see list below}:
Shuttle stop areas include: Sherman Oaks, Studio City, Hancock Park, Santa Monica and Beverly Hills.
Exact times and locations will be released closer to camp

Please use the box below to give us any additional information. While we will be collecting health information in the coming months, we would like to know now about any serious allergies or mental/physical challenges. You may also include information regarding your camper's schedule and/or additional campers to consider during grouping. We would also like to know if there is a camper you prefer your child NOT be placed with.
Additional Comments

Terms and Conditions
Conditions of Enrollment Prior to submitting this application, I have read it in entirety and understood it. Any questions I may have had about the policies and operations of Tocaloma Day Camp have been answered to my satisfaction. If my child is accepted for enrollment I agree for myself and on behalf of my child(ren) that:
I understand and certify that my child¹s participation in Tocaloma Day Camp and its activities is completely voluntary and I have familiarized myself with the camp¹s programs, policies and activities. I recognize that certain hazards and dangers are inherent in the camp events and programs including, but not limited to the activities of swimming, rock climbing, tubing, water skiing, sailing, canoeing, rock climbing, yoga, tae kwon do, athletic activities, tubing, surfing, sports, archery, sea kayaking, ice skating and arts & crafts, and allow my child to participate in these and all camp activities knowing the dangers, risks and hazards inherent in each. I acknowledge that Tocaloma can not insure nor guarantee that the participants, equipment, premises and/or activities will be free of hazards.
If Tocaloma, in its judgment believes my child requires medical attention, Tocaloma has my authorization to obtain such medical care from a licensed hospital or physician as Tocaloma deems necessary. I shall be responsible for all physicians, hospital, and related costs so incurred.
On behalf of my child(ren) I voluntarily assume all risks of injury, loss, or damage that may be sustained and release and discharge Tocaloma Day Camp, its employees, officers, agents and staff from all loss or damage and from any claim or demand on account of injury or death. I agree to hold harmless, indemnify and defend Tocaloma Day Camp, its officers, staff, employees and agents for and from any and all liability, claims, expenses, demands, fees, judgments and/or damages arising directly or indirectly from my child¹s participation in camp programs or at any time my child is on the premises of or premises used by Tocaloma Day Camp, save and except claims arising out of the sole willful misconduct of Tocaloma Day Camp. I will reimburse Tocaloma Day Camp, its officers, staff, employees and agents for all expenses including reasonable attorney fees for all such claims made
I agree to pay all tuition and fees set forth on Tocaloma's 2011 Tuition Schedule and this form.
Tocaloma may use my child¹s photograph / likeness in promotional materials.
Tuition Payment - A $400 deposit, which will be applied to the camp tuition, is required for each camper enrolled. The balance of tuition is due and payable by March 10th for the Early Rate and May 1 for the Regular Rate
Schedule Changes - Please call the camp office before 7:30 A.M. if your child will be absent. Each camper is allowed 2 schedule changes, after that, each schedule change will incur a $15.00 charge. Email requests for schedule changes will be accepted and confirmed by email with a valid credit card. All requests must be paid in full before they are confirmed. Credit toward another Tocaloma session may be given for extended absence (more than five days) at the discretion of the Director. No refunds will be given.
Withdrawal/Expulsion - No refund or reduction of tuition will be made for the withdrawal/expulsion of a camper, his/her late arrival or early departure.
Cancellation - There are no refunds once tuition has been paid in full. The tuition will be refunded, less a $200 registration fee, when written notice of cancellation is received prior to March 1st. Cancellations received after March 1 or payment in full will be subject to a cancellation charge equal to the monies received.
Late Charges - A charge of $5 for the first 15 minutes and $10 for each 15 minutes thereafter will apply to children remaining after 4:00 P.M.
Health/Activities - If your child is unable to participate in any activity for any reason, please note it on his/her health history form. If your child is recovering from any health problem please notify us in writing of your wishes regarding activity and camp participation. For your child¹s safety, a Health History Form stating your child¹s ability to participate in all activities is required prior to admission
The Person Herein Described Has Permission To Engage In All Prescribed Camp Activities Except As Noted. Authorization For Treatment: I Hereby Give Permission To The Medical Personnel Selected By The Camp Director To Order X-Rays, Routine Tests, Treatment; To Release Any Records Necessary For Insurance Purposes; And To Provide Or Arrange Necessary Related Transportation For Me Or My Child. In The Event I Cannot Be Reached In An Emergency, I Hereby Give My Permission To The Physician Selected By The Camp Director To Secure And Administer Treatment, Including Hospitalization, For The Person Named Above.
	*	I agree to Tocaloma Day Camp's Terms and Conditions
"Signature" of Parent/Guardian	*
Date	*