The Youth Center
Summer Camp S.H.A.R.K. at Rossmoor Park
2018 Registration Form


Camp located at: 3200 Hedwig St., Rossmoor
Youth Center Business Office: 10909 Oak St.,
Los Alamitos (562) 493-4043



Please complete a separate registration form for each child to be enrolled - Thank You!!

PLEASE allow 1-2 business days (M-F) to process your request.

* Required Fields!

* Child's Last Name:
* Child's First Name:
* Age:
*Date of Birth:
* Gender:
* School:
* E-Mail:
* This Registration is for:
1st Child
2nd or more siblings
(Weekly Campers - Minus $10/week if 2nd or more siblings)

Home Phone:
Work Phone:
* Cell Phone:
* Parent's Last Name:
* Parent's First Name:
* Address:
Address 2:
* City:
* State:
* Zip:

List people you authorize to drop off and/or pick up your child (they will need to show their ID as well at time of pick-up):
*Emergency Contact Name 1:
Emergency Contact Phone 1:
Emergency Contact Name 2:
Emergency Contact Phone 2:
Emergency Contact Name 3:
Emergency Contact Phone 3:

Please list any allergies to foods or medications. You can also share information such as medical or other conditions, if medications are stored at school, etc.

Please type "none" if applicable.

(We do not discriminate against children with disabilities and will make reasonable modifications to accommodate any child unless it will constitute a fundamental alteration to our program. Parent-provided aides or parents are welcome to attend any of our programs with their children. The Youth Center is entitled to make individualized assessments about whether we can meet the particular needs of a child without fundamentally altering our program.)

How did you hear about us?

Attended your camp before
Via internet search
Newspaper article
Facebook or other social media
Postcard
Summer Camp Brochure
Referred by a friend
Name of friend (optional):

BOOK YOUR CHILD'S CAMP EXPERIENCE:

It's easy! Choose weekly or daily schedule, basic or extended hours, and add-on field trips, walking trips and/or classes!

Camp S.H.A.R.K. Hours:

Basic: 9am - 4pm
Extended: 7am - 7pm

About the Camp Schedule, Add-On Trips and Classes:

  • No registration or processing fees charged! Space is limited and trips fill up fast!!
  • If booking camp on a weekly basis, a $25 deposit for that week is due in advance and will guarantee your spot. The balance for any given week is due by the Wednesday prior to the start of week your child is attending. Deposits guarantee space but are neither refundable nor transferable to other weeks or program elements. Failure to pay balance due by deadline will result in forfeiture of guaranteed space and loss of all deposits.
  • If booking camp on a daily basis, the total amount for each day booked is due in full in advance.
  • Whether you choose a daily or weekly schedule, field trips, walking trips, and classes must be paid in advance.
  • All add-on instructional classes are 1+ hours and are held on-site at camp.
  • NEW "Walking Trips" - kids play games while walking with staff to/from destination. Of the $15 fee, kids get to spend $10 at destination. Limited to 22 kids. Not refundable and last minute registration subject to availability.
  • Field Trips are Tuesdays and Wednesdays except on July 4th (closed for holiday). Limited to 60 kids. Not refundable and we cannot "wait list".

Week 1 from June June 18 – 22

Optional add-on trips and class:

Tuesday - Get Air Trampoline Park (+$27.00)
Wednesday - Discovery Science Center (+$25.00)
Thursday - Walking Trip: Starbucks, ages 8-12 (+$15.00)
Friday - Class: Soccer (+$10.00)

WEEKLY
Basic-$104
Extended-$129
(Minus $10/week if 2nd or more siblings)
DAILY
Basic: $26.00
Extended: $33.00
Basic Extended - Monday
Basic Extended - Tuesday
Basic Extended - Wednesday
Basic Extended - Thursday
Basic Extended - Friday

Week 2 from June 25 - 29

Optional add-on trips and classes:

Monday - Class: Volleyball (+$10.00)
Tuesday - John's Incredible Pizza & Lunch (+$23.00)
Wednesday - El Dorado Park, Archery & Picnic (+$25.00)
Thursday - Walking Trip: In-and-Out, ages 8-12 (+$15.00)
Friday - Class: Basketball (+$10.00)

WEEKLY
Basic-$104
Extended-$129
(Minus $10/week if 2nd or more siblings)
DAILY
Basic: $26.00
Extended: $33.00
Basic Extended - Monday
Basic Extended - Tuesday
Basic Extended - Wednesday
Basic Extended - Thursday
Basic Extended - Friday

Week 3 from 2 - 6 (Closed July 4)

Optional add-on trips and classes:

Monday - Class: Hip Hop Dance (+$10.00)
Tuesday - Aquarium of the Pacific (+$26.00)
Thursday - Walking Trip: Chick-fil-A, ages 5-7 (+$15.00)
Friday - Class: Baseball (+$10.00)

WEEKLY
Basic-$84
Extended-$109
(Minus $10/week if 2nd or more siblings)
DAILY
Basic: $26.00
Extended: $33.00
Basic Extended - Tuesday
Basic Extended - Wednesday
Basic Extended - Thursday
Basic Extended - Friday

Week 4 from July 9 - 13

Optional add-on trips and classes:

Monday - Class: Modeling (+$10.00)
Tuesday - Seal Beach (+$17.00)
Wednesday - Knott's Berry Farm (+$42.00 no pass)
or
Wednesday - Knott's Berry Farm (+$16.00 with your pass)
Thursday - Walking Trip: Snow Station, ages 8-12 (+$15.00)
Friday - Class: Wacky Science (+$10.00)

WEEKLY
Basic-$104
Extended-$129
(Minus $10/week if 2nd or more siblings)
DAILY
Basic: $26.00
Extended: $33.00
Basic Extended - Monday
Basic Extended - Tuesday
Basic Extended - Wednesday
Basic Extended - Thursday
Basic Extended - Friday

Week 5 from July 16-20

Optional add-on trips and classes:

Monday - Class: Tennis (+$10.00)
Tuesday - Soak City (+$42.00)
or
Tuesday - Soak City (+$16.00 with your pass)
Wednesday - Big Air Trampoline (+$25.00)
Thursday - Walking Trip: Chipotle, ages 8-12 (+$15.00)
Friday - Class: Art (+$10.00)

WEEKLY
Basic-$104
Extended-$129
(Minus $10/week if 2nd or more siblings)
DAILY
Basic: $26.00
Extended: $33.00
Basic Extended - Monday
Basic Extended - Tuesday
Basic Extended - Wednesday
Basic Extended - Thursday
Basic Extended - Friday

Week 6 from July 23 - 27

Optional add-on trips and class:

Monday - Class: Soccer (+$10.00)
Tuesday - Glow Zone H. Beach (+$39.00)
Wednesday - Los Angeles Zoo (+$27.00)
Thursday - Walking Trip: Yogurtland, ages 8-12 (+$15.00)
Friday - Class: Baseball (+$10.00)

WEEKLY
Basic-$104
Extended-$129
(Minus $10/week if 2nd or more siblings)
DAILY
Basic: $26.00
Extended: $33.00
Basic Extended - Monday
Basic Extended - Tuesday
Basic Extended - Wednesday
Basic Extended - Thursday
Basic Extended - Friday

Week 7 from July 30 - August 3

Optional add-on trips (no classes this week)

Monday - Hip-Hop Class (+$10.00)
Tuesday - Boomers Irvine (+$39.00)
Wednesday - Rockin' Jump (+$27.00)
Thursday - Walking Trip: Starbucks, ages 8-12 (+$15.00)

WEEKLY
Basic-$104
Extended-$129
(Minus $10/week if 2nd or more siblings)
DAILY
Basic: $26.00
Extended: $33.00
Basic Extended - Monday
Basic Extended - Tuesday
Basic Extended - Wednesday
Basic Extended - Thursday
Basic Extended - Friday

Week 8 from August 6 - 7

DAILY
Basic: $26.00
Extended: $33.00
Basic Extended - Monday
Basic Extended - Tuesday




T-shirts (required for field trips)
You can use the yellow Camp S.H.A.R.K. t-shirt from last year if you still have it.

  * Field trips are limited to the first 60 participants. Last minute registration subject to availability.
Quantity: x$15.00      
** Space is limited.

 
PAYMENT:  
Pay in Full Pay in Full (includes all weekly or daily camp fees and any add-on activities)  
Pay Deposits Only (includes a $25 deposit for every week of camp selected, any individual days that are booked, and any optional classes for trips)  
Approved for Scholarship (amount to be determined by office)
   
DISCOUNTS*: The Youth Center provides $10.00 discounts on weekly camp fees to the following: siblings, teachers and uniform personnel. (Proof via ID may be required.)

*These discounts are calculated manually and cannot be combined with other offers.

OPTIONAL - SNACK BAR ACCOUNT:

We recommend that campers bring their lunch 2-4x per week. Cashless Snack Shack is available for purchase of breakfast and lunch meals, snacks, drinks and treats. You can load and add any restrictions at any time by calling our office. At the end of the summer, you will have an opportunity to obtain a refund or donate the balance of your card.
To set up a weekly flat fee to be charged to your credit card, please click below:

$10 per week
$20 per week
$100 for the summer

HELP ANOTHER CHILD?:

Can you help us make a difference in a child's life by giving a tax-deductible donation towards our Camp S.H.A.R.K. program? Tax ID is 95-2142369

$10
$30
$50
$100
$500
$1000

PAYMENT:

Credit Card

  Card Number  
  Expiration Date (Mo / Yr) /  
  Cardholder's name as it appears on credit card

FINANCIAL POLICIES

FINANCIAL RESPONSIBILITY:

The parent/guardian registering their child will be solely responsible for making payments.


DEPOSITS & PAYMENTS:

A minimum deposit of $25 is required in advance to reserve your child's spot for any given week. The balance for a given week must be paid by the prior Wednesday. If payment is not received by Monday of the week your child is attending, they will not be able to attend.


REFUND POLICY:

Deposits and payments for Field Trips, Walking Trips and Classes are non-refundable and cannot be "transferred" to other weeks, program elements or campers.


LATE FEES:

A late fee of $20 will be charged should a check be returned to us. AFTER HOURS PICKUP: Please call the office if you anticipate being more than 15 minutes late in picking up your child (after 4:00 p.m. if you're signed up for Basic hours, after 7:00 p.m. if Extended). If you are more than 15 minutes late, you will be charged $10. Children who are not picked up within 30 minutes will be cared for by the local Sheriff's Office or Police Department.


AGREEMENTS AND CONSENTS


INDEMNITY AND HOLD HARMLESS AGREEMENT

I/we hereby grant permission for my child to participate in the Los Alamitos Youth Center, Inc. program(s) for which I am registering. I/we agree to indemnify and hold harmless the Los Alamitos Youth Center, City of Los Alamitos, Los Alamitos Unified School District, Rossmoor Community Services District, and any other entity associated with the program, their officers, agents, and employees from any liability, claim or action arising out of such participation. I/we understand that this program is not bound by the responsibilities and legalities that accompany a licensed day care program. I further certify that my child is in good health and has no physical or other impediment which would endanger him/her or any other participant in taking part in such an activity.


CONSENT TO TREAT A MINOR/CONSENT FOR FIRST AID TREATMENT

I/we certify that I am the parent or legal guardian of the child being enrolled in this program. I/we hereby authorize the staff of The Youth Center to provide immediate first aid to my child in the event of illness or injury. Additionally, I/we hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medicine Practice Act or Dentist licensed under the provisions of the Dental Practice Act and on the staff of any acute general hospital holding a current license to operate a hospital from the State of California Department of Public Health. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care required but is given to provide authority and power to tender care which the aforementioned physician in the exercise of his/her best judgement may deem advisable. It is understood that effort will be made to contact the undersigned prior to rendering treatment of the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached. This authorization is given pursuant to the provisions of section 25.8 of the Civil Code, State of California.
This consent will remain in effect until rescinded in writing.


CONSENT FOR TRANSPORTATION and PHOTOGRAPHIC RELEASE

If this program provides for the transportation of my child, I/we hereby grant permission to The Youth Center to provide such transportation.


Further, I/we hereby give the Los Alamitos Youth Center, Inc., its successors and assigns, the absolute and irrevocable right and permission with respect to photographs, videos, motion pictures, and/or sound recordings being taken of my child: (a) to use, re-use, publish and re-publish in whole or in part and (b) to use my child's name. I further release The Youth Center from any claims and demands arising out of the use of the same. Please initial below to indicate that you have read, understand, consent and agree to the above policies and releases:


Please be sure you've typed the Validation code correctly. If you don't, your form will be erased.


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