A NON-PROFIT ORGANIZATION Anaheim Hills Costa Mesa Encinitas Glendale Las Vegas Long Beach Mission Viejo Northridge San Diego Santa Monica South Bay Temple City Tucson Ventura Dear Parents, Thank you for considering the German Immersion Camp at Irvine Ranch for your children s summer enrichment activities. We look forward to seeing you all, (perhaps again!) this June. There are just a few points I would like to go over before you start filling out the forms. This will not take long. First of all, I want to make sure that you are aware that, due to forces beyond our control, the children will need to be picked up at 9pm on Thursday night. Hopefully this should be late enough that traffic will not be an issue. Also, I know that we all lead busy lives and the enrollment process can sometimes seem arduous, but please take the time to fill out the forms completely. Specifically: Please sign and date each page where a signature is requested. Please fill out pages 2, 3 and 4 for each child. At the top of page 3, please be sure to give us the Month and Year of your child s last tetanus shot. At the bottom of page 3, please fill out medical insurance information completely. On page 4, please have each of your children sign the OEC Recreational Waiver. This form is required by Irvine Ranch, and they have requested that the forms be submitted complete. The Parent Consent form on the last page is only required if someone other than yourself or your spouse will be driving your child to and/or from camp. If you or your spouse will be driving them both ways, you do not need to fill out this form. It is just included for your convenience. Payment can be made with Mastercard, Visa or by check. If paying with a credit card, enrollment can be sent in via email or fax. The email address and fax number are at the bottom of this page and on the top portion of the enrollment and payment forms. When paying with a check, please send physical copies of the forms with payment to our Whittier office address. Also, please be aware that the forms have fields, so they can be filled out on your computer. It works best if you have a recent version of Acrobat Reader to do so. That s it!!! Thank you for taking the time to read this note. If you have any questions, please do not hesitate to call or email us. We look forward to seeing you and your children in June. Sincerely, Christine Reiff Camp Coordinator / GASA Administration 13601 Whittier Blvd., Suite 400, Whittier, CA 90605 T:562-693-0223 F:562-693-3753 office@gasaschool.org www.germanschool4kids.org
13601 Whittier Boulevard, Suite 400 Whittier, California 90605 (562) 693-0223 FAX (562)693-3753 office@gasaschool.org www.germanschool4kids.org A Non-Profit Corporation (Tax ID 95-2259663) Payment Information for the German Immersion Camp at Irvine Ranch Outdoor Education Center in Orange, CA June 23 28, 2018 By signing up my child/children for the camp, I am aware that I am responsible for the transportation to and from camp. Arrival time is 12 pm (Noon) on the 23 rd and departure time is 9 pm on the 28th. Camper(s): Last Name: First name: First name 2 nd camper: First name 3 rd camper: First name 4 th camper: Camp Fees 1st camper: $ 650.00 $ 2nd camper: $ 600.00 $ Each additional camper: $ 600.00 camper(s) at $ 600.00 $ total $ ------------------------------------------------------------------------------------------------------------------------------------------------------------ Method of Payment: Check [ ] # Credit Card: Visa [ ] Mastercard [ ] Credit Card Number : / / / Expiration Date: / There are NO refunds after 5/01/2018 A $25 fee will be charged for all declined credit cards and bounced checks. Signature of Parent/Guardian: date Name of Parent/Guardian: Please print Payment Information_Camp 2018 Page 1
13601 Whittier Boulevard, Suite 400 Whittier, California 90605 (562) 693-0223 * FAX (562)693-3753 * office@gasaschool.org www.germanschool4kids.org A Non-Profit Corporation (Tax ID 95-2259663) Enrollment for German Immersion Outdoor Immersion Camp at Irvine Ranch Outdoor Education Center in Orange, CA June 23 28, 2018 1. BIOGRAPHICAL INFORMATION CAMPER: LAST NAME FIRST NAME M / F BIRTH DATE / / AGE HOME PHONE ( ) E-MAIL Complete MAILING ADDRESS ZIP Camper must be able to understand and use very basic phrases in German, express needs, ask and answer questions about personal details; specifically should at least a) be able to count to 30, b) know colors, c) days of the week, d) common commands (like setz dich, steh auf, etc.), e) forms of greeting CAMPER ATTENDS A GASA SCHOOL: YES NO GOETHE INTERNATIONAL CHARTER: YES NO FRANKLIN MAGNET SCHOOL: YES NO EINSTEIN ACADEMY: YES NO 2. PARENT/GUARDIAN: Phone numbers where you can be reached during the week of camp: Daytime phone: ( ) Evening phone: ( ) Pager: ( ) Cell: ( ) 3. MEDICAL INFORMATION (Must be fully completed) History of Medication Is the camper currently taking any medications? Yes No Current Medication Dosage(mg)/Frequency Type of Illness being treated If more than 3 medications are being used, please attach a separate sheet. If this information changes before camp, please report to GASA. Immunizations current? Yes No I speak and understand: Only the basics Fairly fluent Somewhere in-between 1. 2. 3. Camp Enrollment 2018 Page 2
Date of Last Tetanus Shot: (Mo & Yr) This must be current! Asthma? Yes No Diabetis? Yes No Heart Disease? Yes No Explain: ALLERGIES and/or DIETARY RESTRICTIONS 4. SPECIAL ACTIVITIES Please initial if your child will participate in swimming/pool activites. Yes No Please initial if your child will participate in wall climbing. Yes No Please initial if your child will participate in zip lining Yes No All activities are supervised, but I understand and recognize the dangers inherent with swimming, archery and zip lining. I am assuming the hazard of this risk for my child. I realize that my child is subject to injury from these and any other activities, like hiking and sport, and that no form of preplanning can remove all the dangers to which my child is exposed. (Parent or legal guardian s signature is required below.) ACTIVITY RESTRICTIONS/LIMITATIONS: Please attach separate sheet to more fully explain any above conditions/concerns which could affect camper s health during camp. 5. PARENTAL STATEMENTS AND PERMISSION THE HEALTH HISTORY PROVIDED on this form is correct and the camper herein described has my permission to engage in all camp activities except as noted previously. I WILL BE RESPONSIBLE for notifying GASA of any new medical information regarding this camper between now and start of camp. I REALIZE that individuals at camp can injure themselves without fault on the part of GASA personnel. I release GASA from responsibility for injury to my child. I UNDERSTAND that emergency care, even by ambulance, can take up to 15 minutes. The camper named above has no current condition that would warrant closer emergency medical care. AUTHORIZATION FOR TREATMENT: I HEREBY GIVE PERMISSION to the medical personnel selected by the camp director, to provide medical treatment for the above named camper, as deemed necessary, i.e. the administration of age appropriate doses of Acetaminophen (Tylenol) or Ibuprofen (Motrin) for pain. This may also include transportation to a medical facility. In the event of an emergency in which I cannot be reached, I hereby give my permission to the physician selected by camp director to secure & administer treatment, including hospitalization for the above named camper. I GIVE PERMISSION on behalf of my child for the use of the following by GASA for promotional purposes: (a) pictures taken while at camp; (b) quotations from evaluations/letters relating to camp experience. I UNDERSTAND that GASA assumes no responsibility for campers who leave camp grounds for any reason other than programmed activities. I UNDERSTAND that smoking by campers or counselors is not permitted while at camp and will so inform my child. I UNDERSTAND that health and accident insurance protection is my responsibility. INSURANCE INFORMATION (Please fill out completely) Name of company: Policy Holder s Name Relation to Camper: Policy / Group #: Is pre-approval required? Insurance Co.# (for pre-approval) PARENT / GUARDIAN SIGNATURE Date Print Name Camp Enrollment 2018 Page 3
Recreational Activity Waiver PLEASE READ IT CAREFULLY Shooting Sports (Archery, BB Gun,Tomahawk & Wrist-Rockets) California Penal Code Section 12552: Every person who furnishes any BB device to any minor, without the express or implied permission of the parent or legal guardian of the minor, is guilty of a misdemeanor. Zip Lines, Challenge Courses, Climbing & High Ropes Area (C.O.P.E.) Shooting Sports, Zip Line and C.O.P.E. Course participants MUST wear sturdy, closed-toe shoes at all times. Aquatics (Swimming, Water Sports, Water Slide) In consideration of the benefits to be derived and after carefully considering the risk involved and in view of the fact that the Boy Scouts of America is an organization in which participation is voluntary, and having full confidence that precautions will be taken to ensure the safety and well-being of myself (and any minor children for whom I have the capacity to contract), I have carefully considered the risk involved and have given the participant identified below, my consent to participate in the Recreational Activities available at The Irvine Ranch Outdoor Education Center* (IROEC). In consideration of accepting this registration, and to the extent permitted by law, I hereby agree to release, indemnify, defend and hold harmless on behalf of myself (and any minor children for whom I have the capacity to contract), the IROEC, the Boy Scouts of America, Orange County Council, program staff, activity coordinators, all employees, volunteers, or other organizations associated with IROEC from and against any and all liabilities, claims, penalties, losses, or expenses (including attorneys' fees), of any kind or nature whatsoever, whether related to bodily injury, property damage or any other form of injury or loss to myself (and to any minor children for whom I have the capacity to contract), caused by any negligent act or omission of the IROEC or its officers, clients, agents or employees, arising out of or in any way related to participation in the activity for which I (and any minor children for whom I have the capacity to contract) am registering. I give permission to the IROEC to take photographs of me, my children and any minor children for whom I have the capacity to contract, while participating in this activity for use in future publicity and understand that I will not receive any compensation for such use. In case of emergency, I hereby give my permission to the physician selected by the IROEC, to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for myself or any minor children for whom I have the capacity to contract. *The Irvine Ranch Outdoor Education Center is owned and operated by Orange County Council, Boy Scouts of America. I acknowledge that the activities to which this release applies can be dangerous and as a result of signing below, I am accepting those risks for myself and for any minor participants for whom I can contract. I CERTIFY THAT I HAVE READ, UNDERSTAND AND AGREE TO ALL THE SPECIFICATIONS OF THIS WAIVER. GASA German Immersion Camp 2018 June 23rd - June 28th, 2018 DATE DATE THE IRVINE RANCH OUTDOOR EDUCATION CENTER Page 4
13601 Whittier Boulevard, Suite 400 Whittier, California 90605 (562) 693-0223 FAX (562)693-3753 office@gasaschool.org www.germanschool4kids.org A Non-Profit Corporation (Tax ID 95-2259663) Parent Consent Form for Passenger Transported in Private Vehicle As the parent/guardian of the student listed below, I do hereby authorize Name of driver to transport my child to and from the German Immersion Camp at the Irvine Ranch Outdoor Education Center in Orange, CA, June 23 June 28 2017. I understand that GASA does not furnish transportation to the camp. As the parent/guardian of the passenger listed below, I do hereby authorize him/her to ride as a passenger in a privately-owned vehicle driven by the person listed above for the purpose of camp transportation. The driver is responsible for carrying valid liability insurance, operating the vehicle in a safe manner and for maintaining the vehicle in a safe working condition. I am fully aware of and accept the special dangers and risks inherent in the operation of a motor vehicle, including physical injury, death or other consequences that may arise or result directly or indirectly from operation of a motor vehicle. Being fully informed as to these risks, I hereby assume all risk of injury or liability and shall hold harmless, and waive any right of recovery from or to bring suit against GASA from any liability for any personal injury, death or consequences arising out of operation of a motor vehicle needed to transport my child to the camp. Name(s) of student passenger(s) I certify that I am the parent or legal guardian of the participant named above, that I have read and understand the foregoing release, and that I join in the release without reservation, granting full consent and authorization for his/her being transported in a private vehicle to participate in the German Immersion Camp at the Irvine Ranch Outdoor Education Center in Orange, CA. Signature of parent/guardian Date Parent or Guardian s Name (Please Print) Camp Driver Authorization 2018 Page 5