CONTACT INFORMATION Cindy Coelho Recreation Technician 625-7044 coelho@ci.oakley.ca.us
Lindsey Bruno Recreation Manager 625-7042 bruno@ci.oakley.ca.us
Participant Name: ____________________________________ Program Name:
Program Number: Oakley Resident:
Age/Grade:
Program Fee:
Total:
IN PERSON
DROP BOX
Parent/Guardian (If under 18): __________________________________
City: ______________
State: ________
Zip: ________
Day Phone: ___________
Evening Phone: ___________
Mobile Phone: __________
E-mail Address: ____________________________________ Please make checks payable to The City of Oakley (Return check fee of $57.00 will be automatically charged to the liable guardian or participant of said activity)
The completed registration: 3231 Main St. Oakley, CA 94561 Payment Accepted: Check
PRE-REGISTRATION Please register one week prior to the class start date. Each class has a minimum enrollment requirement to cover the cost of the program. Early registration is recommended. ACCOMMODATIONS Please indicate special accommodations required on the registration form and speak to the program supervisor.
Register at: 3231 Main St. Oakley, CA 94561 M-F 8:30AM-5PM Payment Accepted: Cash/ Check Visa /Master Card
REFUNDS If you are not satisfied with a program you have attended please contact the program supervisor for refund information. YOUTH SCHOLARSHIP Scholarships are available for income-qualified youth who reside in Oakley. Applications are available online and at City Hall.
After Hours registration: Drop Box at Recreation Desk 3231 Main St. Oakley, CA 94561 Payment Accepted: Check
WHAT SHOULD I BRING? Required items will be listed in the class or program description. For questions please contact the program supervisor. PLAN AHEAD City Hall is closed the third Friday of every month for furlough. FAX REGISTRATION Fax registration is available upon request. For information call 925-625-7041.
As the parent/guardian of a minor participating in the City of Oakley’s Recreation Programs, Field Trip and Services, I recognize and acknowledge that there are certain risks of physical injury. This Waiver, Release and Indemnity Agreement is intended to discharge in advance the City of Oakley, the Oakley Union School District, the Liberty Union High School District and its officers, employees, volunteers, and agents from any and all liability arising out of or connected in any way with myself or my child/ward’s participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is further agreed that this Waiver, Release and Indemnity Agreement is to be binding on my heirs and assignees. I agree to assume the full risk of any injuries, damages or loss that I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with each activity. I additionally agree to indemnify the City against any claims or rights of action for damages which I or the minors has/have before or after they reach age of majority. I further agree that certain marketable information may be used in accordance with State Laws and regulations. Such items include: e-mail addresses, photos and press releases that include statements made by myself or my child/ward in publication of said activities. In the event of any emergency, I authorize City Officials to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my minor child’s immediate and emergency care if it be deemed to sustain life. I also agree that I will be responsible for payment of any and all medical services rendered. In case of an emergency during activities In case of emergency whom should we contact?
Name: __________________
Phone:_____________
Relationship: _____________
Name: __________________
Phone: _____________
Relationship: _____________
Physician: ______________
Insurance Carrier: ______________
Does your child take any medications or have any allergies or other health problems we should be aware of? If yes, please explain:
________________________________________________________________________________________ ________________________________________________________________________________________ __________________________________________________________________________________ * I agree to all of the above conditions: * I understand that I am subject to dismissal from participation of said activity for inappropriate and disrespectful behavior. * I understand that my child’s/ wards enrollment is subject to dismissal due to certain violations of the Recreation Division’s program code of conduct (available for viewing in the Recreation Division main office.) * I have read and fully understand the above Waiver, Release and Indemnity Agreement and Permission to Secure Treatment. Participant/ Guardian Signature: ___________________________ For Office Use Only: Date Received: ________________
www.oakleyinfo.com
Group Number: ______________
Shirt Size: _____________
Summer 2013
Date: ______________
REGISTRATION FORM
CONTACT INFORMATION
Street Address: __________________________________
Incrediflix
Basketball Camp
Instructor: Incrediflix Staff
Instructor: Rebound Basketball Academy
Location: 204 Second Street
Location: Creekside Park
Ages: 7- 13 years old
Fee: $165 Resident, $175 Non- Resident
Date: July 1- July 3 Fee: $140 Resident, $150 Non- Resident a $30 Production fee is due to the instructor on the 1st day of camp. All flix will be professionally edited & a DVD will be mailed to students. Superhero Filmmaking Flix
Green Screen Animation 8am-noon Take your characters underwater, to a volcano, or even to outer space. In this camp you’ve got no limits. In age appropriate groups, you’ll brainstorm ideas, create your characters, film your movies with a greenscreen backdrop, select your locations and add voice-overs.
12:30pm- 4:30pm What super hero power do you want? Flying? Invisibility? Super Karate skills? Shot in front of a green screen, in this action packed movie camp kids will get to act, write and direct in their own super hero adventure movie.
Kids K-2nd Grade will learn dribbling, passing, and shooting through fun activities as well as fun games at the end of each day. Emphasis still remains on the basic skills utilizing fun activities. Kids grade 3rd to 8th emphasize team concepts that are presented in games to give the students the beginning of tactics and the development of individual skills while moving to the game level. Participants should wear appropriate clothing and sport shoes; please bring snacks, a water bottle, and sunscreen. T-shirt included. REBC001
K- 2nd
June 10- June 14
Monday to Friday
9am- noon
REBC002
3rd to 8th
June 24- June 28
Monday to Friday
9am- noon
REBC003 REBC004
K- 2nd 3rd to 8th
July 8- July 12 July 15- July 19
Monday to Friday Monday to Friday
9am- noon 9am- noon
Lego Summer Camp
Tennis Camp
Instructor: Wes Pitter
Instructor: Diamond Hills Athletic Club Staff
Location: Iron House Elementary School Library
Location: Diamond Hills Sports Club
Fee: $150 Resident, $160 Non- Resident Lego Summer Camp is the best place to create fun! Your Lego builder will love the variety of sets to play with, from Star Wars to Friends, the endless tubs of sorted Lego, and the extreme challenges, contests and activities. A huge Lego collection will spark the imagination of every builder. Lego trophies and prizes will be awarded to contest winners, and each day will end with Lego raffle prizes. Every camper will take home a Lego creation built at camp. A Shutterfly page will keep parents connected with the excitement. Snacks will be provided each day. Campers of all skill levels welcome.
Ages: 4-18 years old
Age: 6-10 years old
LEGO005
June 17- June 21
Monday to Friday
9am- noon
Age: 7-12 years old
LEGO006
June 24- June 28
Monday to Friday
9am- noon
Fee: $185 Resident, $195 Non- Resident Tennis campers spend fun-filled days learning new skills, participating in fun drills and competing in inter-club matches and tournaments. The 1 week program is supervised by DHSC Tennis Director Darrin Cohen and a staff of certified tennis instructors. Campers can also participate in optional, supervised swimming to cool off as well as SNAG Golf, a proven learning and training tool for entry level TCAMP001
June 10- June 14
Monday to Friday
9am-4pm
TCAMP002
June 17- June 21
Monday to Friday
9am- 4pm
TCAMP003
June 24- June 28
Monday to Friday
9am- 4pm
TCAMP004
July 8- July 12
Monday to Friday
9am- 4pm
TCAMP005
July 15- July 19
Monday to Friday
9am- 4pm