WELCOME TO

SUMMER CAMP 2012

MADRONA SUMMER CAMP

@ MADRONA ELEMENTARY 612 CAMINO MANZANAS

(805)498-7915 x200

E-mail address– madronaccsummer@conejousd.org

CVUSD Child Care Summer Camp Important Dates To Remember…

Summer Camp Open House Dates and Times

EARThS– Monday, June 4th at 6:30pm Lang Ranch– Tuesday, June 5th at 6:00pm

Madrona-June 5th at 6:30pm Sycamore-June 6th at 6:00pm

Session 1 - (June 11th-June 29th)

Tuition Due May 7th

Session 2 - (July 2nd-July 20th) Tuition Due June 4th

Session 3 - (July 23rd-August 10th)

Tuition Due June 25th

All payments must be made on or before due dates.

All Summer Camp Payments must be made at the District Office If your payment is not received by the appropriate date, you will forfeit your

summer camp spot.

Credit cards may be called into the District Office. See your summer camp policies for more details. University Center-CVUSD Child Care District Office

2801 Atlas Ave. Thousand Oaks, CA 91360

Summer Hotline- (805) 492-3567 X151

CVUSD Child Care Summer Camp 2012

Special Medical Needs Student’s Name:_____________________________ Summer Center:____________________________________ Please advise us if your child is a diabetic, has insect or food allergies, asthma or other special medical needs that will require staff supervision. Please explain below and indicate the specific issue and the procedure you would like staff to follow. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Parent Signature:__________________________________________________

CVUSD Child Care Summer Camp 2012

Special Medical Needs

Student’s Name:_____________________________ Summer Center:____________________________________ Please advise us if your child is a diabetic, has insect or food allergies, asthma or other special medical needs that will require staff supervision. Please explain below and indicate the specific issue and the procedure you would like staff to follow. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Parent Signature:__________________________________________________

SUMMER

Conejo Valley Unified School District

Child Care Program

Sign-Out Authorization

Child’s Name:______________________ School:_____________________ Child’s Name:______________________ This form must be filled out in addition to the Emergency Authorization. Children will only be released to people who are listed on this form. Please list names of all persons who are authorized to sign out your child (including yourself, spouse,

siblings, friends, etc.): 1. Name:____________________________ Relationship:_____________________ 2. Name:____________________________ Relationship:_____________________ 3. Name:____________________________ Relationship:_____________________

List two local persons who could be called to pick up your child in your absence

1. Name:____________________________ Relationship: _____________________ Work Phone:_______________________ Home Phone:_____________________ Cell Phone: _____________________ 2. Name:____________________________ Relationship: _____________________ Work Phone:_______________________ Home Phone:_____________________ Cell Phone: _____________________ _______________________________________ Parent/Guardian Signature

CVUSD Summer Camp Swimming Information

CHILD’S NAME:_________________________________ AGE:___________

Has your child taken swim lessons? YES NO

If yes, how many years? ________________

How would you classify your child’s swim ability? *(See below for additional information)

Non-swimmer Adequate swimmer Confident swimmer

*Non-swimmer cannot swim crawl stroke (freestyle) any yardage. Has

little or no water experience and can not put face in the water.

*Adequate swimmer has basic skills, but is still not able to swim great

lengths. Is not comfortable in deep water and working on the ability to float and be an independent swimmer.

*Confident swimmer has had at least two to three solid summers of consistent and confident swimming skills. Is comfortable putting face in

the water and able to float. Can be in portions of the pool that they are

unable reach the bottom or hold on to the side.

Additional information regarding your child’s swim ability:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Swim tests may be given to campers to confirm swimming ability. There

will be no test for “non-swimmers” and those campers must remain in

the wading pool. In order to swim in the larger pools, campers must be

able to:

Swim 15 yards

Swim 25 yards (to use the diving boards)

_______________________________________________________ _______________

PARENT SIGNATURE DATE

CVUSD #94-00077 (01/2012)

Form not required if you are permitting release of your student’s information PARENTS: Please read and complete the information below & return it to the office at your school. Student Name: Grade Level:

Address: Date of Birth:

City: Zip Code:

Home Phone: Work/Cell Phone:

Email Address:

School Name: School Year:

The primary purpose of directory information is to allow the CVUSD to include this type of information from your child’s education records in certain school publications. Directory information includes names, addresses and telephone listings, information that is generally not considered harmful or an invasion of privacy. The district and schools use multi-media to provide information about school activities and programs to students, parents, staff, and the community. The Family Educational Rights and Privacy Act (FERPA) and Education Code 49073 permits the CVUSD to disclose appropriately designated “directory information” without written consent, unless you have advised the District that you do not want your student’s directory information disclosed.

Please initial any statement below that you agree with and sign on the line provided: I do not want any directory information released to any individual or organization. I do not want the student’s name, school of attendance, grade level, honors, activities, recorded

pictures, digital images, website images, videotapes, and/or DVD’s released to the media.

Print Parent/Guardian Name (if student is under 18) Signature of Parent/Guardian (if student is under 18) Date

RELEASE OF DIRECTORY

& MULTI-MEDIA INFORMATION

If you do not return this form to the office at your school,

the district will assume it has permission to release this information.

CVUSD #94-00077 (01/2012)

No es requerido si usted está permitiendo consentimiento de la información de su estudiante

PADRES: Por favor lean y completen la siguiente información y regrésenla a la oficina de su escuela. Nombre del estudiante: Nivel de Grado:

Domicilio: Fecha Nacimiento:

Ciudad: Código Postal:

Teléfono Casa: Trabajo/Celular:

Email:

Nombre de la escuela: Año Escolar:

El propósito principal del directorio informativo es para permitir a CVUSD incluir este tipo de información en ciertas publicaciones escolares de los archivos educativos de su hijo. El directorio informativo incluye nombres, direcciones y listas telefónicas, información que no es generalmente considerada nociva o una invasión de privacidad El distrito y las escuelas usan diversos medios para proporcionar información sobre las actividades y programas escolares para los estudiantes, padres, personal y la comunidad. Los derechos y código de “The Family Educational Rights y Privacy Act (FERPA) y Education Code 49073” permiten que el CVUSD pueda otorgar información apropiadamente designada del “directorio informativo” sin su consentimiento por escrito, a no ser que usted haya notificado al Distrito que usted no desea que esa información sea publicada.

Por favor ponga sus iniciales abajo en lo que usted esté de acuerdo y firme en la linea proporcionada: Yo no deseo que se otorgue ninguna información del directorio a ningún individuo/organización. Yo no deseo el nombre del estudiante, escuela de asistencia, nivel de grado, honores,

actividades, fotografías grabadas, imágenes digitales, imágenes del sitio web, videograbaciones, y/o DVDs sean otorgados a los medios de comunicación.

__ __ Imprima nombre Padre /Tutor (estud. menor de 18 años) Firma del Padre/Tutor (estudiante menor de 18 años) Fecha

CONSENTIMIENTO DEL DIRECTORIO

Y DE INFORMACIÓN MULTI-MEDIA

Si usted no regresa esta forma a la oficina de su escuela,

el distrito asumirá que tiene el permiso para publicar esta información.