Distinguished LEARNIN(G)ROUP

Camp N’Vision 2011 Application


Applicant Information
First Name:
Date of Birth:
Age:
School:
Applicant Address:

City:
State:
Zip Code:
Contact Phone:
Email Address:

Parent/Guardian Information
Parent/Guardian Name:
Parent/Guardian Address:

City:
State:
Zip Code:
Parent Phone:
Work Phone:
Cell Phone:
Parent Occupation:
Email Address:

Emergency Contact Other Than Parent/Guardian
Contact Name:
Contact Phone:
Emergency Contact Address:
City:
State:
Zip Code:
Relationship:

Camp Dates: 4-Week Summer Camp Grades K–8 Session I: June 5–July 15 Session II: July 18–July 29 Must Sign Up For At Least One Session Monday–Friday 8:30 (Before Care) 9:00am–3:00pm (After Care Available) Available 3:30-5:00 Camp Location: Venice Lutheran School 815 Venice Blvd Venice, CA 90291 Camp Fees: The total cost of each session is $490 + registration fee of $100. The total cost of both sessions is $1080 + registration fee. Please include weekly aftercare fees ($15/day) We will accept checks or money orders. Please make checks or money orders payable to: Distinguished Learning Group, LLC Signatures: We, the parents or guardians, hereby register the camper, whose name appears on this registration, in the DL(G)™ summer camp. In doing so, we acknowledge that we have read and that we agree to all of the camp policies and code of conduct and have reviewed them with your child.
Applicant Name:
Parent Guardian Name:
Date:
Parents: Does your child have any food allergies? If yes, please explain: