1. Summer 2006 at the Boys and Girls Clubs of Burbank June 2006 Week of June 19 – 23 19 – Horseback Riding 20 – Swimming 21 – Out to the Movies 22 – Swimming 23 – Universal Studios June 2006 Week of June 26 – 30 26 – Santa Monica Pacific Park 27 – Swimming 28 – Ice Skating 29 – Swimming 30 – Bowling July 2006 Week of July 3 - 7 3 – LA Zoo 4 – Club Closed 5 – California Science Center/IMAX 6 – Swimming 7 – Disneyland July 2006 Week of July 10 - 14 10 – Long Beach Aquarium 11 – Swimming 12 – Beach 13 – Swimming 14 – Burbank History Museum July 2006 Week of July 17 - 21 17 – Natural History Museum 18 – Swimming 19 – LA Maritime Museum 20– Swimming/LA Galaxy 21 – Hurricane Harbor July 2006 Week of July 24 24 – Horseback Riding 25 – Swimming/Cal. African American Museum 26 – Out to the Movies 27 – Swimming/Countrywide Tennis Classic (See Jay) 28 – Burbank Recycle Center July/August 2006 Week of July 31 –August 4 31 – Santa Monica Pacific Park 1 – Swimming 2 – Ice Skating 3 – Swimming 4 – Magic Mountain August 2006 Week of August 7 - 11 7 – LA Zoo 8 – Swimming 9 – Cal. Science Ctr. / SPARKS (See Jay) 10 – Swimming 11 – Bowling August 2006 Week of August 14 - 18 14 – Long Beach Aquarium 15 – Swimming 16 – Beach 17 – Swimming 18 – Knott’s Berry Farm August 2006 Week of August 21 - 25 21 – Natural History Museum 22 – Swimming 23 – LA Maritime Museum 24 – Swimming 25 – Summer BBQ Boys & Girls Club of Burbank 2244 N. Buena Vista Street Burbank, CA 91504 (818) 842-9333 Day Camp – 7AM – 7 PM Monday through Friday $80.00/Week Please place a check by the trips that you will be sending your child on. Please note all field trips are on a “First Come First Serve Basis.”

2. Club Membership Fee: $75.00 Weekly Fee: $80.00 Field Trip Prices Unlimited Swimming:___ X $11.00 Horseback Riding: ___ x $18 = _____ Out to the Movies: ___ x $9 = _____ Santa Monica Park: ___ x $11 = _____ Ice Skating:___ x $8 = ______ LA Zoo: ___ x $6 = ______ Bowling: ___ x $8 = ______ California Science Center: ___ x $8 = _____ Long Beach Aquarium: ___ x $11 = _____ Beach: ___ x $5 = _____ LA Maritime Museum: ___ x $4 = _____ Natural History Museum: ___ x $8 = _____ Universal Studios: $38.00 ______ Knott's Berry Farm: $29.00 ______ Hurricane Harbor: $20.00 ______ Disneyland: $40.00 ______ Magic Mountain: $27.00 ______ Total: $______ Summer 2006 OF BURBANK 2244 N Buena Vista Street Burbank, CA 91504 Phone: 818-842-9333 Fax: 818-842-0694 Website: www.bgcburbank.org Summer Camp 2006 Registration Childs Name: ________________________________ D.O.B.: _________________ Age: _____________ Home # ____________________________________ Contact: ____________________________________ Emergency # ________________________________ Contact: ____________________________________ Work # ____________________________________ Contact ____________________________________ PARTICIPANT CONSENT I hereby authorize my child’s full participation in the above named program conducted by the Boys and Girls Club of Burbank, I agree to not hold the Boys and Girls Club, its staff, volunteers, or board of directors responsible for the conduct or any loss, damage or personal injury to my child. Further I understand I am required to pick up my child by the stated closing time or I must pay the applicable late fees as defined by the Boys and Girls Club of Burbank, Inc. $5.00 FOR THE EVERY 15 MINUTES. Medical Treatment Release In case of an accident or emergency, I authorize a staff member of the Boys and Girls Club of Burbank to call for medical attention. Further I agree that the Club may personally transport my child to the nearest known hospital and to hold the Club harmless of any consequences related to such transportation. Additionally I will accept full responsibility for the emergency treatment or measures that are deemed necessary for the safety and protection of my child. I release the Boys and Girls Club of Burbank, its staff and board of directors of any and all liability involved in this emergency procedure. Medical Information Doctor: __________________ Dr. #: ______________ Medical Ins. # ________________________________ Medical Conditions Allergies, Medications,Devices Worn) _____________________________________ Parent Signature: ______________________________