Endeavour Camp Registration 2008
Welcome to ENDEAVOUR CAMP!
Please complete the registration form below and then either mail your check or call us at (805) 734-1747 to give us your credit card information to reserve your child's place at camp!
Mail checks to: Endeavour Camp, P. O. Box 5090, Vandenberg AFB, CA 93437. If you have any questions prior to camp, please call (805) 734-1747. We look forward to seeing you!
Sessions for Ages 8-11
Sessions for Ages 10-14
1 - June 16 thru June 20 <-- cancelled 2 - June 23 thru June 27 4 - July 07 thru July 11
6 - July 21 thru July 25 8 - Aug 04 thru Aug 08
3 - June 30 thru July 04 5 - July 14 thru July 18* 7 - July 28 thru Aug 01 * Advanced camp
1st Camper Name
1st Camper School
1st Camper Birthdate
Age
1st Camper Session No.
M/F
2nd Camper Name
2nd Camper School
2nd Camper Birthdate
2nd Camper Session No.
3rd Camper Name
3rd Camper School
3rd Camper Birthdate
3rd Camper Session No.
Please complete the following address information:
Address
City
State
Zip
Phone number
E-mail
Parent would like to volunteer at camp?
Yes
No
Emergency Information
If possible, please indicate a contact name other than a parent. We will always attempt to contact parents first.
Emergency Contact
Wk Ph #
Dr's Name
Dr.'s Address
Insurance Co
Ins. Address
Group/Policy #
Insured's Name
1st Camper Medical Information
If you are allergic to bee stings, bring your prescription bee sting kit to camp and/or if you have diabetes, bring your emergency kit.
Camper Name
Last physical Date
Tetanus Shot Year
Allergies
Asthma
Diabetes
Epilepsy
Heart
Lactose
Vegetarian
Describe any problem which would keep child from fully participating in camp activities. List all medications child will be using while attending camp. Medications will be dispensed by adult camp staff members only. If you want medications self-administered, you must sign for this when you drop your child off at camp.
Special Medical Instructions:
2nd Camper Medical Information
3rd Camper Medical Information
Camper 3
Endeavour Camp Payment Information
Day Camp
Overnight Camp
1 camper (basic rate) 2 campers Groups of 2 or more Extended Hours 7-8 a.m. 5-6 p.m. Evening Activity 5-9 p.m (dinner incl.)
325.00 630.00 $10 off Basic Rate 10.00 10.00 120.00
1 camper (basic rate) 2 campers Groups of 2 or more
599.00 1158.00 $20 off Basic Rate
1/2 Day Camp
Active duty military discount:
$25 off per family
1 camper (basic rate)
199.00
Please enter on the following table the amount of your child(ren)'s camp and any extras you wish to purchase at this time. Then enter Total Cost.
Campership Cost (1, 2, or Group Camper Rate)
Day Camp Extended Hours
Day Camp Evening Hours
T-Shirt (Adult Sizes) $16.16 ea
1 Small 2 Small 3 Small
1 Medium 2 Medium 3 Medium
1 Large 2 Large 3 Large
Sweatshirt (Adult Sizes) $26.94 ea
Cap (one size) $16.16 ea
1 Cap 2 Caps 3 Caps
Total Cost
Because we are not yet prepared to safeguard with absolute certainty your credit card information on the internet, we ask that after you send in this online registration form that you call us with your Credit Card information at (805) 734-1747 or fax credit card information to (805) 734-1030. Information required: Name exactly as it appears on the card: ___________________ Credit Card#: ______________________ Exp Date: ___________
or mail your check to:
Space Endeavour Center P. O. Box 5090 Vandenberg AFB, CA 93437
Camp Rules & Participation Agreement
Parent(s) or Guardian(s), please read and discuss carefully the Agreements, Camp Rules and Application documents with your sons and daughters who will be participating in Space Endeavour Camp to make sure they understand the expectations we will have of them at camp. Be sure to check off each agreement in the appropriate box!
1- Camp Rules Agreement: To ensure a positive experience for everyone, we ask that all Endeavour Campers abide by the same rules. By launching this agreement, you are indicating your willingness to obey all Camp Rules which are included in this application, which means to obey directions and instructions given to you by Endeavour Camp staff. I understand that the success of each participant, and the entire program is dependent upon each person keeping these agreements. If I break any of these rules, it MAY result in my being sent home immediately, without refund. I understand and agree to all items of this agreement as a condition of my participation in Endeavour Camp.
I agree to follow all of the rules
2- Activities Agreement: I/We understand that some Endeavour Camp activities take place outdoors. I/We recognize there is an element of risk associated with outdoor activities. I/We certify that my/our child is physically and mentally capable of participating in the Space Endeavour Camp activities, except as noted in this form. It is my/our duty to consult a physician and receive approval if my/our child has an injury or illness which prohibits an activity. In the event that I/we cannot be reached in an emergency situation, I we verify you have my/our permission to take my/our child to the nearest emergency medical facility for treatment, and hereby give permission to the physician selected by Space Information Laboratories, Inc. (the Camp Director) to secure proper treatment, hospitalization, order injections, surgery or anaesthesia for my/our child named in this application. All medication instructions are attached.
I/We give our permission for medical treatment and have given all necessary medical information to the camp.
3- Publicity Agreement: I/We give permission to use any photos or videos of my/our child to Space Information Laboratories, Inc. (Camp Manager) for promotional purposes and agree to do so without compensation.
I/We give our permission for the Endeavour Center to use any photos or videos of my/our child without compensation.
4- An Agreement to Hold Harmless The following agreement is required by Vandenberg Air Force Base in order for SPACE ENDEAVOUR CAMP to use their facilities. (The USAF is NOT a sponsor or affiliated with the program.) In consideration for my child(ren)/dependent(s) as aforementioned in this application: who is (are)/will be traveling/participating as a member of the Endeavour Camp being allowed to enter and use certain facilities and transportation on Vandenberg Air Force Base, California and being aware of the potential and possible hazards involved in the use of these facilities and modes of transportation and their related activities, including but not limited to personal injury, property damage and death, do hereby agree to assume full responsibility for my child's (children's) /dependent's presence within Vandenberg Air Force Base in connection with the above cited use. This agreement includes, but is not limited to, an agreement that anyone who attempts to claim or sue, whether for accident or negligence, however designated, shall pay all attorney's fees, costs, and expenses for all opponents whether named or not. Each person enters and uses Vandenberg Air Force Base and uses its facilities and modes of transportation entirely at his or her own risk. This is to include the United States Air Force and Space Information Laboratories, Inc., transportation procured/used for transit on and off the installation.
I/We agree to the above statement and take responsibility for our child's presence on VAFB recognizing potential hazards.
These agreements are effective upon launching this document. I hereby acknowledge that I have read and understood the above releases and that I am sending this as the parent of the above listed child(ren).
Parent's Name
Date
Comments go here:
This campership will not be reserved until payment is made either by check or by telephone confirmation and credit card information.