LANG RANCH SUMMER LANG RANCH ELEMENTARY 2450 WHITECHAPEL PL address langccsummer@conejousd.org

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1 WELCOME TO SUMMER CAMP 2012 LANG RANCH SUMMER LANG RANCH ELEMENTARY 2450 WHITECHAPEL PL address langccsummer@conejousd.org

2 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 Summer Hotline- (805) X151

payments must be made on or before due dates.

3 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:

4 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

Please list names of all persons who are authorized to sign out your child (including yourself, spouse, siblings, friends, etc.): 1. Name: Relationship: 2.

5 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

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.

6 RELEASE OF DIRECTORY & MULTI-MEDIA INFORMATION 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: Address: City: Grade Level: Date of Birth: Zip Code: Home Phone: Work/Cell Phone: 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 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 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 # (01/2012)

Student Name: Address: City: Grade Level: Date of Birth: Zip Code: Home Phone: Work/Cell Phone: Email Address: School Name: School Year: The primary purpose of directory information is to allow the

7 CONSENTIMIENTO DEL DIRECTORIO Y DE INFORMACIÓN MULTI-MEDIA 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: Domicilio: Ciudad: Nivel de Grado: Fecha Nacimiento: Código Postal: Teléfono Casa: Trabajo/Celular: 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 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 Si usted no regresa esta forma a la oficina de su escuela, el distrito asumirá que tiene el permiso para publicar esta información. CVUSD # (01/2012)

Nombre del estudiante: Domicilio: Ciudad: Nivel de Grado: Fecha Nacimiento: Código Postal: Teléfono Casa: Trabajo/Celular: Email: Nombre de la escuela: Año Escolar: El propósito principal del

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