Thank you for using the Boys & Girls Club of Burbank and Greater East Valley's Web Registration System for Summer 2017 Program. Any question with a red asterick is a required field and the system will not process your application unless you complete all boxes with the red asterick.
Release is also given for medical, hospital, or surgical care in the case of an accident or emergency, when administered by a licensed physician, provided neither parent can be reached.
Further, I agree that the Club may personally transport my child to the nearest known hospital and will hold the Club harmless of any consequences related to such transportation.
I grant permission for the Club to take and use photos and video footage of my child in the news and press releases included but not limited to, promotional materials.
Further, I herewith acknowledge a WAIVER OF CLAIMS, which releases and forever discharges the Boys & Girls Club of Burbank and Greater East Valley, its staff, and Board of Directors, from any claim or demand what so ever arising out of the participation of my child or ward in the Boys & Girls Club of Burbank and Greater East Valley planned programming conducted in or outside a Boys & Girls Club facility or in the handling of an emergency involving the aforementioned Boy/Girl member.
Please list all Emergency Contact with their First and Last Name and a contact phone number
Daily Fee = $30
Weekly Fee = $130
Block 1: WK 1-6, May 29 - July 7 = $700
Block 2: WK 7-11, July 10 - August 11 = $585
(Please note last day to purchase block fees are 2 weeks before block start date.)
Please choose the club site that your child will attend for summer camp.
Thank You For filling out Your Application Online!
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