Camp Breakaway is here and open to all teens entering 5

Foster City Parks and Recreation Department
Camp Breakaway is here and open to all teens entering 5-8th grade! Gather
all your friends and join the Recreation staff for a summer of awesome
adventures! Campers will have a blast participating in sports and games,
creating art projects, and making new friends. Each week, we will visit some
of the Bay Area’s popular parks and attractions!
Join us for another great summer! For additional information, check out our
Summer Camp Day Guide. For more information, visit www.fostercity.org
or call 650.286.3374.
This is not a Foster City/San Mateo School District sponsored program.
The ViBE
670 Shell
Blvd.
Youth’s Name:
Age:
Camp Breakaway
Dates
Full Day Camp
Mon. - Fri.
7:30am - 5pm
(All trips subject to changes)
Session 1
 6/20-6/24
Waterworld, Boomers,
Blackberry Farms
Session 2
6/27-7/1
Yerba Buena, Laser Quest,
Great America
Session 3
7/5-7/8
Don Castro, Kayaking, Santa
Cruz Beach Boardwalk
Session 4
7/11-7/15
Shoreline Lakes, Rock N Jump,
VIBE Lock In 7/14
Session 5
7/18-7/22
Silver Creek Sportsplex, Raging
Waters, Camp International Day
Session 6
7/25-7/29
Blackberry Farms, Great
America, Cull Canyon
Session 7
8/1-8/5
Golfland, Overnighter: Anthony
Chabot Park 8/4
Session 8
8/8-8/12
Exploratorium, A’s Game,
Camp BBQ

D/O/B:
Entering Grade:
Extended Care
Non
for
Resident 5th Graders
T, Th, F 7:30-5pm (trips)
Fee
5-6pm
Half Day Camp
Mon & Wed 1-5pm
Act. #106754-A1
$235
Act. #106754-A2
$195
$10
$20.00
Act. #106754-B1
$235
Act. #106754-B2
$195
$10
$20.00
Act. #106754-C1
$190
Act. #106754-C2
$155
$10
$20.00
Act. #106754-D1
$245
Act. #106754-D2
$205
$10
$20.00
Act #106754-E1
$235
Act. #106754-E2
$195
$10
$20.00
Act. #106754-F1
$235
Act. #106754-F2
$195
$10
$20.00
Act. #106754-G1
$245
Act. #106754-G2
$205
$10
$20.00
Act. #106754-H1
$235
Act. #106754-H2
$195
$10
$20.00
Request for inclusion services (deadline: 4/25/16). Please see camp brochure for more info.
I have read and understand the Camp Refund Policy
REGISTRATION
TOTAL
TOTAL:
(Parent/Guardian Initials)
PARENT/GUARDIAN NAME:
ADDRESS:
CITY:
Home #:
Work #:
Cell#:
ZIP:
Email:
Recreational Opportunities for Persons with disabilities. Persons with disabilities are welcome to participate in any class or activity offered. If you have
any special needs related to participating in an activity, please attach a note to your registration form. We will make reasonable efforts to accommodate
your special needs.
I hearby agree to hold the City of Foster City, the Estero Municipal Improvement District, their employees, officers, and program and activity
instructors harmless from all liability which may arise as a result of my participation in the above activities. In the event that the above
named participant is a minor I hereby give my permission for his/her participation in the above listed activities and also agree to hold the City
of Foster City, the Estero Municipal Improvement District, their employees, officers, and program and activity instructors harmless from all
liability which may arise from said minor’s participation in such activities. I understand that the above named activities may involve risk or
accidental injury and hereby voluntarily assume such risks. I/we agree to allow use of my/our photo for program publicity. If the participant is
a minor the parent or guardian must sign below.
PARENT/GUARDIAN SIGNATURE:
DATE:
I hereby authorize the use of my PRINT NAME AS IT APPEARS ON CARD:
MasterCard or Visa account.
Signature:
It’s Easy!
Now You Can
Use Your Credit Card
MC/VISA ONLY
MasterCard or Visa # :
Expiration Date (00/00):
Security Code (CCV) :