Now Registering for Summer Program Fun Happens Here! June 7

Now Registering for Summer Program Fun Happens Here! June 7

 Girls Incorporated of Metropolitan Dallas Now Registering for Summer Program Fun Happens Here! June 7 – August 13 Register your girls today for 10 weeks of Girls Inc. Summer Camp Mania! These weekly camps will be held throughout the summer beginning the week of June 7 and are open to girls and young women ages 6 to 18. Camps are held from 7:30 a.m. to 6:00 p.m. and the cost is $200 for all summer. Camp sessions will be divided into the following groups: 6 ‐ 8 years, 9 ‐ 11 years, 12 ‐ 14 years and 15 ‐ 18 years. Curriculum and activities will be targeted toward each age group, their interests and abilities. Camps are held at the four Girls Inc. campuses in Dallas. At Girls Inc. Summer Camp Mania, girls learn the value and fun of sharing experiences in an all‐girl environment with caring, trained adults serving as mentors and role models. All activities are designed with girls in mind to spark their interests, build their skills and explore the world around them. With dynamic hands‐on activities, every camp is filled with adventure! Summer Camps for Ages 6 to 18
June 7 – 11: Dallas Stars Sports on the Go! Sports are not just a boy’s thing! Girls, let’s show them what we can do. At the end of this camp, you will be able to climb it, slam it, dunk it, goal it, serve it, spike it, kick it and putt it. Girls learn about individual and team sports through hands on activities that facilitate cardiovascular fitness. June 14 – 18: JPMorgan Chase Savvy Spenders Since money does not grow on trees, when you “get it,” learn to “spend it” wisely. With so much going on in the world’s economy, why not stay on top of it all by enhancing your financial knowledge. Enjoy interactive and engaging activities comprised around economic activities, from saving for the future to differentiating wants and needs and comparison shopping. June 21 – 25: Culinary Arts and Art Show your artistic ability through cooking, carving, decorating, drawing, scrapbooking and painting. Learn the skills of master chef’s artistry and other creative professions. June 28 – July 2: Travelers Foundation Futures & Options What does your future hold? Come explore career options, engage in interactive workshops, learn interview skills and prepare for college. From a college fair to FAFSA applications to choosing the right career ‐ explore your options and think about your future!
July 6 – 9: Fashion Design Express yourself through bold creative designs that will be showcased on a runway inspired by YOU! This camp helps you explore the in’s and out’s of the fashion world. July 12 – 16: Camp H.I.P (Healthy Innovative People) Learn fun, non‐traditional ways of staying healthy and fit. You will participate in different forms of dance such as hip hop, jazzercise, dance aerobics, salsa, etc. H.I.P. provides a fun and inspiring challenge in fitness while allowing for teamwork in a diversity of activities. July 19 – 23: Camp Scimatech Think you don’t like science, math and technology? You will when you become a part of this fun and innovative experience that will “blow” you out of this world and have you exploring icosahedrons. Beware… this camp will keep you coming back for more! July 26 – 30: Starbucks Shared Planet Youth Action Reaching Out The joy in giving can change lives, open doors and give hope for the future. Learn leadership skills; participate in civic engagement and involvement through a community project. Come discover the power to make positive change and how to contribute to the common good! Assist in building homes and ramps, become a volunteer and donate world‐wide. Let’s make a difference! Aug. 2 – 6: Mind, Body & Soul What is a beauty stereotype? Explore women around the world and how they see beauty and themselves. You’ll learn how to appreciate and respect your body and love you, just for being you. Get ready to explore how to identify and approach healthy relationships. You are beautiful just the way you are! Aug 9 – 13: Lights, Camera & Action Join the performance arts program designed to explore behind the scenes and in front of the camera experiences. Through media, acting, music and photography, you will be challenged to create your own fun and exciting documentary. Additional Summer Camps for Ages 9 to 11 June 21 – 25 • June 28 – July 2 • July 12 – 16 • July 19 – 23 Texas Instruments Camp Thinking SMART Through fun and interesting hands‐on experiments, you will develop an enthusiasm for science, technology, engineering, and mathematics. Get ready to explore, ask questions and solve problems. Thinking SMART is grounded in three E's and an F: equity, exploration, empowerment, and fun! Additional Summer Camps for Ages 12 to 14 June 21 – 25 • June 28 – July 2 • July 12 – 16 • July 19 – 23 Dean Foods Commit to be FIT Camp Want to be strong, smart, bold and healthy? Through hands‐on interactive activities, learn the tools to lead a healthy life by exploring the importance of good nutrition and fitness. You will maintain a food diary and attend related special events. Points are earned based on pre‐set benchmarks. SUMMER CAMP OVERVIEW 
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Summer Camp Mania is for girls and young women ages 6 ‐ 18. Camp sessions will be divided into the following groups: 6 ‐ 8 years, 9 ‐ 11 years, 12 ‐ 14 years and 15 ‐ 18 years. Curriculum and activities will be targeted toward each age group, their interests and abilities. Summer food program through DISD Food and Child Nutrition Services Department Summer camp hours: 7:30am – 6pm; Monday, June 7 – Friday, August 13 Cost: $200 CAMPS ARE AVAILABLE AT ALL 4 CAMPUSES Love Field Campus 2040 Empire Central Dr. Dallas, TX 75235 214‐654‐4551 Oak Cliff Campus 350 N. Zang Blvd. Dallas, TX 75208 214‐941‐0787 West Dallas Campus 2607 Toronto Street Dallas, TX 75212 214‐630‐0868 South Dallas Campus 4411 Meadow Street Dallas, TX 75215 214‐426‐2691 To get started, complete an enrollment form, swing by the campus you are interested in attending and speak with the Campus Director. GIRLS INCORPORATED OF METROPOLITAN DALLAS
ENROLLMENT FORM 2010
Date:
/
/
For office use only
 Fee Paid: $_________
Date: _____/_____/_____
Certify Enrollment Form
complete:_____________
Campus: Love Field, Oak Cliff, South Dallas, West Dallas
(Circle One)
Child’s Name: ____________________________________________________________
Campus Director initials
Address: ___________________________________________________________________________________________
City: ________________________ Zip Code: ________________ Phone: (_____)____________________________
Phone #2: (_____)____________________ Email Address: __________________________________________________
Birthday:
/
/
Grade:
School: ______________________
Age:
Race:
 White
 Black
 Hispanic
 Asian
 American Indian
 Other
Disabled:  Yes
 No
(Describe type of disability) : ___________________________________________________________________________
Language spoken at home:  English  Spanish  French  Other _________________________________
Parent’s (Guardian’s) Name: ___________________________________________________________________________
Address: ____________________________________________________________________________________________
City: ________________________ Zip Code: ________________ Phone: (_____)____________________________
 Father  Both
 Other _______________________________________
Child resides with:  Mother
Mother’s Place of Employment: ________________________________________________________________________
Address: ____________________________________________________________________________________________
City: ________________________ Zip Code: ________________ Phone: (_____)____________________________
Father’s Place of Employment: _________________________________________________________________________
Address: ____________________________________________________________________________________________
City: ________________________ Zip Code: ________________ Phone: (_____)____________________________
In case of an emergency, if parent cannot be reached, please contact:
Phone: (_____)_______________________
Phone: (_____)_______________________
My child may be picked up from Girls Incorporated Site by the following people ONLY:
1.
2. _____________________________________________
Any Allergies:
 Yes
 No
If yes, list: _______________________________
Any Medications?
 Yes
 No
If yes, list: _________________________________________________
Other information that we should know about your child:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Do you qualify for school lunch program?
 Yes
 No
How did you hear about Girls Inc.? *Radio *Television *Newspaper Friend School Other _______
*Which station or newspaper?: _____________________________________________________________
(For Statistical Purposes)
Family Income
0 - 10
10 - 15
T-SHIRT SIZE:
XXXL
Family Status
15- 20
20- 25
Above 25
YOUTH:
S
M
Single Mother Single Father
Both Parents Other (Grandparent, Great
Grandparent, Aunt, or Uncle)
L
ADULT:
S
M
L
XL
XXL
GIRLS INCORPORATED OF METROPOLITAN DALLAS
PERMISSIONS AND ACKNOWLEDGMENTS
My daughter ___________________________________, has permission to
participate in the programs of Girls Incorporated of Metropolitan Dallas. She has
permission to be transported in the Girls Incorporated vehicles. I agree not to hold
Girls Incorporated liable for any injury or accident which might occur.
She has my permission to swim during Girls Inc. programming. I agree that I will
not hold Girls Incorporated of Metropolitan Dallas for any injury or accident that
might occur while participating in the swim program.
I give my daughter permission to walk home from the Girls Incorporated Site.
Yes No 
I authorize Girls Incorporated of Metropolitan Dallas to obtain medical care for my
child in the case of a medical emergency. I understand that I am financially
responsible for the care given and that efforts will be made to contact the doctor of
my choice.
Is your daughter covered by insurance? Yes No 
Name of Health Provider i.e. Chip, Aetna, Unicare, Kids First, (Parkland):
_____________________________________
My daughter’s doctor/clinic is:
__________________________________
Doctor’s name/Clinic address
_________________
Phone #
_______________
Policy #
Date of last physical: _____/_____/_____
I have read and understand the policy statement of Girls Incorporated and will
cooperate with staff to ensure my daughter will comply with Girls Incorporated
policies and procedures of Girls Incorporated of Metropolitan Dallas.
__________________________________
Parent (Guardian’s) Signature
__________________________________
Relationship to the child
______/______/______
Date
Girls Incorporated does not discriminate on any basis prohibited by applicable law
including race, religion, sex, national origin, disability, age, and citizenship status.
Rev. 5/11/2010 esj
GIRLS INCORPORATED OF METROPOLITAN DALLAS
FORMULARIO DE ADMISIÓN 2010
Fecha:
/
/
Campo: Love Field, Oak Cliff, South Dallas, West Dallas
For office use only
 Fee Paid: $_________
Date: _____/_____/_____
Certify Enrollment Form
complete: _____________
Campus Director initials
(Circular Uno)
Nombre de la niña: _______________________________________________________
Dirección: ___________________________________________________________________________________________
Ciudad: _____________________ Código Postal: _____________ # de Teléfono: (_____)______________________
# de Teléfono: (_____)________________ Email Dirección: _________________________________________________
Fecha de nacimiento:
/
/
Grado:
Escuela: ________________________
Edad:
Raza:
 Blanca  Negra
 Hispana
 Asiática
 Indio Americano
 Otra
 No
Incapacitada:  Si
(Describa la incapacidad): ___________________________________________________________________________
Idioma que se habla en casa:  Inglés  Español  Francés  Otro _______________________________
Nombre del padre (o tutor): ___________________________________________________________________________
Dirección: ___________________________________________________________________________________________
Ciudad: _____________________ Código Postal: _____________ # de Teléfono: (_____)______________________
 Padre  Los dos
 Otro _______________________________________
La niña vive con:  Madre
Lugar de trabajo de la Madre: ________________________________________________________________________
Dirección: ___________________________________________________________________________________________
Ciudad: _____________________ Código Postal: _____________ # de Teléfono: (_____)______________________
Lugar de trabajo del Padre: _________________________________________________________________________
Dirección: ___________________________________________________________________________________________
Ciudad: _____________________ Código Postal: _____________ # de Teléfono: (_____)______________________
En caso de emergencia, si los padres no pueden ser localizados, por favor póngase en contacto con:
# de Teléfono: (_____)______________________
# de Teléfono: (_____)______________________
Mi niña SOLO puede ser recogida de la Agencia de Girls Inc. por las siguientes personas:
1.
2. _____________________________________________
Alguna clase de alergias:
 Si
 No
Medicinas:
 Si
 No
En caso afirmativo enumérelas: _____________________ En caso afirmativo enumérelas: _____________________
Alguna otra información que deberíamos saber de su hija:
____________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Califica UD. para el programa de almuerzo en su escuela?
 Si
 No
¿Como oyó acerca de Girls Inc.?  *Radio  *Televisión  Amigo  Escuela  Otro _______________________
¿*Que estación o periódico?: _______________________________________________________________
(Sólo para propósitos de Estadística)
Ingreso Familiar
15- 20
0 - 10
20- 25
10- 15
Sobre 25
TALLAS DE T-SHIRTS: NIÑAS:
Estado Civil de los Padres
Madre Soltera Padre Soltero
Ambos padres Otro (Abuelo/a, Bisabuelo/a, Tia, o Tio)
S M L ADULTOS: S M L XL XXL XXXL
GIRLS INCORPORATED OF METROPOLITAN DALLAS
PERMISOS Y CONSENTIMIENTOS
Mi hija ___________________________________, tiene permiso para participar en
los programas de la agencia de Girls Incorporated del Área Metropolitana de
Dallas. Ella tiene permiso para ser transportada en los vehículos de propiedad de la
agencia. Yo estoy de acuerdo en no hacer responsable a la agencia de Girls
Incorporated por algún accidente que pudiera ocurrir.
Ella tiene permiso para nadar durante la programación de Girls Inc. del Área
Metropolitana. Yo estoy de acuerdo en no hacer responsable a la agencia de Girls
Incorporated en caso de que pudiera ocurrir algún accidente mientras ella esté
participando en el programa de natación.
Yo doy permiso a mi hija para que camine sola a mi casa desde la agencia de Girls
Incorporated.
 Si
 No
Yo autorizo a la agencia de Girls Incorporated del Área Metropolitana a obtener
servicios médicos para mi hija en el caso de que ocurriera alguna emergencia
médica. Yo entiendo que soy financieramente responsable por los servicios médicos
prestados y que se harán los esfuerzos necesarios para ponerse en contacto con el
médico de mi preferencia.
 Si
¿Esta su hija cubierta por algún seguro médico?
 No
Nombre de la Compañía de Seguro Médico por ejemplo, Chip, Aetna, Unicare, Kids
First, (Parkland):
_____________________________________
El doctor/clínica de mi hija es:
__________________________________
Nombre del Doctor/Dirección de la Clínica
_________________
# de Teléfono
_______________
# de la Póliza
Fecha del ultimo examen medico: _____/_____/_____
He leído y entendido los reglamentos de la agencia de Girls Incorporated del Área
Metropolitana de Dallas. Estoy de acuerdo en cumplir con todo lo expuesto por
dichos reglamentos y cooperar con el personal de Girls Incorporated para asegurar
que mi hija acate y obedezca los reglamentos de la agencia de Girls Incorporated.
_________________________________________
Firma del Padre o Tutor
_______________________________________
Relación con la niña
______/______/______
Fecha
Girls Incorporated no discrimina de ninguna manera en base a edad, sexo, raza, incapacidad,
nacionalidad de origen, estado de ciudadanía, creencias políticas o religiosas, tal como la ley lo prohíbe
y especifica.
Rev. 5/11/2010 esj