Roosevelt University

RU GLAMOROUS C.S.I.
Camp for Girls Application (Applicants must be entering seventh through ninth grade during the 2008-09 academic year. Maximum of 25 students each session – additional applicants will be placed on a waiting list.)

SESSION 1 is July 21-25, 2008 | Roosevelt University, Schaumburg Campus
SESSION 2 – July 28-August 1, 2008 | Roosevelt University, Schaumburg Campus
Application Deadline: June 30 or until all spots are filled

Student's First Name	Last Name	Nickname
Student's Address	City	State	Zip
Home Phone	Grade in Fall '08	Name of School
Age by start of camp	Birthday (mm/dd/yy)	Select one
EMERGENCY INFORMATION AND CONTACTS
Parent or Legal Guardian Name	Relationship to Camper
Cell Phone	Work Phone	Email
Additional Contact (in the event that the above can not be reached)	Additional Contact Phone
Pick-up Contact	License Plate #/Vehicle Model/Color	Phone
Pick-up Contact	License Plate #/Vehicle Model/Color	Phone
HEALTH
Allergies (food, medicine, environmental, etc.) and chronic health problems:

Medications (please note that RU GLAMOROUS CSI will not administer any medications at the camp):

Child’s Physician/Hospital	Phone
Insurance Carrier	Insurance Number
TUITION The total cost of the camp is $125 without lunch or $150 with lunch provided per camper. Total balance is due with application. No refunds after July 15, 2008. CHECK: Please make checks payable to the Roosevelt University—RU GLAM CREDIT CARD - You will be contacted by telephone to complete your transaction.
PERMISSION By submitting this form, I hereby give my child permission to participate in RU GLAMOROUS - CSI camp activities. I fully assume all responsibility for injuries he/she may receive or articles lost while participating in these activities and hereby release Roosevelt University, Jocelyn Yarbrough, camp counselors and guest speakers from any liability for any injury my child may sustain. I understand my child may not be left at the campsite more than 1/2 hour prior to the beginning of camp and must be picked up daily at the assigned dismissal time or a $10.00 late fee per 30 minutes will be assessed. RU GLAMOROUS and Roosevelt University and their staff members are not responsible for children not picked up. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by Roosevelt University to hospitalize and secure proper treatment for the child named above in case of accident or sudden illness. I give my permission to Roosevelt University to take and use photographs or videos of camp activities that contain an image of my child for the limited purpose of promotion and advertising. Questions? Contact Jocelyn Yarbrough at: 847.619.8551 jyarbrou@roosevelt.edu