2017 Summer Enrichment Form Schedule
Grade Entering
Torrance Unified School District
Fall 2017
2017 High School Summer Enrichment Enrollment Application Student Name:
Date of Birth:
Address:
Age:
Home Phone: Number & Street Name
City
Zip Code
School Currently Attending:
School Attending Fall 2017:
Parent Name
Work Phone:
Cell Phone:
Parent Name
Work Phone:
Cell Phone:
If parent cannot be reached, contact: Name Insurance Company
Phone Policy #
Group #
Please Identify Summer Program(s) You Wish to Enroll:
Office Use Only
Class:
Instructor:
Times:
Total Classes Enrolled
Class:
Instructor:
Times:
Fees Paid
Class:
Instructor:
Times:
Receipt #
Cost for In Program selected = $100.00 • Each additional Program selected = $90.00
Initials of Approval
AUTHORIZATION TO PARTICIPATE AND RELEASE OF LIABILITY FORM I.
I certify that information given on this application is accurate. If applicable, I have read and agree to abide by the California Interscholastic Federation (CIF) Student Athlete's Code of Ethics, and all student policies and procedures established by the Torrance Unified School District. I understand that many enrichment programs (including athletics) entail unknown and unanticipated risks, which could result in physical or emotional injury, paralysis, death, or damage to myseli to property, or to third parties. I acknowledge that such risks simply cannot be eliminated without jeopardizing the essential qualities of these activities. As a participant in this program I acknowledge that the risks may involve but are not limited to: being struck by another participant, ball, etc. or all that may result in contusions, sprains, fractures, broken bones or concussions. I agree to provide proof of medical insurance with this authorization form. I agree and fully understand that Torrance Unified School District will provide liability only for any negligence on its part which occurs during authorized practices, classes, sessions, i.e., when the authorized instructor is present and supervising the enrichment event/activity. I hereby give my consent to my daughter/son to attend the TUSD Summer Enrichment Program and enroll in the program(s) for which a selection has been made. I agree to ensure that my son/daughter has access to a parent (i.e. home, work or cell phone) in case of emergency, class cancellation, campus evacuation, or any other non-planned event. I understand and accept full academic and financial responsibility for selection(s) made on this application. The classes are not a prerequisite for my son/daughter participating in any program during the regular school year. There will be no grades or credit issued for the classes. I, the undersigned, hereby release and discharge the Torrance Unified School District, including its officers, employees, agents, servants and volunteers (herein collectively referred to as the "District"), from all liability arising out of or in connection with the above-described practice sessions that may be filed on behalf of or for the above-named minor. For the purposes of this agreement, "liability" means all claims, demands, losses, causes of action, suits or judgments of any and every kind on account of any injury 10 the person or property of the above-named minor that occurs during the above-described practice sessions and classes, and that results from any cause other than the negligence of the District.
In case of an accident, I give permission to take to a physician. I hereby authorize the physician to take necessary care of my child and I agree to assume responsibility for all medical services. Parent Signature
Date:
Student Signature
Date:
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2017 SUMMER ENE' ;1111b1E11'. 7 ra.011[11.4 .1k1 WHAT:
A summer program that consists of extra-curricular camps, classes, games, and practices. All instruction provided by district personnel. No grades or credit assigned.
WHO:
Applicants must be returning North High students or enrolling North High freshmen.
WHEN:
Dates and times for each are listed below. Monday, July 4th is an all-school holiday.
COST:
Cost per Student is $100.00 for the 1st program. $90.00 each additional program. Checks payable to North High School. Receipts will be issued.
Complete the form on the back of this page and return to North High School (Site Supervisor's office) Forms are due by June 16th. Checks and forms can be mailed directly to: North High School, 3620 W. 182' St, Torrance, CA, 90504 Attn: Summer Athletics
CLASS NUMBER & NAME #1 Baseball (All Levels) #2 Girls Basketball (Varsity) #3 Girls Basketball (Jv a F5) #4 Boys Basketball (F/5) #5 Boys Basketball (JV) #6 Boys Basketball (Varsity) #7 Cross Country (Coed) #8 Track (Coed)
INSTRUCTOR
#9 Football (Var & JV)
Coach Neily Coach Kamiyama Coach Kamiyama TBA TBA TM TBA Andres Suarez Anthony Bantula Coach Croce
#10 Football (Freshman)
Coach Croce
#11 Girls Soccer (All Levels)
Coach Johnson
#12 Boys Soccer (All Levels) #13 Softball (All Levels) #14 Tennis (Boys & Girls) #14 Girls Volleyball (Var) #16 Girls Volleyball (F/5) #17 Boys Volleyball (All) #18 Wrestling (All)
Coach Rivas Coach Miller Coach Condiff Coach Cronin Coach Cronin Coach Nazarian Coach Mun
#19 Marching Band (all) Both sessions included #20 Dance #21 Pep Squad (All Levels) #22 Swimming #23 Athletic Training #24 Golf (Boys 6 Girls)
Mr. Smith Ms. Taylor Coach Hignight Coach Trujillo Coach Ikari Coach Taualii
DAYS & TIMES Tues & Thurs 10 am-12 pm Mon-Fri 8-10 am Tues & Thurs 8-10 am TBA TBA TM Mon - Fri 7am - 9am Mon-Friday 2pm-4pm Mon, Wed, Friday lpm-2pm Mon, Tue, Thurs, Fri 4-6 pm Weights 3-4 pm Mon, Tue, Thurs, Fri 3-5 pm Weights 2-3 pm Tue & Thurs 1:00-3:30 pm & Wed 3-6 pm Mon & Wed 12-3 pm Tues & Thurs 3:30-5:30 pm Mon-Thurs 3-5 pm Mon - Thurs 1-3 pm Mon - Thurs 1-3 pm Mon - Fri 3-6 pm Mon - Thurs 9-11 am Weight Room TBA Session 1: Mon,Wed,Fri 5-8 pm Session 2: Mon - Fri 1-9 pm Mon - Fri 12-2 pm TBA Tues & Thurs 6:30-8:00 am IBA Wednesday
DATES June 26 - July 28 June 26 - July 28 June 26 - July 28 June 26 - July 28 June 26 - July 28 June 26 - July 28 July 5 - Aug 4 July 28-Aug 25
June 26 - July 28
LOCATION Baseball Field Main Gym Saxon Hall Main Gym Saxon Hall Main Gym Stadium Stadium Weight Room Stadium Field Weight Room Stadium Field Weight Room Stadium Field
June 26 - July 28 June 26 - ;Icily 28 June 26 - July 28 June 26 - July 28 June 26 - July 28 July 17- 21 June 26 - July 28
Stadium Field Softball Field Tennis Courts Main Gym Saxon Hall Main Gym Wrestling Room
TBA IBA June 26 - July 11 TBA
Band Room
July 3 - Aug 3 July 5 - Aug 3
June 26 - July 28 TBA July 12 - Aug 9
Dance Room Cheer Room The Plunge Training Room Alondra
Torrance Unified School District
Fall 2017
2017 High School Summer Enrichment Enrollment Application Student Name:
Date of Birth:
Address:
Age:
Home Phone: Number & Street Name
City
Zip Code
School Currently Attending:
School Attending Fall 2017:
Parent Name
Work Phone:
Cell Phone:
Parent Name
Work Phone:
Cell Phone:
If parent cannot be reached, contact: Name Insurance Company
Phone Policy #
Group #
Please Identify Summer Program(s) You Wish to Enroll:
Office Use Only
Class:
Instructor:
Times:
Total Classes Enrolled
Class:
Instructor:
Times:
Fees Paid
Class:
Instructor:
Times:
Receipt #
Cost for In Program selected = $100.00 • Each additional Program selected = $90.00
Initials of Approval
AUTHORIZATION TO PARTICIPATE AND RELEASE OF LIABILITY FORM I.
I certify that information given on this application is accurate. If applicable, I have read and agree to abide by the California Interscholastic Federation (CIF) Student Athlete's Code of Ethics, and all student policies and procedures established by the Torrance Unified School District. I understand that many enrichment programs (including athletics) entail unknown and unanticipated risks, which could result in physical or emotional injury, paralysis, death, or damage to myseli to property, or to third parties. I acknowledge that such risks simply cannot be eliminated without jeopardizing the essential qualities of these activities. As a participant in this program I acknowledge that the risks may involve but are not limited to: being struck by another participant, ball, etc. or all that may result in contusions, sprains, fractures, broken bones or concussions. I agree to provide proof of medical insurance with this authorization form. I agree and fully understand that Torrance Unified School District will provide liability only for any negligence on its part which occurs during authorized practices, classes, sessions, i.e., when the authorized instructor is present and supervising the enrichment event/activity. I hereby give my consent to my daughter/son to attend the TUSD Summer Enrichment Program and enroll in the program(s) for which a selection has been made. I agree to ensure that my son/daughter has access to a parent (i.e. home, work or cell phone) in case of emergency, class cancellation, campus evacuation, or any other non-planned event. I understand and accept full academic and financial responsibility for selection(s) made on this application. The classes are not a prerequisite for my son/daughter participating in any program during the regular school year. There will be no grades or credit issued for the classes. I, the undersigned, hereby release and discharge the Torrance Unified School District, including its officers, employees, agents, servants and volunteers (herein collectively referred to as the "District"), from all liability arising out of or in connection with the above-described practice sessions that may be filed on behalf of or for the above-named minor. For the purposes of this agreement, "liability" means all claims, demands, losses, causes of action, suits or judgments of any and every kind on account of any injury 10 the person or property of the above-named minor that occurs during the above-described practice sessions and classes, and that results from any cause other than the negligence of the District.
In case of an accident, I give permission to take to a physician. I hereby authorize the physician to take necessary care of my child and I agree to assume responsibility for all medical services. Parent Signature
Date:
Student Signature
Date:
a 3 =la a MIN
a a a• I
a a IMS•••
a -.mail
- ma• -0—
ala- • • Elm
• a an-a
2017 SUMMER ENE' ;1111b1E11'. 7 ra.011[11.4 .1k1 WHAT:
A summer program that consists of extra-curricular camps, classes, games, and practices. All instruction provided by district personnel. No grades or credit assigned.
WHO:
Applicants must be returning North High students or enrolling North High freshmen.
WHEN:
Dates and times for each are listed below. Monday, July 4th is an all-school holiday.
COST:
Cost per Student is $100.00 for the 1st program. $90.00 each additional program. Checks payable to North High School. Receipts will be issued.
Complete the form on the back of this page and return to North High School (Site Supervisor's office) Forms are due by June 16th. Checks and forms can be mailed directly to: North High School, 3620 W. 182' St, Torrance, CA, 90504 Attn: Summer Athletics
CLASS NUMBER & NAME #1 Baseball (All Levels) #2 Girls Basketball (Varsity) #3 Girls Basketball (Jv a F5) #4 Boys Basketball (F/5) #5 Boys Basketball (JV) #6 Boys Basketball (Varsity) #7 Cross Country (Coed) #8 Track (Coed)
INSTRUCTOR
#9 Football (Var & JV)
Coach Neily Coach Kamiyama Coach Kamiyama TBA TBA TM TBA Andres Suarez Anthony Bantula Coach Croce
#10 Football (Freshman)
Coach Croce
#11 Girls Soccer (All Levels)
Coach Johnson
#12 Boys Soccer (All Levels) #13 Softball (All Levels) #14 Tennis (Boys & Girls) #14 Girls Volleyball (Var) #16 Girls Volleyball (F/5) #17 Boys Volleyball (All) #18 Wrestling (All)
Coach Rivas Coach Miller Coach Condiff Coach Cronin Coach Cronin Coach Nazarian Coach Mun
#19 Marching Band (all) Both sessions included #20 Dance #21 Pep Squad (All Levels) #22 Swimming #23 Athletic Training #24 Golf (Boys 6 Girls)
Mr. Smith Ms. Taylor Coach Hignight Coach Trujillo Coach Ikari Coach Taualii
DAYS & TIMES Tues & Thurs 10 am-12 pm Mon-Fri 8-10 am Tues & Thurs 8-10 am TBA TBA TM Mon - Fri 7am - 9am Mon-Friday 2pm-4pm Mon, Wed, Friday lpm-2pm Mon, Tue, Thurs, Fri 4-6 pm Weights 3-4 pm Mon, Tue, Thurs, Fri 3-5 pm Weights 2-3 pm Tue & Thurs 1:00-3:30 pm & Wed 3-6 pm Mon & Wed 12-3 pm Tues & Thurs 3:30-5:30 pm Mon-Thurs 3-5 pm Mon - Thurs 1-3 pm Mon - Thurs 1-3 pm Mon - Fri 3-6 pm Mon - Thurs 9-11 am Weight Room TBA Session 1: Mon,Wed,Fri 5-8 pm Session 2: Mon - Fri 1-9 pm Mon - Fri 12-2 pm TBA Tues & Thurs 6:30-8:00 am IBA Wednesday
DATES June 26 - July 28 June 26 - July 28 June 26 - July 28 June 26 - July 28 June 26 - July 28 June 26 - July 28 July 5 - Aug 4 July 28-Aug 25
June 26 - July 28
LOCATION Baseball Field Main Gym Saxon Hall Main Gym Saxon Hall Main Gym Stadium Stadium Weight Room Stadium Field Weight Room Stadium Field Weight Room Stadium Field
June 26 - July 28 June 26 - ;Icily 28 June 26 - July 28 June 26 - July 28 June 26 - July 28 July 17- 21 June 26 - July 28
Stadium Field Softball Field Tennis Courts Main Gym Saxon Hall Main Gym Wrestling Room
TBA IBA June 26 - July 11 TBA
Band Room
July 3 - Aug 3 July 5 - Aug 3
June 26 - July 28 TBA July 12 - Aug 9
Dance Room Cheer Room The Plunge Training Room Alondra
