O

O.P.E.I.U. LOCAL 153,

AFL-CIO

www.opeiu-tristate.org

265 West 14^th Street, 6^th floor / New York, NY 10011

Tel: 212-741-8282

Fax: 212-463-9479 / E-mail: lp@opeiu-tristate.org

SUMMER CAMP PROGRAM 2008

PLEASE PRINT CLEARLY AND RETURN THIS APPLICATION BACK TO YOUR UNION/LOCAL

Name of Union: O.P.E.I.U. LOCAL 153 .

Coordinator's Name: LUISA POSIVAL Telephone #: (212) 741-8282, EXT. 104 .

Member's Name: ___________________________________ Telephone #: _(_____)___________________

Company: ______________________________________________________________________________

MEMBER/PARENT OR GUARDIAN (please circle one)

Child's Full Name ________________________________________________________________________

Birthdate: __________ Sex: M ___ F ___

Home Address: ________________________________ City: _______________ State: _____ Zip: _______

Home Phone #: _(_____)_________________________ Work Phone #: __(_____)____________________

This year's choice of Camp: 1. __________________________________

(Please see list of camps)

· Please make sure that you call the camp that you have chosen from the list to register your child. Because of the high volume and the "first come, first serve basis" at the camps, we suggest you get your children to the doctor's office early for the physical examination that the camps usually require.

Return this application for approval and scholarship fee no later than May 16, 2007 to:

Local 153, 265 W. 14^th St., New York, NY 10011 or fax to: 212 463-9479

FOR LOCAL OFFICER APPROVAL: Local Union _______________________ includes $100.00 scholarship fee for the applicant (Check Enclosed).

_______________________ _________________________ ________________

Officer's Signature Please Print Name Date

*Notice to all applicants: YOU MUST CALL THE CAMP OF YOUR CHOICE TO REGISTER YOUR CHILD.

All applicants for summer camp will be required to pay the camp to which they are referred. Fees are established by the camps. Some camp fees are on a sliding scale, based on ability to pay. PROOF OF INCOME WILL BE REQUIRED BY THE CAMP. The Central Labor Rehabilitation Council will introduce for the first time a one-hour film on adolescence and substance abuse prevention.