The Day Camp at Rectory School P. O. Box 68 Pomfret, CT (860) The Day Camp at Rectory School Checklist 2018

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1 The Day Camp at Rectory School Checklist 2018 Application Deposit (Due June 1, 2018) Health Examination Form (both sides) Insurance Verification DKH Hospital Agreement Early Pick Up and Late Drop Off (optional) Permission to Travel off Campus Tennis Form will be given out 1 st day of camp Golf Form will be given out 1 st day of camp *(All extra sports are optional and require separate payment) Horse-barn activity form will be given out 1 st day of camp (Optional, separate payment) FULL TUITION DUE JUNE 15 Please mail directly to The Rectory School in care of Camp Director Dena O Hara. Objectives Our camp is designed to develop self-esteem and independence through personal challenges as well as teaching teamwork and cooperation. To expose children to sports, the arts, environmental awareness and cultural activities that will foster lifelong skills and values. The goal is to leave the child feeling challenged and fulfilled while providing them with an enjoyable summer camp experience. The Day Camp at Rectory School is offered on a nondiscriminatory basis without regard to race, national origin, religion, sex, age, marital status or disability.

2 MONDAY, JUNE 25, 2018 to FRIDAY, AUGUST 3, 2018 Hours of Operation: 9:00 AM 4:00 PM Name of Camper: Gender: M / F DOB: Age as of 1/1/18: Returning Camper/New: _ Parent/Guardian Name: Cell Number: _ Home Number: Mailing Address: Address: Responsible financial party: Cell Number: Home Number: _ Mailing Address: Address: _ Please check the appropriate week that you will be attending: Week 1 June 25 June 29 Week 1 $ (Lunch not included M, W, F but pizza provided Tuesday and Thursday) Week 2 July 2 July 6 Week 2 $ (No camp July 4 th ) Week 3 July 9 July 13 Week 3 $ Week 4 July 16 July 20 Week 4 $ Week 5 July 23 July 27 Week 5 $ Week 6 July 30 August 3 Week 6 $ (Lunch not included M, W, F but pizza provided Tuesday and Thursday) *For those campers who join us for 4 weeks $1, *For those campers who join us for 5 weeks $1, *For those campers who join us for 6 weeks $1, PLEASE NOTE: Lunch will not be provided on Monday, Wednesday or Friday of weeks 1 or 6. Pizza will be brought in on Tuesday and Thursday. Additional Fees may be incurred for activities and early drop off or late pick up. Fee Schedule is below. Fee Schedule: Amt Qty Total Weekly Camp Rate: Deposit Required: 6/1/18 Additional Fees Golf ($15 Per Session) $15 x Tennis ($15 per Session) $15 x Horseback Riding ($15 Per Session) $15 x Field Trips ($60 Per Session) $60 x Early Drop Off ($10 Per Occurance) $10 x Late Pick Up ( $10 Per Occurance) $10 x x x Day Camp Registration Commitment Registration fee of $ for each child must accompany each child s application. Please complete a separate sheet for each camper. In the event the application is not accepted, the fee will be returned. Upon acceptance, a place will be reserved for each child registered. The registration fee will be credited against tuition. Refund Policy No refund will be given if a camper withdraws up to two weeks prior to the session in which he/she is enrolled. No refund will be given in event of absence, withdrawal, delayed attendance or dismissal from camp. Total Weekly Rate: I have read the statement above and understand the camp s policy concerning the application fee and refund of tuition. I agree to pay all charges in full prior to my child s attendance at camp. The Director of the Day Camp at Rectory School reserves the right to dismiss a camper when in their judgment that camper s behavior interferes with the safety or rights of others. Signature of financially responsible party: Date: All medical release forms and verification of insurance must be submitted prior to the opening of the camp session. Campers will not be allowed to participate in the camp session without a medical release or a Day Kimball consent form.

3 Early Drop Off / Late Pick Up Program In order to assist working parents there is an early drop off/late pick up program. Camp runs from 9:00 am to 4:00 pm, with early drop off beginning at 8:00 am and the late pick up extends to 5:00 pm promptly. Advanced registration is preferable to ensure appropriate coverage for the children. However, in order to accommodate changing needs, you may arrange the day prior accompanied by full payment. Payment is expected in full prior to service. When dropping off your campers in the morning you must sign them in, and when picking them up in the afternoon you must sign them out. You may sign up for either drop off, late pick up, or both. You may call the day of a camp day and have your camper stay late but you must call first, please. We provide this as an extra service knowing life happens. Should that happen, please call Dena at Camper s Name: Age group: Week: $10.00 Early drop off: $10.00 Late pick up: $20.00 Both:

4 DAILY SCHEDULE Our daily schedule rotates daily from 9:00am-4:00pm. Each day, campers will engage in Red-Cross swim lessons with a certified staff, arts and crafts, dance/drama, exposure to different sports daily (basketball, tennis, soccer, baseball, floor hockey, etc.). A typical day is listed below. A Day in the Life of a Camper: Begin Time End Time Activity 9:00 am 9:15 am Morning Meeting 9:15 am 10:00 am Sports 10:05 am 10:50 am Arts and Crafts 10:55 am 11:40 am Swim 11:45 am 12:30 pm Arts and Crafts 12:35 pm 1:05 pm Lunch 1:10 pm 2:30 pm Free Swim 2:45 pm 3:00 pm Snack 3:00 pm 3:45 pm Yoga or Pick-a-Pocket of Fun 3:45 pm 4:00 pm Camp Clean Up/Parent Pick Up ACTIVITIES In addition to the playing fields, tennis courts and pool, The Rectory School s computer labs, gymnasium, cafeteria and Tang Center all serve as camp facilities. The educational activities program includes: ART BASEBALL BASKETBALL GOLF COMPUTER MUSIC NATURE RUNNING SOCCER STREET HOCKEY DANCE DRAMA FIMO/BEADS FISHING GAMES SWIMMING TENNIS KICKBALL HIKING HORSE-BARN ACTIVITIES Camp The camp continues to provide enjoyable activities, which contribute to the all-around development of your children while occupying and entertaining their eager hands and minds. Our organized activities provide a safe ready-made environment for making friends and socializing. *Children are grouped by ages (4/5/6; 7/8; 9/10 and 11/12/13) according to the grade they will enter in the fall. *Special showcase: Family Night, which features musical and dance performances and an arts and crafts display. Dates for summer 2018 are Thursday July 12 and August 2 at 6:30pm. *The 11/12/13 s Adventure Program takes them off campus two days of each week for hiking, to the beach, tubing down the Farmington River, Nomad Adventure Scape, Seekonk Raceway, the movies, Roger Williams Zoo, Basketball Hall of Fame, and Block Island. Permission to Travel off Campus Date: I give permission for camp activities. I understand that prior notification will be given. to travel via Rectory School van or hired vehicle for off-site Parent or Guardian:

5 Day Kimball Hospital Agreement for Emergency Medical Care This is to acknowledge that Day Kimball Hospital will provide emergency medical services to the staff and clients of The Day Camp at Rectory School located in Pomfret, Connecticut. Day Kimball Hospital also acknowledges and fully understands the information and arrangements provided by the camp as stated below: The camp is in session Monday Friday, beginning June 25, 2018 to August 3, 2018 The camp s on-call physician is Dan Newman, R.N. is responsible for emergency medical care at the camp In an emergency, the camp will attempt to contact the hospital by telephone 911 will be called for emergency transportation to the hospital Staff members/clients will be transported with copies of their medical records as well as the signed DKH consent form DKH should refer to each staff member/client s individual records for their specific insurance carriers The camp s insurance carrier for Workmen s Compensation is Utica Mutual Insurance. The camp will maintain a file for its staff/clients at the DKH Emergency Department. This file will contain medical records as well as the signed DKH consent form. Medical / Health Requirements The camp cannot allow a child attend camp without a doctor s certificate of physical condition, evidence of current vaccinations, immunizations and proof of insurance. We must send home any camper until this certificate is in the hands of the camp nurse. It is understood that parents accent and will abide by the above regulations before applying. Parent/Guardian Permission to Administer Treatment Dear Parents/Guardians: In the event of an injury, or your child becoming sick while at camp, all efforts will be made to contact the parents or guardians before treatment. However, often it can take hours before contact is made, leaving the child uncomfortable with a headache or itchy poison ivy. Rather than do this, I would like to suggest that parents/guardians take a moment to sign below and authorize permission for treatment as deemed necessary by the camp nurse. All treatment will be made in accordance with the camp s Standing Orders as written by our camp doctor, Marc Cerrone of Day Kimball Hospital Pediatric Center. Name of Camper: DOB: Dan Newman, R.N. I,, give/do not give, permission for my child to receive treatment or medications as may be deemed necessary by the camp nurse. Parent or guardian signature Phone number Date In the event of an emergency and the parents or guardians of the camper are not immediately available, please provide two alternative emergency contacts Name Relationship Contact Number

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