Tourette Association of Greater NYS. Camp Ticapalooza

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1 Tourette Association of Greater NYS Announces Camp Ticapalooza Annual 3-Day Overnight Camp September 22-24, 2017 Open for Youth with TS Ages 6-17 Friday 3:00 PM to Sunday 2:00 PM Camp Cory, Penn Yan, NY on Keuka Lake We would like to let everyone know that we will once again be using Camp Cory, a YMCA Camp on Keuka Lake in Penn Yan, NY for our annual Ticapalooza. This is a great facility that gave us the opportunity to introduce our campers to many great activities including basketball, tennis, soccer, rock wall climbing, zip line, archery, canoeing, kayaking, paddle boarding and everyone s favorite, the BOUNCE PILLOW to name a few. There will be one counselor familiar with TS for every 4-5 children. The campers will sleep in cabins that sleep 10 (2 adults per cabin) with full bathrooms in every cabin. Most cabins will have no more than 5-6 campers. All meals will be served in the camp dining room. The camp provides trained and certified staff, who run all activities. There will also be a registered nurse, Sharon Shulz, school nurse from Ken-Ton Schools, on duty all weekend to dispense medications and take care of all health issues. We are able to offer this fabulous weekend to all residents of the TSA of Greater NY State chapter area from across the state for a fee of $ per camper. If you have transportation issues from anywhere in the state, please let us know and hopefully we will be able to help arrange for car pools. We have some full and partial scholarships available for anyone who needs. If you are interested in a scholarship, please fill out the form in the registration materials and send it with your registration and other forms. When you register, we ask that you also fill out, sign and return the attached medical and information forms for your child. You will receive an confirmation once your registration has been received. Once we get closer to the weekend, you will also receive further details of the weekend activities as well as directions to the camp. If any family coming from a distance would like to stay in the main lodge (see description below) at the camp or in a private cabin with bathroom and shower facilities nearby, they do have limited facilities available. Registration form is attached.

2 Registration Form Please fill out the registration form below and it to Sue Conners at or mail it to 20 Thomas Jefferson Lane, Snyder, NY by no later than September 16 with the appropriate registration fee for each camper. If you register by , please then send a check to the address below. You can also pay on the TA of Greater NY State website using Paypal. Space is limited so please register early. Make checks payable to TA of GNYS and send to: TSA of Greater NYS, 20 Thomas Jefferson Lane, Snyder, NY **************************************************************************************** Child s Name Age Address Home Phone Address Will parent(s) be staying at the campground or at a near by hotel? Yes No Tee Shirt Size: Child S M L Adult S M L XL 2XL 3XL Check enclosed (or mailed if done by ) Paying by Paypal on website Paypal # Please do not forget to also fill out the attached medical and informational forms and return them with this registration. Families Interested in Staying at the Campground for the Weekend Parents who wish to stay on the campgrounds may reserve a place at the lodge or a private cabin with bathroom and shower facilities nearby using the attached form. Below we are listing some local hotels where you can also reserve a room if you prefer. We will have several parent activities planned including guest speakers and the parents are welcome to attend the Talent Show Saturday Local Hotels Best Western Vineyard Inn Suites 142 Lake St, Penn Yan, NY Hampton Inn (Hilton) 110 Mace St, Penn Yan, NY Microtel Inn and Suites 124 Elm St, Penn Yan, NY La Belle Vie Bed & Breakfast 206 Main St, Penn Yan, NY Finger Lakes Bed & Breakfast, 128 South Ave, Penn Yan, NY There are also several good hotels in Geneva, NY, which is about 14 miles away from Camp.

3 Medication Sheet Camper s Name Age Birth date Medication 1 Time Friday Saturday Sunday Medication 2 Time Friday Saturday Sunday Medication 3 Time Friday Saturday Sunday Medication 4 Time Friday Saturday Sunday Medication 5 Time Friday Saturday Sunday Medication 6 Time Friday Saturday Sunday

4 TA of GNYS - Camp Information Sheet Child s Name Parent s Name Home Address Home Phone Work Phone Cell Phone Emergency Contact Relation to Family Emergency Contact Phone Number Allergies: Please check other associated disorders that your child has also been diagnosed with: ADHD OCD Autism Spectrum Disorder Rage (Meltdowns) Sensory Issues Does your child have any other health problems besides TS and its associated disorders that we should be aware of? yes no If yes, please provide me with details below. Use back of sheet if necessary.

5 Emergency Medical Release Form I,, give permission to the volunteer counselors from the Tourette Syndrome Association of Greater NY State and the staff of Camp Cory to provide for medical care of my child, the weekend of September 22-24, 2017 in case of an emergency. Parent Name (Printed) Signature Date Please complete, sign and return all forms by no later than September 16 to address on the last page.

6 Lodge Registration for Parents Adults who want to stay on the campgrounds can reserve a place at the main lodge, which has a central common room with a gas fireplace. an open kitchenette, which includes: a full size refrigerator, dish washer, stove, oven, sink, and is stocked with pots & pans, coffee pot, plates, cups, utensils and serving pieces. The rest of the building consists of two large bunkrooms, one for women and one for men. Each bunkroom sleeps 14 individuals with direct access to their own bathrooms and showers. Many of our parents stayed there last year and loved it. The lodge fee is $25 per person per night. There are also private cabins available with bathroom facilities nearby for $15 per person per night. Checks can be sent to TSA of Greater NY State at the same address as above OR you can pay using Paypal on the chapter website (tsa-gnys.org). ALL money for campers as well as parents staying on the campground is due no later than September 16. You can reserve now and pay later. We will be providing a list of local activities for the parents as well as offering workshops by specialists in the area of TS. Each parent will receive a schedule upon arrival at the camp. ALL CABINS MUST BE PAID FOR IN ADVANCE. *************************************************************** Parent Lodge / Cabin Registration Form Name Address Phone number Cell Number No. of people staying ($25 per person per night at lodge or $15 per person per night in cabin) We are requesting to stay at the lodge in a cabin Make checks payable to TSA of Greater NY State or pay on line using Paypal. Check enclosed (or mailed if registered by ) Paying by Paypal MEALS WILL BE AN ADDITIONAL COST. INFORMATION WILL BE PROVIDED WHEN YOU REGISTER.

7 Scholarship Application Parent s Name Camper s Name Address Phone Number Address We are requesting a full scholarship in the amount of $ We are requesting a partial scholarship in the amount of $50.00 $80;00 $ SCHOLARSHIPS ARE LIMITED THIS YEAR. YOU MUST APPLY EARLY. Please return all forms by to conners@roadrunner.com OR By mail to TA of GNYS, 20 Thomas Jefferson Lane, Snyder, NY Registration Deadline - September 16 If you have any questions about camp, please contact Sue Conners, Chapter President, at or