CAMP KCC April Dear KCC Parents,

Transcription

1 April 2017 Dear KCC Parents, Here is your chance to offer your children an exclusive summer camp experience where they can develop and perfect their tennis, golf and swimming skills. In doing so, they will also establish friendships and create memories that will last a lifetime. The Knickerbocker Country Club Day Camp has been in operation since 2006 and continues to evolve to meet the desires of our members. In addition to our regularly scheduled camp activities, campers enjoy local field trips and a wide variety of enriched programs that our camp offers, including; cooking, etiquette, art, dance, story time, exercise classes, pool activities, karaoke, field day, etc. Parents appreciate our professionalism, dedication and willingness to accommodate the special needs of all our campers. Once again this year, we will be accepting children who are as young as four years old and potty trained. The 2017 Camp Session will begin on Monday, June 26th and end on Friday, August 4th. Camp hours begin at 8:30 am and end at 2:30 pm, after-care is available at an additional fee. Parents may choose to enroll their campers in a minimum of 4 weeks of camp with optional 5th & 6th weeks. These weeks may be scheduled throughout the full camp duration. Camp KCC is pleased to offer a counselor in training program for boys and girls ages 11 to 14 again. In this program, the CIT's will work under the guidance of the directors and head counselor. Emphasis will be on developing proper communication skills, games, and activities for the campers, and conflict resolution techniques. Each CIT will be placed with a specific age group and work with the counselor in charge of that group. Weekly meetings will take place with the directors to discuss progress from the previous week. CITs will participate in all of the scheduled activities, field trips and special events with their assigned group. CIT's will receive credit in the form of volunteer hours for 25% of their duration at camp. Participation in this program does not guarantee future employment. Attached you will find a series of forms that must be completed and signed before your child(ren) can attend CAMP KCC. Please attach copies of up-to-date immunization records and a current physical. In order to properly plan for the 2017 camp season, please make sure that we receive all of the requested forms by Friday, May 5 th. After that date, we cannot guarantee admittance and your account will be charged a late registration fee of $250. Please understand, if we do not receive the forms, your child cannot attend camp. If your child(ren) has any special needs and or concerns please feel free to list them on the enclosed forms. Thank you in advance for your time and help. The camp committee, counselors and directors are excited to meet you and your children and are looking forward to a fantastic camp season this year! Sincerely, Amanda Waxman Camp KCC Director

2 Camper Information These forms must be completed and returned to KCC on or before May 5, 2017 Last Name: First Name: Address: Street City State Zip Date of Birth: Age as of 6/2017: Grade as of 9/2017: Gender: Male or Female (circle) Home Phone #: Parent s Information Mother: Name Business # Cellular # Where is the best place to reach you? Home or Work or Cell (circle one) Father: Name Business # Cellular # Where is the best place to reach you? Home or Work or Cell (circle) If parents cannot be reached, please provide additional contact: Name Phone # Relationship Name Phone # Relationship Name Phone # Relationship

3 Counselor in Training ( CIT ) Program Application *CIT's must complete all Camp KCC Camper Registration Forms. Tuition for CIT's is 75% of the cost of a camper. Volunteer hours will be earned by CIT's for 25% of their day. Daily snacks, lunch and fieldtrips are included in the cost of tuition. Requirements: At least 11 years old Former KCC camper (min. of 2 years) First Aid & CPR Certified Life-guard certified or a strong swimmer Clear Criminal History Background check Online Questionnaire/ References Medical History/ Immunization Records Completed KCC Pledge (below) Sample Volunteer Hour Certificate KCC CIT PLEDGE Being involved with our day camp program is a privilege and a serious obligation. Not only will you take control of your own experience, but also that of children and campers with whom you interact. You are expected to live up to the expectations of the program, which are as follows: Take responsibility for your own actions and learning as well as those of your assigned group. ity, staff, campers, and fellow CIT s. I state that the information on this application is true, complete and correct. APPLICANT S SIGNATURE DATE: / / PARENT/GUARDIAN SIGNATURE DATE: / / MANDATORY CIT QUESTIONNAIRE

4 Camp Weekly Enrollment You may choose to enroll your camper in a minimum of four (4) weeks of camp with optional 5th & 6th weeks. These weeks may be scheduled throughout the full camp duration. Otherwise, camp registrations received after the deadline will be automatically scheduled during four consecutive calendar weeks. Please complete the schedule below with your weekly selections. Camper s Name: Please select at least four (4) weeks: Week 1: Monday, June 26 Friday, June 30, 2017 Week 2: Wednesday, July 5 Friday, July 7, 2017 Week 3: Monday, July 10 Friday, July 14, 2017 Week 4: Monday, July 17 Friday, July 21, 2017 Week 5: Monday, July 24 Friday, July 28, 2017 Week 6: Monday, July 31 Friday, August 4, 2017 Camp Tuition Schedule: Tuition will be charged to your KCC Account 4 Week Tuition $ 500 per week Total $2,000 5 Week Tuition $ 470 per week Total $2,350 6 Week Tuition $ 450 per week Total $2,700 Parent s Signature: Date:

5 Camp Lunch Menu Selections Camper s Name: (Please use one form per camper) Special Dietary Needs: *Every lunch is served with a fresh green salad and fruit salad. Please make one selection per day from Monday-Thursday. Please note: A one-time change of menu selection will be allowed after week #2. Week #1 Week #2 Week #3 Monday, June 26 Tuesday, June 27 Wednesday, June 28 Thursday, June 29 Turkey & Cheese Whole Wheat Wrap & Plain Cheese Pizza Mini Chicken Parmigiana Sliders & Grilled Chicken Skewer w/low fat dipping sauce & Baked Chicken Fingers & Baked Pepperoni Pizza Mini Beef Sliders & Select: cheese/plain Grilled Cheese on Whole Wheat Bread w/baked Pasta with butter White Pizza Macaroni & Cheese Pasta with Butter Grilled Veggies w/rice w/butter Grilled Veggie Pizza Gluten Free Plain Cheese Pizza Veggie Burger & Gluten Free Mac & Cheese Pasta Primavera Bolognese Monday, July 3 Tuesday, July 4 Wednesday July 5 Thursday, July 6 No Camp No Camp Mini Chicken Parmigiana Sliders & Grilled Chicken Skewer w/low fat dipping sauce & Mini Beef Sliders & Select: cheese/plain Macaroni & Cheese Veggie Burger & Gluten Free Mac & Cheese Grilled Cheese on Whole Wheat Bread w/baked Pasta with Butter Pasta Primavera Bolognese Monday, July 10 Tuesday, July 11 Wednesday, July 12 Thursday, July 13 Turkey & Cheese Whole Wheat Wrap & Plain Cheese Pizza Mini Chicken Parmigiana Sliders & Grilled Chicken Skewer w/low fat dipping sauce & Baked Chicken Fingers & Baked Pepperoni Pizza Mini Beef Sliders & Select: cheese/plain Grilled Cheese on Whole Wheat Bread w/baked Pasta with butter White Pizza Macaroni & Cheese Pasta with Butter Grilled Veggies w/rice w/butter Grilled Veggie Pizza Gluten Free Plain Cheese Pizza Veggie Burger & Gluten Free Mac & Cheese Pasta Primavera Bolognese

6 Camp Lunch Menu Selections/Form #2 Camper s Name: (Please use one form per camper) Week #4 Week #5 Week #6 Monday, July 17 Tuesday, July 18 Wednesday, July 19 Thursday, July 20 Turkey & Cheese Whole Wheat Wrap & Plain Cheese Pizza Mini Chicken Parmigiana Sliders & Grilled Chicken Skewer w/low fat dipping sauce & Baked Chicken Fingers & Baked Pepperoni Pizza Mini Beef Sliders & Select: cheese/plain Grilled Cheese on Whole Wheat Bread w/baked Pasta with butter White Pizza Macaroni & Cheese Pasta with Butter Grilled Veggies w/rice w/butter Grilled Veggie Pizza Gluten Free Plain Cheese Pizza Veggie Burger & Gluten Free Mac & Cheese Pasta Primavera Bolognese Monday, July 24 Tuesday, July 25 Wednesday, July 26 Thursday, July 27 Turkey & Cheese Whole Wheat Wrap & Plain Cheese Pizza Mini Chicken Parmigiana Sliders & Grilled Chicken Skewer w/low fat dipping sauce & Baked Chicken Fingers & Baked Pepperoni Pizza Mini Beef Sliders & Select: cheese/plain Grilled Cheese on Whole Wheat Bread w/baked Pasta with butter White Pizza Macaroni & Cheese Pasta with Butter Grilled Veggies w/rice w/butter Grilled Veggie Pizza Gluten Free Plain Cheese Pizza Veggie Burger & Gluten Free Mac & Cheese Pasta Primavera Bolognese Monday, July 31 Tuesday, August 1 Wednesday, August 2 Thursday, August, 3 Turkey & Cheese Whole Wheat Wrap & Plain Cheese Pizza Mini Chicken Parmigiana Sliders & Grilled Chicken Skewer w/low fat dipping sauce & Baked Chicken Fingers & Baked Pepperoni Pizza Mini Beef Sliders & Select: cheese/plain Grilled Cheese on Whole Wheat Bread w/baked Pasta with butter White Pizza Macaroni & Cheese Pasta with Butter Grilled Veggies w/rice w/butter Grilled Veggie Pizza Gluten Free Plain Cheese Pizza Veggie Burger & Gluten Free Mac & Cheese Pasta Primavera Bolognese

7 Camp KCC Daily Schedule Monday Schedule Yellow & Red Team (Ages 4-6) Tuesday-Friday Schedule Yellow & Red Team (Ages 4-6) 8:30-8:45 Check-in 8:45-9:45: Programs 9:45-10:00: AM Snack 10:00-10:30: Programs 10:30-11:45: Free Swim 11:45-12:15: Programs 12:15-12:45: Lunch 12:45-2:15: Programs 2:15-2:25: PM Snack 2:25-2:30: Check-out 8:30-8:45 Check-in 8:45-9:45: Tennis 9:45-10:00: AM Snack 10:00-10:30: Golf 10:30-11:45: Free Swim 11:45-12:15: Programs 12:15-12:45: Lunch 12:45-2:15: Programs 2:15-2:25: PM Snack 2:25-2:30: Check-out Blue Team (Ages 7-8) Blue Team (Ages 7-8) 8:30-8:45: Check-in 8:45-9:45: Programs 9:45-10:00: AM Snack 10:00-11:00: Programs 11:00-12:15: Free Swim 12:15-12:45: Lunch 12:45-2:15: Programs 2:15-2:25: PM Snack 2:25-2:30: Check-out 8:30-8:45: Check-in 8:45-9:30: Golf 9:30-9:45: AM Snack 9:45-10:45: Tennis 10:45-12:15: Free Swim 12:15-12:45: Lunch 12:45-2:15: Programs 2:15-2:25: PM Snack 2:25-2:30: Check-out Green Team (Ages 9-12) Green Team (Ages 9-12) 8:30-8:45: Check-in 8:45-10:15 Programs 10:15-10:30: Snack 10:30-11:30: Programs 11:30-12:30: Programs 12:30-1:00: Lunch 1:00-2:15: Free Swim 2:15-2:25: PM Snack 2:25-2:30: Check-out 8:30-8:45: Check-in 8:45-10:15 Programs 10:15-10:30: Snack 10:30-11:30: Golf 11:30-12:30: Tennis 12:30-1:00: Lunch 1:00-2:15: Free Swim 2:15-2:25: PM Snack 2:25-2:30: Check-out *This schedule is tentative and subject to change.

8 Camper Medical History Form (1 of 3) Medication Does your child take any medication on a routine basis? No or Yes (circle) Please list ALL medications your child currently takes. Medication #1: Reason for taking: Medication #2: Reason for taking: Medication #3: Reason for taking: Parent s Signature: Date: Allergies Camper s Name: Food allergies? (circle/list) Medication allergies? (circle/list) Other allergies? (circle/list) Does your child carry an epi-pen? (circle) If yes, enclose a copy of your physician s allergy action plan and complete the following Epinephrine Authorization Form. Is your child allergic to TRACE content of any foods? (circle/list) Are any of the above allergies severe/life threatening? (circle/list) Describe allergic reaction and management of reaction?

9 Camper Medical History Form (2 of 3) General Health Questions Please circle yes or no Had any recent injury, illness or infectious disease? Have a chronic or recurring illness/condition? Ever been hospitalized? Ever had surgery? Have frequent headaches? Ever had a head injury? Have frequent ear infections? Ever had Chicken Pox? Ever had Measles? Ever had German Measles? Ever had Mumps? Ever had seizures? Have diabetes? Have asthma? Ever had an eating disorder? Ever had emotional difficulties for which professional help was sought? If yes, please explain: Describe any health conditions requiring special considerations or restrictions of any kind. Provide any additional information about the camper s behavior and physical, emotional or mental health of which the camp should be aware.

10 Camper Medical History Form (3 of 3) The following section should be completed by the camper s Physician and is required by New Jersey State Department of Health Please give all dates of immunization for: Dates Mo/Yr Mo/Yr Mo/Yr Mo/Yr Mo/Yr Mo/Yr Vaccine: DTaP: HIB: Pneumococ: Polio: Hep B: Dates Mo/Yr Mo/Yr Vaccine: MMR: Varicella (chicken pox): Has the child had a TB Mantoux Test? (circle) If yes, date of last test: Result: Positive Negative *I have examined the camper named above on and found him/her to be free of communicable or contagious disease. This person has no physical, mental or other conditions that would limit normal participation in camp activities except as noted above. Doctor s Name: Practice Name: Address: Phone: Doctor s Signature: Date: Knickerbocker Country Club is licensed by the New Jersey State Department of Health and inspected by the Health Department twice each year. The inspection reports are filed at the Bergen County Department of Health in Tenafly, New Jersey *Please attach copies of up-to-date immunizations and a current physical

11 Parent Health Authorization Camper s Name The health history and immunization records that I have submitted are correct to the best of my knowledge, and the child described has my permission to engage in all camp activities, except as by the examining physician and me. In the event I, or a person so designated by me, cannot be reached in an emergency, I hereby give permission to the camp director to secure proper treatment for my child. I understand it is my responsibility to keep contact information current so that I can be reached at all times and that I will be expected to pick up my child within ½ hour of notification if asked to do so. I understand that I shall be expected to submit a yearly physical exam and provide documentation for immunizations as they occur. I understand that failure to provide this required documentation will result in my child not being allowed to participate in Camp KCC. Parent Signature: Date: Medical Information Waiver I (Please print your name) Do hereby give Knickerbocker Country Club permission to share all pertinent medical information with all staff members of Camp KCC. Signature: Date:

12 Epinephrine Authorization Form I hereby authorize Knickerbocker Country Club Day Camp personnel to administer epinephrine injection(s) as directed by the enclosed physician s allergy action plan. I agree to release, indemnify, and hold harmless Knickerbocker Country Club and any of their personnel from lawsuits, claims, expenses, demands, or actions, etc., against them for administering the injection, provided they follow the physician s allergy action plan. I am aware that the injection may be administered by a specifically trained non-health professional. I have read the procedures outlined on the back of this form and assume responsibility as required. I understand that emergency medical services (EMS) will always be called when epinephrine is given, whether or not the camper manifests any symptoms of anaphylaxis. Camper Name: Parent Signature: Date: Personal Property Disclaimer Camp KCC will not be held responsible for any personal item(s) such as; electronic devices, cards, toys, games, etc., that your child(ren) brings to camp. It is strongly suggested that cell phones not be brought to Camp KCC I acknowledge and agree to the terms above. Member Name

13 Camper Pick-up Please list below all people who are allowed to pick-up your child(ren) from camp. Identify his or her name, address and telephone number. Please be advised that he or she will be asked to show a form of identification upon pick-up (e.g. driver s license) and will be required to sign-out the camper as well. Name: Address: Home Phone: Work Phone: Cell Phone: Name: Address: Home Phone: Work Phone: Cell Phone: Name: Address: Home Phone: Work Phone: Cell Phone:

14 Sunscreen Policy Please be advised that no counselors or camp staff will apply and or reapply sunscreen at anytime. Please make sure all campers come with waterproof sunscreen in the morning. All campers should bring sunscreen in his or her own bag and the camper will reapply after swimming. The camper will be responsible for his or her own application. Please instruct your child prior to camp, how to correctly apply sunscreen. Thank you for your help. Name: Signature: Date: Late Fee Policy There will be a late fee charged directly to my account if I fail to pick up my child before 2:45p.m. The late fees charged will be as follows: $25 after 2:45 p.m. $45 after 3:00 p.m. I acknowledge the above and the club to directly charge my account for any late pick up incurred. Member Name Member Signature Account #

15 After-Care Policy After-care will now be available for campers by Camp KCC Counselors, when there is swim team practice and or meets on-site. There will be a $15.00 fee per day per camper that will be automatically charged to your account. Campers must be picked-up by as soon as the practice and or swim meet ends, if not the late fee policy will apply. If you are interested in this type of care, please complete the form below. I acknowledge the terms mentioned above and I am interested in after-care for my child(ren). As a result, I will permit the club to directly charge my account for this type of care. Member Name Member Signature Account # *Please keep the following documents for your records.

16 Items Needed Daily Below is a list of items that your child(ren) will need to bring with him or her to camp on a daily basis. All items should be labeled and packed into a backpack or knapsack so that your child can easily access them throughout the course of the day. Please remember that you can purchase tennis whites, racquets and golf clubs at the Knickerbocker Country Club. Just call Kirby Krauter ( ) and/or Bill Hook ( ) for more information. Sun Block Aerosol spray Tennis Whites White tennis shorts White polo-shirts White sneakers Swimsuit/ Flip-flops Preferably one-piece Zip-lock for wet suit Backpack/ Knapsack Labeled with campers first and last name Tennis Racquet Labeled with campers first and last name Golf Clubs Age appropriate wedge, putter and iron All clubs labeled with campers first and last name