RAIDERS OF THE LOST CAMP. Day Camp 7C Girl Scout Cadette/Senior/Ambassador June 12-16, 2017 Camp Stonybrook Day Camp Area

Transcription

1 RAIDERS OF THE LOST CAMP Day Camp 7C Girl Scout Cadette/Senior/Ambassador June 12-16, 2017 Camp Stonybrook Day Camp Area Registration Deadline: April 22, 2017

2 Dear Caregiver: Thank you for your interest in sending your Girl Scout to volunteer day camp! At day camp, girls will Discover, Connect and Take Action as they learn to live the Girl Scout Law and make a difference in the world. They will discover their values and talents through a variety of outdoor activities. Girls will also connect with other girls and adults, learn how to work together as a team and use that teamwork to take action and make the world a better place. We hope you will see the value in this progressive opportunity, and will help keep the history and tradition of the day camp alive by volunteering at camp with your Girl Scout. Volunteer day camp is run by a dedicated team of specially trained volunteers who work year round to make this enriching opportunity possible. Volunteer day camps are staffed completely by volunteers, so we welcome moms, dads, aunts, uncles, grandparents and other adult friends to volunteer. A background in Girl Scouting is not necessary. Volunteers are asked to complete a volunteer application and background check, and attend training to prepare for your role at camp. Training is mandatory for all volunteers. For continued progressive opportunities in Girl Scouts, we also offer many other outdoor and camp opportunities listed on our website at gswo.org. Below you will find basic information about day camp. Detailed information and instructions will be sent in a confirmation packet after you have registered. For additional questions or concerns, please contact Jean Campbell, Camp Director at or at rcjc0673@gmail.com or Dawn Cooper at or at dmcooper1972@gmail.com. Transportation: Due to limited parking, no campers can be dropped off at the day camp area. Transportation is available from: $35 - Lebanon (Lebanon Plaza North; pick-up 8:00 a.m.; drop-off 4:20 p.m.) $35 -Springboro (Springboro United Methodist Church, 60 E. North St.; pick-up 8:00 a.m.; drop-off 4:25 p.m.) There is no fee for transportation from Waynesville (school pick-up 8:00-8:45 a.m.; drop off 4:00-4:30 p.m.). The drop off sites will be clearly marked and monitored by day camp staff. Detailed information on pickup locations and times will be in the confirmation packet. When you receive your confirmation packet, please pay special attention to the section concerning pickup procedures. Direct all questions/concerns to Jean Campbell at rcjc0673@gmail.com. Health: A nurse or first aider will be available at camp. Check with your physician to see if a tetanus booster or any immunizations are necessary. Medications are the responsibility of the caregiver. Please give any medications your daughter may need to the health supervisor or unit leader in the original container on the first day of camp. Be sure to include written instructions. Please ensure any allergies or dietary restrictions are recorded on your Girl Scout s Health History form and pointed out during check in. Food: Everyone is to bring a sack lunch and water bottle daily unless otherwise notified. Clothing: Each camper should wear comfortable sneakers with socks and play clothes suitable for the weather and for getting dirty. A hat or bandanna will help the girls stay cool in the sun. A raincoat or poncho is advised, depending on the weather. No umbrellas please. Camp is not cancelled because of rain. Insurance: Every registered Girl Scout and registered adult member is automatically covered under the basic plan by Girl Scouts of the USA. This plan is effective from October to the following October. This insurance provides up to a specified maximum for medical expenses incurred as a result of an accident while a member is participating in an approved Girl Scout activity, after the individual s primary insurance pays out. Caregivers: If you feel this camp is unsafe or a hazard to children, you should contact Warren County Children's Services Department at or Warren County Combined Health District at /2017

3 Calling all archaeologists! Come help us unearth the history of Camp Stonybrook and discover what the ancient inhabitants were trying to tell us. Decipher ancient riddles. Crack secret codes. Work as a unit to make your way through tricky mazes and obstacles. Come dig through the dirt and the clay, finding clues that will lead to our real treasure! Come for the ADVENTURE of the summer! Cadettes and PAit s will get the opportunity to stay late on Thursday evening for special activities. At the end of camp, each camper will receive a unit photo to commemorate their awesome time at summer camp. Girl Scout Cadette, Senior, Ambassador Opportunities Registrations will be accepted on a first come first served basis starting with those registrations postmarked after the opening date of Saturday, March 18, Registration ends Saturday, April 22, The only campers guaranteed a spot will be daughters of five day volunteers whose paperwork is received by Saturday, April 22, Registrations must be complete (all necessary forms and payment) to be considered. If space is available, late registrations will be accepted until Saturday, May 13, 2017 with an additional $20 late fee. No registrations accepted after Saturday, May 13, Find out more about camp at our registration day on Tuesday, April 18, 2017 from 6:00-8:30 p.m. Come to Dorothy Lane Market in Springboro and talk with camp staff and volunteers about all the fun that will happen at camp. Get registered on the spot. Cadette Unit: For girls entering grade 6: This age group will have their own special unit. In addition to camp activities, they will have more opportunity to plan their own activities. Unit size is a maximum of 36. Core Training: This opportunity is for girls entering grade 7 or above. Core campers will complete the Core Training Program, Songs and Games, Outdoor Skills, and Outdoor Cooking Trainings. Campers will have the opportunity to participate in all camp activities. Unit size is a maximum of 20. Program Aide in Training: For girls entering grade 8 or above who have completed Stonybrook Core Training. As a PAiT camper you will interact with a camper unit assisting with activities; polish your leadership skills, and learn about the operation of Camp Stonybrook day camp from behind the scenes. You will have a blast trying out all of our camp activities. Requirements: Unit size is minimum of eight and maximum of 18. Program Aide Unit: This unit is for campers that want to take part in actively leading the campers throughout their week at Camp Stonybrook. As a program aide you are expected to attend the PA training weekend (May 12-14, 2017), attend PA opening flag ceremony practices (dates to be determined), assist with setup and teardown/clean-up of camp (June 11 and 17, 2017) assist the program director in the development of program materials and attend camp each day during the camp week for the whole day. Any exceptions must be approved by day camp staff. PA training weekend requires an additional form and fee ($45). Form will be sent after acceptance into PA unit, fee will be collected at that time. Requirements: A. Completed the Leadership in Action Award (LiA). B. Completion of Stonybrook Day Camp Core training and outdoor specialization or documented proof of completion of Core training and outdoor specialization. C. Prior Camp Stonybrook Day Camp PA experience or documented 20 hours of program assistance experience at a council/community sponsored event and two program assistance references. If your training/experience is not at Camp Stonybrook, day camp documentation must be submitted with your registration.

4 Staff: Our day camp is staffed entirely by adult volunteers. Plan to enjoy this experience with your daughter. WE NEED YOUR HELP! Moms, dads, aunts, uncles, grandparents, and other adult friends are welcome! A Girl Scouting background is not necessary. Volunteers are asked to complete a volunteer application and background check, and to attend training to prepare you for your role at camp. If you are interested in volunteering, please fill in the appropriate information on the registration form. Training is mandatory for all unit volunteers. You only need to attend one training. Training dates are: April 21, :00 8:00 p.m. Stonybrook Resident Camp Barnitz Hall May 21, :00 8:00 p.m. Stonybrook Resident Camp Barnitz Hall June 3, :00 a.m. 12:00 p.m. Stonybrook DAY Camp. Additionally, we will have an optional orientation to camp from 12:00 2:00 p.m. following the training on June 3, All volunteers are welcome even if you ve attended a different training. A Meet and Greet is scheduled for May 31, 2017 from 6:00 8:00 p.m. at Barnitz Hall to meet your unit team. Activity Costs: Cost includes T-shirt, patch, and bandana. Girl Scout Cadettes (Grade 6) $75 Girl Scout CORE (Grades 7 10) $75 Girl Scout CD/SR/AMB (Grades 7 12) $75 Girl Scout PAiT $75 Girl Scout PA $35 Children of 4 or 5 Day Volunteers NO DISCOUNT FOR CORE, CSA, PAiT, PA Girl Scout Cadettes (Grade 6) $45 Boys (Grades 1 8) $45 Pixies (Preschoolers K) $45 Bus Fee (from Lebanon or Springboro) $35 Additional fee for non-registered girls and adults $15 (All girls and adults participating in camp must register as Girl Scouts.) Make Checks Payable To: Girl Scouts of Western Ohio. Complete the registration, additional information and release forms and return with payment to: Dawn Cooper 141 N Plum St Germantown, Ohio DO NOT send registrations to the Girl Scout Center. You are not guaranteed a place in this camp if you send registration forms to the Girl Scout Center. Financial Assistance: Financial assistance may be available for girls who want to attend but are unable to do so because of limited family income. Applicants are expected to contribute at least 40% of the fee. See the Financial Assistance Form included in this packet.

5 Refund Policy: Money may be refunded for the following reasons only: 1. Moving out of town. 2. Illness or exposure to communicable disease. 3. Required attendance at summer school 4. Camp capacity is reached and no other camp is attended; refund will be sent within 4 weeks of registration date To request a refund send a written request within ten business days from the end of camp to: Program and Partnership Manager Girl Scouts of Western Ohio 4930 Cornell Rd Cincinnati, OH 45242

6 Day Camp 7C Camp Stonybrook Raiders of the Lost Camp Camper s Name: Phone: Address: City: State: Zip: School: DOB: Age: Grade in fall: Parent/Caregiver: Parent/Caregiver Phone: Troop Leader s Name or Troop #: Service Unit Name or #: OR Check box if not currently registered as a Girl Scout. (Please submit your $15 registration fee to be a Girl Scout with your camp fee.) Custodial Care: Mother only Father only Both Other Re-registering Girl Scout New Girl Scout Units: Volunteering: Girl Scout Cadettes (Grade 6) I am interested in volunteering at camp Girl Scout Core (Grades 7 10) I would like to work with: (Grade level, person) Girl Scout CAD/SR/AMB (Grades 7 12) Girl Scout PAiT I would like to be in the same unit with my child/children. Girl Scout PA Yes No Boys (Grades 1 8) (We will try to meet your requests, but placement will be made Pixies (Preschool-K) made based on needs of the camp) T-Shirt Sizes: Youth: SM MED LRG Adult: SM MED LRG XL XXL Bus: Lebanon Springboro Waynesville Financial Assistance (if needed): Please complete the section below. To be answered by parent/caregiver: How would this girl benefit from day camp? I give full permission for my daughter/son to attend day camp and participate in all phases of activities, except those noted. I have read the Day Camp flier and agree to cooperate with the guidelines listed. I understand that my camper must have written permission to leave camp early or with someone other than a caregiver. If I cannot be reached in an emergency, I give permission to give emergency treatment to my child. Caregiver Signature: TOTAL FEES Day Camp Fee $ Registration Fee for non-girl Scouts (if applicable) Bus Fee $ TOTAL $ $ Date: Mail completed registration form, transportation form, health forms and late night form with fee to: Dawn Cooper 141 N Plum St Germantown, Ohio Deadline: Registrations will be accepted from March 18 April 22, Girls will be accepted on a first come, first served basis based on the number of volunteers available and according to postmark. Priority will be given to girls with parents/guardians who are volunteering /2017

7 Transportation Information: Camper s Name: I understand that my daughter will only be released to the people listed below with proper ID. Parents be sure to list your name if you will be picking up your child. You may list only 4 names. Name Relationship to girl Phone # Name Relationship to girl Phone # Name Relationship to girl Phone # Name Relationship to girl Phone #

8 Over-the-Counter Medication Form Name: Age: For minor discomfort, the camp health supervisor(s) may treat my child with over-the-counter medication(s), according to the prescribed directions/dosage, such as acetaminophen, Pepto Bismol, throat lozenges, calamine lotion, Caladryl lotion, Benadryl and Neosporin. I give permission to the appropriate camp personnel to care for minor illness/injury using over-the-counter medications/procedures: Medications she may take (check all that apply): Acetaminophen (Tylenol) Pepto Bismol Throat Lozenges Calamine Lotion Caladryl Lotion Benadryl Neosporin Allergies (check all that apply): Pollen Dust Mites Molds Latex Insect Stings Medications: Animal Dander: Food: Other: The camp health supervisor(s) will contact you immediately under the following circumstances: The program assistant spends the night in the health center The program assistant must visit a medical care facility The program assistant develops any condition that poses a health or safety risk to the child or other campers Parent/Caregiver Signature: Date: /2017

9 Photo Release Date(s): June 12-16, 2017 Photographer/Producer: Girl Scouts of Western Ohio Assignment: Day Camp 7 C Stonybrook Raiders of the Lost Camp Location: Storybrook Day Camp Area Activity: Camp is a great way for girls to explore leadership, build skills and develop a deep appreciation for nature. RELEASE FOR MINORS For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent and agree to the following: 1. I hereby grant to Girl Scouts of Western Ohio, and others working for Girl Scouts of Western Ohio or on its behalf, and each of its respective licensees, successors and assigns (each a Releasee ), the irrevocable, royalty-free, perpetual, unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, modify, create derivative works of, reproduce or otherwise exploit my name, picture, likeness and voice (including any video footage of the same) (collectively, Media ), or to refrain from so doing, anywhere in the world, by any persons or entities deemed appropriate by Girl Scouts of Western Ohio, for any purpose (except defamatory) including, without limitation, any use for educational, advertising, non-commercial or commercial purposes in any manner or media whatsoever (whether known or hereafter devised) including, without limitation, on the internet, in print campaigns, in-store and via television. I agree that I have no interest or ownership in any of the Media. 2. I shall have no right of approval, no claim to compensation and no claim (including, without limitation, claims based upon invasion of privacy, defamation or right of publicity) arising out of any use, alteration, blurring, illusionary effect or use in any composite form of my name, picture, likeness and voice. I agree that nothing in this Release will create any obligation on Girl Scouts of Western Ohio to make any use of the Media or the rights granted in this Release. I hereby release and hold harmless Releasees from any claim for injury, compensation or negligence resulting or arising from any activities authorized by this Release and any use of the Media by Girl Scouts of Western Ohio. Name of Minor (please print): Address: City: State: Zip: Daytime Phone Number: ( ) Additional Phone (optional): ( ) Release for minors (those under the age of eighteen): I, the undersigned, being a parent or guardian of the minor, hereby consent to the foregoing conditions and warrant that I have the authority to give such consent. Name of Caregiver (please print): Signature of Caregiver (Required): Caregiver Address*: (*will not be used for any other purposes or distributed to third parties) Region: Troop#: Service Unit: /2017

10 LATE NIGHT PERMISSION FORM Day Camp 7C Parents/Caregivers of Girl Scout in grade 6, Cadettes, and PAiTs: Thursday, June 15, 2017 will be the optional; Day Camp Late Night. The girls will eat dinner at camp and participate in a special program. If your daughter has special dietary needs, please plan accordingly (contact Jean for more information). Late night will go until 9:00 p.m. and is supervised by adult volunteers. For parents who are not able to help during the day, this is an excellent opportunity to enjoy camp. We need parents to help from 4:30 p.m. (or as soon as you can arrive) to 9:00 p.m. Please consider volunteering for this event. No training is necessary. I can help at late night My name: I can be reached at: NO GIRL WILL BE ALLOWED TO STAY LATE WITHOUT A SIGNED PERMISSION FORM. YOU MUST RETURN THE LATE NIGHT FORM WITH THE REGISTRATION FORM EVEN IF YOU DAUGHTER IS NOT STAYING LATE. Pickup will be 9:00 p.m. in the RESIDENT PARKING LOT at Camp Stonybrook. Event contact and phone number will be Ashley Buhrlage at We will use the same pick up procedure as when we dismiss camp. Be sure you have the cards to pick up your girls. Daughter's name: My daughter will stay late My daughter will NOT stay late Daughter's emergency contact phone number during late night is: Camper will be picked up by parent/caregiver Camper will ride home with (name): Parent/Caregiver Signature: _ /2017

11 Volunteer s Name: Adult Registration Form Day Camp 7C Phone: Address: City: State: Zip: DOB: Cell Phone: Volunteer is a: Currently registered Girl Scout Re-registering Girl Scout New Girl Scout (If adult is not a currently registered Girl Scout, please submit your $15 Girl Scout membership fee*.) Are you a leader/assistant leader? Yes No Troop #: Troop Grade Level in Fall: Service Unit Name/#: Do you have any camping experience? Yes No I would like to be a unit leader and work with: Pixies/Tagalongs Boys Girl Scout Daisies/Brownies Girl Scout Juniors Girl Scout Cadettes Daughter's unit There is an adult at camp that I would like to work with (name) T-Shirts: T-shirts cannot be returned or exchanged. If in doubt, order the next larger size. T-shirts are provided for adults working three to five days of camp. Adults working less than three days, who want a T-shirt, should send $5 with their camp registration. Sizes: Adult: Small Medium Large X-Large XX-Large XXX-Large Registrations will be accepted postmarked by April 22, Do not send camp registrations to the Girl Scout Center. All registrations received at the Girl Scout Center will be forwarded to the appropriate day camp on a weekly basis and may cause your child to be closed out of camp. TOTAL FEES (payable to GSWO) Membership Fee for non-girl Scouts (if $ applicable)* Adult T-shirt (optional) $ TOTAL $ Mail completed Adult Registration Form, Adult Medical History Form and Photo Release with fee (if applicable) to: Dawn Cooper 141 N Plum St Germantown, Ohio *All adult volunteers are required to have a current Girl Scout membership and background check. A Girl Scout membership ensures that adults involved in Girl Scouting are covered under Girl Scouts of Western Ohio insurance in case of accident or incident. Membership, with a volunteer role, will trigger a background check, this protects the safety of all youth involved. Background checks are completed once every 3 years. Be aware that additional steps will need to be taken to secure your Girl Scout volunteer role. ed instructions will be sent out and action must be taken at that time. Adults who do not have a current background check will not be permitted to stay at camp.

12 Date(s): Photographer/Producer: Assignment: Location: Activity: Photo Release 7/16 RELEASE FOR ADULTS For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent and agree to the following: 1. I acknowledge that I am eighteen (18) years of age or older. I hereby grant to Girl Scouts of Western, and others working for Girl Scouts of Western Ohio or on its behalf, and each of its respective licensees, successors and assigns (each a releasee ), the irrevocable, royalty-free, perpetual, unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, modify, create derivative works of, reproduce or otherwise exploit my name, picture, likeness and voice (including any video footage of the same) (collectively, media ), or to refrain from so doing, anywhere in the world, by any persons or entities deemed appropriate by Girl Scouts of Western Ohio, for any purpose (except defamatory) including, without limitation, any use for educational, advertising, non-commercial or commercial purposes in any manner or media whatsoever (whether known or hereafter devised) including, without limitation, on the internet, in print campaigns, in-store and via television. I agree that I have no interest or ownership in any of the media. 2. I shall have no right of approval, no claim to compensation and no claim (including, without limitation, claims based upon invasion of privacy, defamation or right of publicity) arising out of any use, alteration, blurring, illusionary effect or use in any composite form of my name, picture, likeness and voice. I agree that nothing in this release will create any obligation on Girl Scouts of Western Ohio to make any use of the media or the rights granted in this release. I hereby release and hold harmless releasees from any claim for injury, compensation or negligence resulting or arising from any activities authorized by this release and any use of the media by Girl Scouts of Western Ohio. Signature: Date: Name (please print): Home Address: City: State: Zip: Daytime Phone: ( ) Additional Phone (optional): ( ) (*will not be used for any other purposes or distributed to third parties) Region: Troop#: Service Unit:

13 Adult Medical History 7/16 Name: Phone: Address: City: State: Zip: Physician s Name: Phone: Physician s Address: City: State: Zip: Dentist s Name: Phone: Insurance Company: Contract #: Through (Employer): Insured Name: Emergency Contacts Name: Relationship to Participant: Address: City: State: Zip: Home Phone: Work Phone: Cell Phone: Name: Relationship to Participant: Address: City: State: Zip: Home Phone: Work Phone: Cell Phone: Medications Current Medication(s), dosage(s) and frequency: Allergies: Check all that apply. Specify what reaction to look for and first aid/treatment your physician recommends. Penicillin Other Medicines Food Allergies Bee/Wasp/Insect Stings Plants (Poison ivy, etc.) Asthma Hay Fever Other Other Health Conditions: Check all that apply. Diabetes Hearing Impairment Bedwetting Convulsions/Seizures Visual Impairment Constipation Heart Defect/Disease Emotional Behavior/Disturbance Menstrual Cramps Rheumatic Fever Sleep Disturbance Nosebleeds Sickle Cell Trait/Disease Ear Infections Motion Sickness High Blood Pressure Urinary Infections Fainting Bleeding/Blotting Disorders Musculoskeletal Disorders Other:

14 Please explain any items that are checked and indicate any information that would be useful in relation to any of these health conditions. Chronic or Recurring Illnesses: Operations or Serious Injuries (Include dates): Are there any other facts not listed that would be important information to the first-aider, nurse or doctor that may treat you for any illness or injury? Immunization History: Year Primary Series Completed Diphtheria/Whooping Cough/Tetanus (D.T.P.) Tetanus (TD) Measles/Mumps/Rubella (MMR) Oral Polio Tuberculin Test (Most recent) Result: Date of Last Booster In the event that reasonable attempts to contact my designated person in an emergency have not been successful, I hereby give my consent for the administration of any treatment deemed necessary by medical personnel. This health history is complete and accurate. Signature of Participant Date

15 Additional Information, Release and Health History Form Camper s Name: Date of birth: Age: Address: Caregiver s Name: Phone: Caregiver s Transportation Information I understand that my daughter will only be released to the people listed below with proper ID: Name Relationship to girl Phone # Name Relationship to girl Phone # Medical Information This section must be completed by all girls and adults attending in order to register for camp. Name Date of last injection if this information is no longer available, write C for childhood if immunized as child. DOB DPT: Measles/Mumps: TB: Polio: Tetanus: Hepatitis: Are medications currently being taken: No Yes, please specify: (Medication must be in original container with written instructions and given to the health supervisor at camp.) Are there any special needs or accommodations required? If yes, please explain: Are there any known behavior and/or emotional problems? If yes, please explain: Allergies and/or dietary modifications:

16 Is participant in good physical condition with no serious illness or operation since last health exam? Yes No If no, please specify: Physician s Name: Phone #: Insurance Information: Is the participant covered by family medical/hospital insurance? Yes No If so, indicate carrier or plan name: Group #: Name of insured: Relationship to participant: Social security number of policyholder or insurance ID number: Emergency Contact Information Emergency contact in case we can t reach caregiver: Name Relationship to girl Phone # Caregiver Permission and Consent to Treatment (Name of participant) is in good physical health and has had a physical examination in the past 12 months. Participant has my permission to attend Girl Scout day camp and to participate in all activities except those noted. I have read the day camp flier and understand and agree to cooperate with all regulations. I further understand that the deposit is refundable only for the reasons noted on the flier. Emergency Medical Authorization: This health history is correct to the best of my knowledge, and the person herein described has permission to engage in all prescribed Girl Scout activities except as specifically noted. Authorization for Treatment: In the event reasonable attempts to contact me at the provided phone numbers have been unsuccessful, I hereby give my consent to the administration of emergency medical treatment by any licensed physician or dentist and to transfer the child to any reasonably accessible hospital facility. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery. My daughter may be registered as a Girl Scout member through September 30, Caregiver Signature: Date: