2018 REGISTRATION PACKET

Transcription

1 2018 REGISTRATION PACKET 1

2 350 W. Woodrow Wilson Drive, Suite 731 B Jackson, MS (601) Facebook: MS Sickle Cell Foundation CAMP SICKLE STARS 2018 Dear Parents, The Mississippi Sickle Cell Foundation invites your child/children to attend Camp Sickle Stars 2018 during June 13-16, We are returning to Camp Wesley Pines in Gallman, MS. Camp Sickle Stars is the only camp in the state of Mississippi that is exclusively for children with Sickle Cell Disease. MS Sickle Cell Foundation funds Camp Sickle Stars through various fundraisers and donations. The camp is free to all children between the ages of 6-14 and transportation is available for those who need it. We are very fortunate to have the excellent medical staff from UMC Children s Clinic and MS Dept. of Health on site 24 hours a day. On-site physicians are Dr. McNaull, Dr. Davis and Dr. Smith with registered nurses Teresa Walker, Glenda Thomas, Kim Gross and Amber Williams. The dedicated medical staff caters to the children s medicine needs and any other medical issues that may arise. We have additional adult staff and former campers who now serve as camp counselors. Our camp counselors go through a full day of training exercises to prepare them for all camp events and activities. All counselors are fully screened by our administrative staff. Camp Sickle Stars has one main purpose - to provide a safe, fun filled experience for all children with Sickle Cell Disease. The children participate in canoeing, swimming, indoor and outdoor games, talent show, art & crafts, education, hayride, bon fire cookout and more. There are certified life guards on duty for all water activities. Attached you will find an application and a list of supplies your child will need to bring to camp. Please allow us to give your child the fun filled camp experience. Sincerely, Courtney Davis, Mattie Coburn & Nancy Tharp Co-Directors, Camp Sickle Stars 2

3 Camper s Address City, County, Zip Camp Registration Form Grade DOB Sex Male Female Parent s Work # ( ) # Home ( ) Cell ( ) Address Insurance Company Insurance Number Medicaid Number Physician Physician Contact City ( ) T-Shirt Size: (Circle Size) Child Sizes S M L XL Adult Sizes S M L XL 2X 3X Medical Information: Allergies, etc. Medical Problem: List medications, doses and times taken: *All medications must be brought to Camp except for *Narcotics* (pain pills) which the doctors will have available. Emergency Contacts: FOR OFFICIAL USE ONLY Group Transportation Counselor 3

4 Photograph Consent We/I authorize the use of any legitimate photograph of us or my child/children for the sake of advertising or publicity, videos, or any manner related to Sickle Cell Disease. We/I agree that we/i are to receive no financial compensation for such photos or news releases. In consideration of the benefits to be derived, we/i waive all claims against the camp staff, MS Sickle Cell Foundation, its Board of Directors, officers and their representatives, and assigns from any liability for all claims by us or any third party on the use of such photos or news releases as it relates to Sickle Cell Disease. Comments or exceptions are listed below. Permission Statement We/I give permission for the child listed on the first page of this registration form to take part in Camp Sickle Stars and all related activities. In consideration of the camp experience, we waive all claims against the camp, camp staff, MS Sickle Cell Foundation, its Board of Directors, officers and their representatives, Camp Wesley Pines, the camp, camp staff, its Board of Directors, officers and their representatives. Signatures of Both Parents and/or Legal Guardians Child s : Date: Mother s : Date: Father s : Legal Guardian: Date: Date: Camp Sickle Stars is Smoke Free, Drug Free, and Alcohol Free. Camp Sickle Stars is funded by donations made payable to the MS Sickle Cell Foundation. Registration forms may be ed to mssicklecellfnd@yahoo.com or mailed to the address below: Children s Cancer Clinic Camp Sickle Stars c/o Mississippi Sickle Cell Foundation Attn: Teresa Walker 2500 North State Street Jackson, MS For more information, call or or mssicklecellfnd@yahoo.com 4

5 Camp Registration Supply List All Campers MUST bring the items listed below: 3 towels 1 set of twin size sheets & blanket OR Sleeping Bag 1 pillow & pillowcase 1 pair shower shoes/flip flops 3 pairs long jeans or trousers 3 long sleeve shirts or blouses 4 pair of shorts 4 T- shirts 1 Jacket (gets cool in cafeteria) 3 pairs of night wear 6 pairs of socks 6 sets of underclothing 1 swim wear 1 hat or cap 1 pair of tennis shoes 1 pair of sunglasses 1 toilet accessory each comb, brush, hair oil, toothbrush, tooth paste, shower cap and deodorant 1 flashlight Please be sure to bring all medications needed for the weekend Except for Narcotics (pain medicines). The doctors will have these available. DO NOT BRING Cell s Money Weapons Electronic games Other Valuables For more information, call Camp Coordinator Courtney Davis at , , or mssicklecellfnd@yahoo.com 5