OPEN FOR NEWS ABOUT DAY CAMP!

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1 STONYBROOK COUNTY FAIR Day Camp 7 C Girl Scout Daisy/Brownie/Junior Camp Stonybrook Day Camp Area June 20 24, 2016 Registration Deadline: Friday, April 22, 2016 OPEN FOR NEWS ABOUT DAY CAMP!

2 Dear Caregiver: Thank you for choosing to send your Girl Scout to volunteer day camp. Through day camp, girls will have the opportunity to try new things and meet new people in a fun, safe and nurturing environment. Girls will participate in a variety of outdoor activities and Girl Scout activities led by trained volunteers. Girls will learn new skills and create new memories that will stay with them long after day camp is over. Welcome to the County Fair! Enjoy the atmosphere of the County Fair at Camp Stonybrook. Enjoy the excitement of the Midway with rides and games. Brush up on your cooking skills for the cooking contest. Express your inner artist through the arts and crafts competition. Demonstrate your way with words through the speech competition. Learn all about farm animals. Try out your dancing skill at our Square dance. Explore the Fair grounds and all they have to offer. Join us for the Stonybrook County Fair. Girl Scout Juniors 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. Registrations will be accepted on a first come first serve basis starting with those registrations postmarked after the opening date of Friday, March 18, Registration ends Friday, April 22, The only campers guaranteed a spot will be daughters of five day volunteers whose paperwork is received by Friday, April 22, Registrations must be complete (all necessary forms and payment) to be considered. If space is available, late registrations will be accepted until Friday, May 13, 2016 with an additional $20 late fee. No registrations accepted after Friday, May 13, Find out more about camp at our registration day on April 18, 2016 from 6:00-8:30 p.m. Come to Dorthy 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. We hope you will see the value in this progressive opportunity for your Girl Scout 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 Girl Scouting background is not necessary. Volunteers are asked to complete a volunteer application, background check and attend training to prepare you for your role at camp. Training is mandatory for all volunteers. Training dates are Monday, April 11, 2016, from 6:00 8:00 p.m.; Monday, April 21, 2016 from 6:00 8:00 p.m.; and Saturday, May 21, 2016 from 10:00 a.m. 12:00 p.m. All trainings will be held at Stonybrook Resident Camp in Barnitz Hall. You only need to attend one training. There is also a Meet and Greet on May 31, 2016 from 6:00 8:00 p.m. at Barnitz Hall. 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 rcjc0673@gmail.com or Abby Marinich at lydia202@yahoo.com. Transportation: Due to limited parking, no campers can be dropped off at the day camp area. Transportation is available from Lebanon (Lebanon Plaza North; pick-up 8:00 a.m.; drop-off 4:20 p.m.) and Springboro (Springboro United Methodist Church, 60 E. North St.; pick-up 8:00 a.m.; drop-off 4:25 p.m.) for a fee. 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. Special diets and 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.

3 Food: Everyone is to bring a sack lunch and water bottle daily unless otherwise notified. Clothing: Proper dress for the weather is necessary. No halters or sandals. Wear sturdy shoes, socks, head cover and bring rain gear (no umbrellas). Camp is not cancelled because of rain. Insurance: Automatic insurance coverage occurs from Girl Scouts of the USA for all registered participants. Caregiver: 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 Activity Costs: Cost includes T-shirt, patch, bandana Girl Scout Daisies (Grades K 1) $ 75 Girl Scout Brownies (Grades 2 3) $ 75 Girl Scout Juniors (Grades 4 5) $ 75 Children of four or five day volunteers Girl Scout Daisies (Grades K 1) $ 45 Girl Scout Brownies (Grades 2 3) $ 45 Girl Scout Juniors (Grades 4 5) $ 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: Jean Campbell 9575 Winding Lane Loveland, OH Do not send registrations to the Girl Scout Center. All registration received at the Girl Scout Center will be forwarded to the appropriate day camp on a weekly basis. 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 must pay 40 percent of the day camp fee. Payment must accompany registration to be considered. If the full amount requested is not awarded, payment for the remainder of the balance must be worked out with the day camp. Refund Policy: Money may be refunded for the following reasons ONLY: 1. Moving out of town. 2. Illness or exposure to a communicable disease. 3. Required attendance at summer school. 4. Camp capacity is reached and no other camp is attended; refund will be sent within four weeks of registration date. To request a refund send a written request within ten business days from the end of camp to: Cindy Smith Program and Partnership Manager Girl Scouts of Western Ohio 4930 Cornell Rd Cincinnati, OH 45242

4 Stonybrook County Fair Day Camp 7 C Camper s Name: Phone: Address: City: State: Zip: School: DOB: Age: Grade in fall: Caregiver Name: Phone: Caregiver 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: Boys/Pixies Girl Scout Daisies (Grade K 1) Girl Scout Brownies (Grades 2 3) Girl Scout Juniors (Grades 4 5) Volunteering: I am interested in volunteering at camp I would like to work with: (Grade level, person) I would like to be in the same unit with my child/children Yes No (We will try to meet your requests, but placement will be made based on needs of the camp) Buddy s Name (ONE NAME ONLY): 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 caregiver: How would this girl benefit from day camp? $ Amount family can pay (applicants must pay some portion of the fee) + $ Financial assistance requested = $ TOTAL Caregiver Signature: Date:

5 TOTAL FEES Day Camp Fee $ Registration Fee for non-girl Scouts (if applicable) Bus Fee $ TOTAL $ $ Mail completed registration form, transportation form, health forms, high risk form, and late night form with fee to: Jean Campbell 9575 Winding Lane Loveland, OH Deadline: Registrations will be accepted from March 18 April 22, Girls will be accepted on a firstcome, 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. Additional Information and Release Form 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 #

6 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 Caladryl Lotion Benadryl Neosporin Calamine Lotion Allergies (check all that apply): Pollen Dust Mites Insect Stings Medications: Animal Dander: Food: Other: Molds Latex 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 Caregiver Signature: Date:

7 Photo Release 1/16 Date(s): June 20 24, 2016 Photographer/Producer: Girl Scouts of Western Ohio Assignment: Day Camp 7 c: Camp Stonybrook County Fair Location: Stonybrook 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, noncommercial 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 cargiver 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 (*will not be used for any other purposes or distributed to third parties) Date: Region: Troop#: Service Unit:

8 Late Night Permission Form Day Camp 7 C Caregivers of Girl Scout Juniors: Thursday, June 23, 2016, 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 your camp 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 Donna Shell at We will use the same pickup procedure as when we dismiss camp. Be sure you have the cards to pick up your girls. My daughter will stay late My daughter will not stay late Daughter's name: Daughter's emergency contact phone number during late night is: Camper will be picked up by caregiver Camper will ride home with (name): Caregiver Signature:

9 Camper General Release and High Risk Form This form must be returned with camp registration (not collecting them on first day of camp). Camper s Name: Name and Date of Session/Event: June 20-24, 2016 Location of Activity: Camp Stonybrook County Fair Day Camp TRANSPORTATION PERMISSION My daughter has my permission to participate in off camp activities as described in the program activity. My daughter may also be transported to medical facilities/appointments if the need arises. I understand that she will be transported in a camp vehicle designed for passengers. MEDICAL RELEASE/PERMISSION My daughter is in good physical condition and has not had any serious illness or surgery since her last health examination. In case of an emergency, when I cannot be reached, I give permission for her to be treated by a qualified physician at the nearest hospital. HIGH RISK ACTIVITY RELEASE I understand that if it is included in the description of my daughter s camp session, she may be participating in activities on and off camp property that are considered high risk. I feel that my camper is developmentally ready, both physically and emotionally, and possesses the skills needed to participate in the activities I have marked below. I have discussed with my daughter the importance of following safety guidelines, while participating in high risk activities. (There may also be additional release forms specific to the activities listed below that need to be signed.) I understand the risks inherent in the below activities: (Please, check all those that apply to the program activity your camper is attending or that she has permission to participate in if given the opportunity.) Amusement Park Rides The purpose of the Camper Release/High Risk Form is to inform caregivers of the risk and to provide the opportunity for both their own evaluation of their camper s readiness for the activity and the reinforcement with their camper of the skills and behavior necessary to safely participate in the activity. Date Signature of Caregiver CS:rs/

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