YMCA CAMP FULLER 2016 PARENT FORMS CHECKLIST

Transcription

1 YMCA CAMP FULLER 2016 PARENT FORMS CHECKLIST FORMS ARE DUE BY MAY 1 ST Please read the entire Family Information Packet and complete all required forms (all forms are available on our website at Health History Form Physicians Examination Form Health and Dental Insurance Cards Parent Authorization Form Code of Conduct, Letter to Counselor and Buddy Request (two pages) Optional Services Request (includes Camp Store Account, Waterski, Birthday, Changeover, Laundry) Domestic Transportation Request or International Transportation Form (if needed) HAND IN YOUR CAMPER FORMS (WITH THE EXCEPTION OF THE PHYSICIAN S EXAM FORM) BY APRIL 1 ST, 2016, AND RECEIVE A $25 CREDIT TOWARDS AN OPTIONAL SERVICE! LATE FORMS (AFTER MAY 1 ST, 2016) WILL RESULT IN A $40 ADMINISTRATIVE FEE LATE REGISTRATIONS (After May 1 st ) If you register after May 1, forms must be downloaded and returned within 10 days of registration with the exception of physicians examination form (pending physicals). FORMS HANDED IN AFTER 10 BUSINESS DAYS WILL BE SUBJECT TO A $40 ADMINISTRATIVE FEE. IMPORTANT PAYMENT DATES April 1, 2016 May 1, 2016 Leadership Development final fees due All other sessions final fees due All Required Forms are due to ensure your camper s registration. *the exception is the physician s examination form

2 2016 YMCA CAMP FULLER FAMILY INFORMATION PACKET Welcome to YMCA Camp Fuller! This booklet provides essential information - please read it carefully with your camper. If you have any questions, please don t hesitate to call us at (800) or (401) The office is open weekdays from 9:00 AM to 4:00 PM. FORMS Please fill out all appropriate camper forms by May 1, 2016 (with the exception of the Physicians Examination Form, which must be sent in no later than two weeks before arrival to camp). Camper forms can be sent through the mail or by . If you decided to scan and the forms, please send the forms in a PDF format to campfulleroffice@gpymca.org. If you are an international camper, we have created a separate packet of international camper forms which are available online. HAND IN YOUR CAMPER FORMS (WITH THE EXCEPTION OF THE PHYSICIAN S EXAM FORM) BY APRIL 1 ST, 2016, AND RECEIVE A $25 CREDIT TOWARDS AN OPTIONAL SERVICE! LATE FORMS (AFTER MAY 1 ST, 2016, WILL RESULT IN A $40 ADMINISTRATIVE FEE LATE REGISTRATIONS (After May 1 st ) If you register after May 1, forms must be downloaded and returned within 10 days of registration with the exception of physicians examination form (pending physicals). FORMS HANDED IN AFTER 10 BUSINESS DAYS WILL BE SUBJECT TO A $40 ADMINISTRATIVE FEE. IMPORTANT PAYMENT DATES April 1, 2016 May 1, 2016 Leadership Development final fees due All other sessions final fees due All Required Forms are due to ensure your camper s registration. *the exception is the physicians examination form 1

3 GENERAL INFORMATION YMCA MISSION: The mission of the YMCA of Greater Providence is to build healthy spirit, mind and body for all, through programs, services and relationships that are based upon our core values of caring, honesty, respect and responsibility. Although rooted in the Christian tradition, the YMCA is an international organization that embraces people and practices from all denominations. HISTORY: Camp Fuller is entering its 129th camping season and is the third oldest youth camp in the country. Since 1912, the camp has been at its present location approximately one mile inland from the Atlantic Ocean on Point Judith Pond. Over the years, Camp Fuller has built a reputation as one of the finest saltwater sailing camps in America. Today a well-rounded traditional camping experience is offered, plus unique specialty programs. ACCREDITATION: YMCA Camp Fuller is accredited by the American Camp Association (ACA), and as such, undergoes periodic standard inspections. The camp meets or exceeds all regulations for youth camps and is inspected by the RI Department of Health and YMCA camping officials. Camp Fuller also subscribes to the Principles of Operation set forth by the Rhode Island Association of Camps. PROGRAM DESCRIPTIONS ELECTIVE PROGRAMS: Camp Fuller strongly believes in campers making individual choices. Campers register weekly for up to 8 electives per day. Most electives are organized by age and ability groups. The only required program is swimming lessons for non-swimmers and beginners. WATER-SKIING/TUBING (Form required): Water-skiing lessons are available for 11/2 hours per day for five days for an additional fee of $95. Please enroll your child prior to coming to camp using the Optional Services form. Every effort will be made to reschedule cancelled lessons but YMCA Camp Fuller will not refund for missed lessons. Individual instruction uses the National Water Ski Association guidelines. Space is limited and waterskiing fills most sessions; early registration is advised. Also, please make sure your child knows they are enrolled. All campers will participate in a swim evaluation upon arrival at camp, if your camper does not pass a basic level swim test or if they are afraid of the water then we will contact you and they may be removed from the optional program of waterskiing-tubing. CHAPEL AND DEVOTIONS: Non-denominational services are held on the middle Sunday of each session. Each evening, just before lights out, cabin groups conduct devotions. Devotions are conversations between campers and staff. Participants are encouraged to reflect on the happenings of the day or discuss issues of concern in their daily lives. Devotions focus on the YMCA values of respect, responsibility, caring and honesty. Many parents report that devotions have a meaningful impact on their children's lives. 2 IN THE DIVISIONS HOUSING: Campers live in either enclosed cabins or cabin-tents. The youngest campers sleep in fully enclosed cabins with electricity. The cabin-tents are rustic with large open air windows protected by canvas flaps. Eight to ten campers are assigned to a cabin according to their age, with four divisions separating the older and younger children. Counselors live in the cabins. Beds are double-bunk cots with mattresses. Most campers bring sleeping bags, although sheets and blankets are acceptable. Personal belongings are kept in footlockers, luggage bins, etc. Containers holding personal belongings are stored under the bunks which are 14 inches off the floor. We recommend a spare key be given to the counselor if locks are used. Visit and use code trail459fr for an option for footlockers.

4 CABIN BUDDY REQUESTS (Form required): Camp provides an opportunity to make new friends. For this reason, we discourage requests that specific campers be placed together in a cabin. However, if you feel strongly that two campers should be together in a cabin, we will strive to honor the request. One bunk request per camper will be accepted. Bunk requests must be reciprocal and will not be honored unless both campers submit the form. Please do not list multiple names. One week campers can not request to bunk with two week campers. LOST & FOUND: Mark all clothing and towels, or use iron-on name tapes. Campers should check the divisional lost and found regularly. On departure day before leaving, parents should look through the divisional lost and found. Lost items will not be mailed back to campers. Items left at camp will be given to a local charity. Name tapes for marking clothing are available at STAFFING: A carefully selected and trained college-age counselor and a junior counselor live with the campers. Staff members are chosen on the basis of their maturity, ability, values, and their sincere desire to work and live with children. Seasoned leaders, including a full-time Executive Director, Associate Director, seasonal Program Directors, Head Counselor, and key staff are responsible for supervision. Directors live on site during the summer season. STAFF APPRECIATION (Tipping): Tipping of individual staff is prohibited. Please feel free to show your appreciation of staff by giving a donation directly to the camp office. An easy way to do this is to contribute leftover store money to the Staff Appreciation Fund. This money is used during the summer for staff events and for an end of the season staff banquet. As always, staff members enjoy short notes/letters of thanks from their campers. Mail should be addressed as follows: 3 Camper's Name Division (provided at check-in) YMCA Camp Fuller 619 Camp Fuller Road Wakefield, RI CONTACTING YOUR CAMPER LETTERS: Campers are encouraged to write home. It is a good idea to send a letter to your camper a few days before s/he leaves for camp. Receiving a letter on Monday can be a real boost to first time campers. In your letter show interest in camp life by asking what activities were chosen, and what new friends they have been made. Child psychologists recommend refraining from writing about what they are missing at home. Encourage your children to try new things and tell them that you are proud they are at camp. PACKAGES: PACKAGES SHOULD BE NO LARGER THAN A SHOEBOX. Packages that are too large will be returned to sender unless the contents are identified on the box. Please send no more than one package per week. Packages should be sent via UPS or FedEx. Other carriers, including the post office, do not deliver packages to camp. Contents: Part of the YMCA mission is to build healthy kids. Include healthy options such as dried fruits, crackers, granola bars, etc. Nut products (including nutella), gum and beverages other than water are not allowed. Campers look forward to receiving games, puzzles, magazines, etc. Care packages are available through and other companies on-line. If you bring food for your child with you on arrival day, please limit it to the amount noted above. You are welcome to send your children through our partnership with Bunk1.com. To set up your e- mail account, please use the Bunk1 link on the Camp Fuller website ( charges are accrued through Bunk1.com. A reminder: s are batched and ed to us every night. We print them each morning and deliver them that evening. It may take almost two days for to get delivered.

5 PHOTO GALLERY: We want to make sure that you feel connected to your camper while s/he is at Camp Fuller. Throughout the summer, we will be downloading photos of daily life to the Bunk1.com web site. TELEPHONE: Campers are not permitted to make or receive telephone calls. The camp office will relay important messages to campers, but will not call campers to the phone. Please confine important calls to the hours of 9:00 to 12:00 and 1:00 to 4:00. After 4:00 PM you might reach a voice mail. This is checked periodically in case emergencies occur. Campers may not bring cell-phones. If a camper brings a cell-phone to camp, it will be held in the office until the end of the session. CHANGEOVER WEEKENDS AND VISITING CHANGEOVER WEEKENDS (Form required): Two-week camp sessions end Saturday mornings. Campers who are staying for another session may stay at camp, this is called Changeover. These Changeover campers enjoy a special staff supervised activity. There is a $90 fee for campers that stay for the Changeover. LDs interested in staying for Changeover will need to pay for the service (it is not included in the LD program fees or the Four Week Special camper fees). Note: There is no Changeover between August 20 th and 21 st (Session IV and Specialty Camp). Space is limited, so early registration is advised. This fee is not pro-rated if campers miss meals or the program. There is a $50 fee for early arrivals or late pick-ups. VISITING DURING CHANGEOVER: If you want to visit please let us know in advance so that your camper can be available as often Changeover campers can be together on the far side of camp or off site on a trip. If family members want to visit a camper during changeovers, they must sign the camper out. Due to the scheduled activity there might not be anyone at camp from 2:00 PM to 8:30 PM on Saturday. Campers will be released only to those individuals listed on the Pick-up Authorization Form. VISITING DURING SESSIONS: Visiting is not permitted during the sessions. If it is necessary for a child to leave camp during a session, written permission must be provided in advance by a parent or guardian and the person must be listed on the Pick-up Authorization Form. Note: Removing a child from camp during a session is detrimental to their camp experience. 4 WHAT TO BRING This suggested list of items to bring to camp is based on a two-week session. Campers staying longer should plan to do laundry. (see Laundry under the Services section). We recommend older clothing, and certainly no valuables! In addition, campers may wish to bring personal items such as skateboards, baseball gloves, cameras, etc. Please be certain to mark everything clearly; we suggest an inventory list taped to the inside of your footlocker, suitcase, etc. Sandals and/or Water Shoes (for showers and water-based activities) Box of tissues 8-12 pairs underwear Disposable camera(s) 12 pairs of socks 5 bath/beach towels and washcloth 3 pairs jeans/long pants Raincoat or poncho 8-12 t-shirts or jerseys Insect repellent (non-aerosol) 6-8 pairs of shorts Flashlight with extra batteries 3 long sleeve shirts Hat for rainy/sunny days Sleep wear Sleeping bag or sheets/blanket 2 pair sneakers Pillow and pillowcase Jacket plus sweatshirt Sunblock 3 swimsuits Playing cards Soap and Shampoo Water bottle (labeled with name)

6 Toothbrush, paste Comb/brush Plastic pail for shower items Day Pack for carrying towel, swimsuit, water bottle, etc. Pens and stationery with stamps & pre-addressed envelopes 2 trunk keys--it is a good idea to give one to the counselor Fanny Pack (for inhalers or epi-pens) Laundry bag (labeled with name in ink) Camp Fuller reserves the right to have campers inventory their belongings in the presence of staff if the health or safety of other campers or staff indicates the need. Please Do Not Bring: Cell-phones Electronic devices that that has internet access or display any video images (including I-Pods with video playing capabilities and e-readers) Nut products (peanut butter, nutella, etc.) Gum, soda or large amounts of junk food Money/Valuables (jewelry, etc.) Aerosol cans (bug spray, deodorant, hair spray) 5 HEALTH AND WELLNESS HEALTH HISTORY FORM: (Form required): No camper will be allowed in camp without a completed health history form and physicians examination form! The Heath History Form must be completed and signed by a parent or guardian and submitted with copy of insurance to camp by May 1, PHYSICIANS EXAMINATION FORM: (Form required): No camper will be allowed in camp without a completed health history form and physicians examination form! The Physicians Examination Form must be completed and signed by a physician. All campers must have proof of a medical examination dated after May1, The completed form MUST be mailed at least two weeks prior to your child s arrival at camp. MEDICAL EXPENSES & INSURANCE: A copy of the front and back of your child's medical and dental insurance cards must be submitted with the Health History Form. Camp Fuller does not carry accident or medical insurance policies for campers. No coverage of any type is offered or implied. Ultimate responsibility for all medical bills incurred lies with the parent or legal guardian. Such services will be billed to you or your insurance carrier. PRESCRIPTIONS (Form required): All medications must be in original packaging with the campers name, doctors name and contact information and dosage on the label. PLEASE DO NOT BRING PRESCRIPTION MEDICATIONS NOT IN ORIGINAL BOTTLE. We ask that you only bring enough of the medication as necessary for the campers stay and if your pharmacy offers sealed blister packs for medication please bring the medication that way to camp. If your camper has a prescription that is not in pill form (liquids, eye drops, inhalers, etc.), the medication will be dispensed accordingly. On check in days, we ask that the parents with campers (who take medication) check in with the health center staff to ensure everything is in order and no medication is to be left with the camper (including vitamins). At camp, your child will self-administer his/her medication under the supervision of the nurse or nurse s assistant. Parents must pick up medications from the nurse on check out days. Children are expected to participate in their medical care and report to the assigned medication area when necessary. They must be familiar with the medication, when it is to be dispensed, and how much is to be dispensed.

7 6 Medications at camp will be dispensed at these times only: 8:00 AM, 12:30 PM, 6:00 PM, and 9:30 PM. Please consult your doctor to make sure your child's prescription(s) can be adjusted to these times. If your doctor has concerns about the medication times, please contact the nurse prior to the start of camp. Children with allergies or with asthma may carry their inhalers or epi-pens with them. Please provide a fanny pack to carry these items. Please discuss this with the nurse at check-in. If a prescription is required during camp, Camp Fuller will contact you for the credit card information. If we are unable to contact you, you will be billed at a later date. MEDICAL SERVICES: Camp Fuller has a nurse available at all times. Thundermist Health Center of South County provides additional medical services, including referrals and routine office visits. Emergency Room care is provided at South County Hospital. If a camper requires hospitalization, physicians admit them to South County Hospital. WELLNESS CENTER & CAMPER ILLNESS: Children who are suffering with a fever or acute illness stay in the Camp Fuller Wellness Center. A child must be picked up from camp if s/he must be isolated from other children, if the infirmary cannot provide the level of comfort the child requires, or if the child is suffering with a fever or acute illness lasting two days. Parents will be notified if their child requires a doctor s visit. If necessary, we will make appointments for campers to go to Thundermist Health Center. Parents also have the option of picking up their child and taking him/her to their physician. Parents will be notified in the event of an emergency. LICE CHECKS: Head lice infestation can be a persistent medical problem in any communal setting where children are in close contact. Please check your camper s head the day before departure for Camp. If there is evidence of lice and/or nits, delay his/her departure for camp for medical reasons until all lice and nits have been removed. On check-in day, campers will be screened for nits or lice. We will contact the parents if treatment is needed. HOMESICKNESS: Some campers become homesick. Staff are trained in how best to help a homesick camper. It is typical for a camper to be homesick for a few days, write a heart-wrenching letter home, and then become adjusted to camp by the time the family receives the letter and calls camp. Parents/guardians will be contacted if the situation warrants it, but most of the time it is not helpful to have the campers talk to their parents/guardians. Parents can help avoid homesickness by: 1. Talking to the child about worries they might have about camp. 2. Sharing similar experiences 3. Arranging for the child to spend a night away from home with friends or a relative before coming to camp. 4. Telling the camper that if s/he feels homesick to share those feelings with the counselor or division leader. 5. Not telling their child that they will come pick her/him up if s/he is feeling homesick (that sets everyone up for disappointment). FEES AND PAYMENTS FEES & PAYMENT SCHEDULE: The balance of all camp fees must be paid no later than May 1, For those that enroll after May 1, full payment is due upon receipt of the registration. If necessary, a payment plan for monthly payments can be agreed on by May 1; please call our office for more information. We accept Visa, MasterCard, American Express and Discover credit or debit cards. Note: LD balances are due April 1, Payment and forms for Optional Services should be turned is with camper forms. REFUNDS: Your deposit is refundable, less a $25 processing fee, until May 1, After May 1, no refunds of deposits or fees will be given. Cancellations or changes to registrations must be made in writing. Participants in the LD program will not have a deposit refunded after January 1, WAIT LISTS: If a session is filled, your camper s name may be put on a wait list. Last minute cancellations do occur and vacancies will be filled in the order in which the registration was received.

8 SERVICES TRANSPORTATION: VAN SERVICE: Van service is available from: * Metro North Station in Rye, NY * Logan International Airport in Boston, MA * Kingston Amtrak Station in Wakefield, RI * TF Green Airport in Providence, RI Rye, NY van service (both to and from camp) will be on each Sunday check-in date, with the exception of the return trip at the end of Session IV, when campers return on Saturday, August 20, Coming to Camp: Departure from Metro North Station (south side) at 12:00 noon. Arrival at camp at approximately 3:00 P.M. Departure from Camp: Campers returning home via the van to Rye will stay one extra day (This is included in the fee). These campers will arrive at the Metro North Station (south side) at approximately 11:45AM. The station telephone number is: Directions to the Metro North Train Station in Rye: From the South: Rt 95 North to Exit 20 (Rt 1 South/Post Rd). Turn right onto Post Road. Turn right onto Purdy Avenue. Go under the tracks and make a right on Cedon Street. From the North: Rt 95 South to Exit 22 (Midland Avenue). At the end of the exit, turn left onto Midland Avenue. Turn right onto Peck. Turn right into the station parking lot. Airline Transportation: Domestic flights should fly in to TF Green Airport outside of Providence. International flights should fly in to Logan Airport in Boston. Flights should arrive on Sunday between 1:00 and 4:00 PM. Departures should be Saturday between 3:00 and 7:00 PM. Flights scheduled outside of these time periods will be subject to an additional fee or be asked to use a limousine service. Airlines are requiring minors (children under 16 years of age) to fly unaccompanied minor or are requiring an adult chaperone to wait until the child s plane has departed. Any additional costs associated with this process will be the responsibility of the camper family. The airline fee for unaccompanied minors can be as much as $ Please contact your airline about its policy. CAMP STORE ACCOUNTS (Form Required): There are a variety of items available in our camp store, including: t- shirts, hats, sweatshirts, batteries, postcards, stamps, and personal items. Food is not available in the camp store. We recommend that campers deposit $20- $25 in the camp store for each week they attend camp. Store money submitted on check in day may not be available for your camper until Thursday of that week, so deposit camp store money by May 1, Please do not allow your camper to keep any cash with them while at camp. Remaining store account balances are refunded only upon request and must be claimed by October 1, All non-refunded money will go to the Staff Appreciation Fund. LAUNDRY (Form Required): Laundry services are available for campers staying more than one session. One and two week campers should bring enough clothing to last the entire session. Laundry is done each Monday at a commercial laundry. The cost is approximately $15.00 per load. A standard laundry bag holds 2 loads. Campers must have a sturdy laundry bag with their first and last name permanently marked on the bag. All clothes and towels should have nametapes or be marked with permanent ink. Camp Fuller cannot be responsible for items that may be damaged or lost by the laundry service. We do not allow camper to have cash so laundry money will need to be deposited by May 1,

9 ARRIVAL AND DEPARTURE PICK-UP AUTHORIZATION FORM (Form Required): This form ensures the safety and welfare of your child in the event of an emergency that prevents you from picking your child up from camp. Please write the names of at least two people, other than yourself, who are authorized to pick up your child. The person who picks your child up will be required to show a Photo ID and will sign your child out. Your child will only be released to the people listed. ARRIVAL DAY: Campers should arrive according to the schedule below. Once you arrive at the main gate, staff will direct you to the proper division. If you are late, please call the office at (401) Campers who arrive before 1:30 PM will be charged a $50 fee. Please remember that the camp road is closed to traffic from 1:00 PM to 1:30 PM. DEPARTURE DAYS: Parents arrive on Saturday (except for the specialty camps) at 9:45 AM to pick your camper up from camp. Please do not arrive early! Parents who arrive before 9:45 AM to pick up a camper will be charged a $50 fee. All campers should be picked up by 11:15 at the latest. Campers picked up after 11:15 will be charged a $50 fee. If you are detained for any reason, please call camp at (401) DIRECTIONS TO YMCA CAMP FULLER FROM PROVIDENCE/BOSTON: Follow I-95 South to Exit 9 (left exit) to Route 4 South. Route 4 merges with Route 1 South, heading towards Narragansett. Follow Route 1 through Wakefield, watch for highway sign Jerry Brown Farm Road/Camp Fuller Road, Next Left Make a U-turn at this exit and travel north on Route 1 for about 500 yards. Do not take the Jerry Brown Farm Road exit. Take the Camp Fuller Road exit. **Go about 200 yards and you will see the Camp Fuller sign on the right. Turn right onto the dirt road, which is Camp Fuller Road. Follow this road to the end, which is about 1.3 miles. Please be sure to drive slowly (10 MPH) and carefully, as it is very narrow and you may need to give way to cars coming in the opposite direction. FROM CONNECTICUT/NEW YORK: There are two ways to reach Camp Fuller from the south and west. On any good beach day, we recommend the alternate route, as traffic around Westerly can be tied up for hours. DIRECT ROUTE: Follow I-95 North to CT Exit 92 (toward Westerly). At the bottom of the ramp, go right and follow to the signs for Route 78. Take Route 78 East to Route 1 North. Follow Route 1 North until you pass the exit for Jerry Brown Farm Road you will see the Camp Fuller Road exit right afterwards. Take this exit and then follow the directions above. ALTERNATE ROUTE: Follow I-95 North to RI Exit 3 Route 138 East towards Newport and URI. Continue on Route 138 to Route 110 in South Kingstown. Turn right at the light onto Route 110. Follow Route 110 to the end and merge onto Route 1 South. At the first chance, make a U-turn onto Route 1 North. Once on Route 1 North, follow directions above. 8

10 IMPORTANT DATES AND TIMES TO REMEMBER April 1 Final payment due for Leadership Development March 12, April 9 & May 7 Spring Open Houses 10:00 to 2:00 May 1 Final payment and forms due for all campers ARRIVALS Session 1 Sunday, June 26 1:30 3:30 OWS1a Sunday, June 26 1:30 3:30 OWS1b Sunday, July 3 1:30 3:30 Session 2 Sunday, July 10 1:30 3:30 Session 3 Sunday, July 24 1:30 3:30 Session 4 Sunday, August 7 1:30 3:30 Specialty Week Sunday, August 21 3:30 4:30 DEPARTURES Session 1 Saturday, July 9 9:45 OWS1a Saturday, July 2 9:45 OWS1b Saturday, July 10 9:45 Session 2 Saturday, July 23 9:45 Session 3 Saturday, August 6 9:45 Session 4 Saturday, August 20 9:45 Specialty Week Friday, August 26 5:00 9

11 YMCA CAMP FULLER 2016 CAMPER HEALTH HISTORY FORM * Immunization History- MANDATORY! Please provide a written record of the camper s most recent immunizations. Campers may not attend without this record. * Please include a copy of all your health insurance cards (medical and dental) with this form Health Form Check List Copy of insurance cards (2 sides) Immunization records Current medical history Physician s signature Current Medications Name: Birth date: / / Gender: M F Age: Dates Attending: Name of Parent/Guardian: Home Phone: Work/Cell Phone: Address: Street City State Zip If I am not available in an emergency, please notify (Name) (relationship) Home Phone: Work/Cell Phone: Please circle any conditions that your camper has experienced Frequent Ear Infections Heart Defect/Disease Convulsions Diabetes Bleeding/Clotting Disorders Hypertension Mononucleosis Psychiatric Treatment Diseases Chicken Pox German Measles Measles Mumps Allergies Hay fever Poison Ivy Poison Oak Insect Stings Penicillin Other Drugs Asthma INFORMATION TO BE PROVIDED BY PARENT/GUARDIAN 1. Has the camper required any psychiatric counseling or hospitalization? If yes, please explain 2. Please list any medications your camper is currently taking, including the dose and reason 3. Please list the date and nature of any operations or serious injuries 4. Please describe any disability or chronic or recurring illness 5. Please list any activities encouraged or limited by the physician 6. Please describe any dietary modifications or considerations 7. Females Only: Has the camper begun menstruation? YES NO If NO, has she been told about it? YES NO If YES, is menstrual history normal? Please describe 8. Name of Physician Phone 9. Name of Dentist Phone Parent/Guardian Acknowledgment This health history is correct, as far as I know, and the person herein described has permission to engage in all prescribed camp activities excepted as noted. I hereby give permission to the medical personnel selected by the camp director to order routine tests, x-rays, treatment and necessary transportation for the individual named above. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to secure and administer treatment, including hospitalization, for my child named above. In accordance with Section of the Rhode Island General Laws Exemption from Liability to Participants in Sponsored Athletic or Sports Events, I hereby waive any liability against the Greater Providence YMCA, its officers, directors, trustees, agents, servants or employees. They shall not be held liable for any bodily injury incurred while my child is participating in any activity sponsored by YMCA Camp Fuller, except for injury occasioned by an employee s intentional behavior, assault or reckless disregard. Parent/Guardian Signature Date YMCA Camp Fuller 619 Camp Fuller Road I Wakefield, RI I I campfulleroffice@gpymca.org I

12 YMCA CAMP FULLER 2016 PHYSICIANS EXAMINATION FORM * Immunization History- MANDATORY! Please provide a written record of the camper s most recent immunizations. Campers may not attend without this record. Name: Birth date: / / Gender: M F Age: Dates Attending: Name of Parent/Guardian: Home Phone: Address: Work/Cell Phone: Street City State Zip If I am not available in an emergency, please notify (Name) (relationship) Home Phone: Work/Cell Phone: Camper Name: General Health of Camper Date of Examination INFORMATION TO BE PROVIDED BY PHYSICIAN Height Weight Blood Pressure The camper is under care of a physician for the following condition(s): The camper is currently taking the following medications: Does the camper have epilepsy? YES NO Does the camper have diabetes? YES NO Please explain any reported loss of consciousness, convulsions or concussion. Are there any medically prescribed meal plans or dietary restrictions? YES NO If yes, please explain. Are there any conditions that would preclude this camper s participation in an active camp program? YES NO If yes, please explain. PHYSICIAN SIGNATURE I have examined the above-named camper within the past two years. I have found him/her to be in good physical condition and there are no conditions precluding participation in an active camp program except those noted above. Signature of Licensed Physician Physician Name Phone: Date Address: Street City State Zip Date of form completion: by YMCA Camp Fuller 619 Camp Fuller Road I Wakefield, RI I I campfulleroffice@gpymca.org I

13 YMCA CAMP FULLER PHOTO COPY OF HEALTH INSURANCE CARD (BOTH SIDES)

14 YMCA CAMP FULLER PHOTO COPY OF DENTAL INSURANCE CARD (BOTH SIDES)

15 YMCA CAMP FULLER PARENT AUTHORIZATION FORM Camper s Name: Dates attending: M F Age: Photo Release: As the authorized legal guardian of the child listed above, I hereby grant permission to YMCA Camp Fuller and the YMCA of Greater Providence to take and use photographs that may include my child for the media to use as promotional material and social media sites. Initial here Off-Site trips: As the authorized legal guardian of the child listed above, I hereby grant permission for my child to be transported on trips to off-site locations sponsored by YMCA Camp Fuller. Initial here Pick-up Authorization: Parents/guardians are required to sign out their child and show a photo identification card when they visit or pick-up a camper. Please list yourself, a second spouse or guardian if appropriate, and at least two other individuals (spouse, who are authorized to pick up your child from camp. These individuals must present a photo ID upon arrival. If you have any concerns about non-custodial parents attempting to pick up your child from camp, or trying to arrange for a visit during camp, please attach a note to this form explaining the situation. I authorize the following individuals to pick my child up in the event of an emergency (Please print): 1. Parent/Guardian: Telephone #: (yourself) 2. (Parent/Guardian): Telephone #: 3. (Other Individual): Telephone #: 4. (Other individual): Telephone #: Authorization Signature of Parent/Guardian Date CAMPER SIGN OUT Signature of person signing child out of camp Signature of person signing child out of camp Signature of person signing child out of camp YMCA Staff Signature YMCA Staff Signature YMCA Staff Signature YMCA Camp Fuller 619 Camp Fuller Road I Wakefield, RI I I campfulleroffice@gpymca.org I

16 YMCA CAMP FULLER CODE OF CONDUCT Camp Fuller strives to promote and encourage the YMCA character values of Honesty, Responsibility, Caring and Respect. The basic guidelines at camp are: Be respectful of other campers and staff. Be honest and forthcoming in your interactions with campers and staff. Be responsible with Camp Fuller s equipment and property. Be caring towards yourself and others. Campers must agree to abide by the following rules inclusive in this Code of Conduct. I will be respectful to everyone and will not swear, use derogatory language, bully or harass others. I will be responsible for helping clean my cabin and division. I will respect camp property and not deface it with graffiti. I will respect the property of others by asking to share and I will not steal. I will respect curfew, and I understand that being out of my division after curfew may result in immediate dismissal. I will bring no weapons to camp, including pocketknives. I will not bring or use alcohol, drugs, tobacco or electronic/vapor cigarette products at camp. I will not bring electronics devices that have internet access or display any video images (including I-Pods with video playing capabilities) as well as cell phones. I will do my best to make this a good experience for myself and my fellow campers. I understand that failure to live up to this agreement may result in my dismissal from camp (without a refund). Camper Name (Please print) Camper Signature Parent/Guardian Signature YMCA Camp Fuller 619 Camp Fuller Road I Wakefield, RI I I campfulleroffice@gpymca.org I

17 YMCA CAMP FULLER INFORMATION FOR THE COUNSELOR To be completed by the camper and parents Camper Name or is there a name your camper prefers to be called? Tell us something special we should know about your camper: What activities does your child participate in? Tell us if you or your camper have any concerns about coming to camp: What activities at camp would be most interesting for your camper? BUDDY REQUEST Camp provides an opportunity to make new friends. Therefore, we discourage requests that specific campers be placed together. However, if you feel strongly that two campers be placed together, we will strive to honor that request. One week campers cannot request to bunk with two week campers. Requests must be reciprocal and will not be honored if both campers do not make the request. One request per camper. See our Family Information packet for more details. Camper FULL name Age at camp REQUESTS TO BE WITH: FULL name of friend Age at camp Dates/ Sessions Attending YMCA Camp Fuller 619 Camp Fuller Road I Wakefield, RI I I campfulleroffice@gpymca.org I

18 YMCA CAMP FULLER 2016 OPTIONAL SERVICES Please see the Family Information Packet for more details about these services. Please select optional services for your camper by May 1 st (may be done on-line). Some services fill with waitlists. Last minute requests must be in writing and may not be able to be honored. Camper s name: Dates attending: Birthday Party - $ Includes 3 pizzas, cake, drinks, and decorations. This serves a cabin group (10). LDs and CiTs should contact camp to arrange for a larger group party (approx.18). Applies only to campers whose birthday falls when they are at camp. Changeover Weekend: Camp sessions end on Saturday mornings. Campers staying on for another session may remain at camp for the changeover. In addition to lodging and food, campers will enjoy a special staff supervised activity. LDs interested in staying for changeover will need to pay for the service (it is not included in the LD program fees). The charge is $90.00 for campers who stay at camp for a Changeover Weekend. Laundry: A cloth laundry bag permanently marked with the first and last name of the camper is required. Campers staying longer than a two-week session should consider this service. Laundry is sent out on Monday of each week and the cost is approximately $15.00 per load. A standard laundry bag holds 2 loads of laundry. Store Account Money - $50.00 for a two week session is recommended Water skiing/tubing - $95.00 per week YOUR CHOICES AND PAYMENT Birthday Party ($65.00) Changeover ($90.00) Laundry ($15.00) per load Store Account Money Water skiing/tubing ($95.00) $ $ $ $ $ TOTAL $ Please submit this completed form with your final payment of camp fees. Included is my check for: Use charge card # Exp. Name on Card: YMCA Camp Fuller 619 Camp Fuller Road I Wakefield, RI I I campfulleroffice@gpymca.org I

19 YMCA CAMP FULLER DOMESTIC TRANSPORTATION FORM Transportation requests will not be processed without payment and full flight information. We will confirm transportation requests prior to your child s session. Please note: Airlines are requiring minors (children under 17 years of age) to fly unaccompanied minor or are requiring an adult chaperone to wait until the child s plane has departed. Any additional costs associated with this process will be the responsibility of the camper family. Please see the Family Information Packet for more important transportation information, including recommended arrival and departure times. Camper Name: Session(s) Attending: TO YMCA CAMP FULLER Van from Rye, NY: $75 There are limited seats so we require a minimum of 4 and a maximum of 9 campers per trip, parents will be notified within a week of the date of transport if any cancellations occur Sunday June 26 (Session 1) Sunday July 10 (Session 2) Sunday July 24 (Session 3) Sunday August 7 (Session 4) Van from TF Green Airport (PVD): $65 Date (mm/dd) Flight # Airline Arrival Time Departure Time and City Will camper be flying as an Unaccompanied Minor? YES NO FROM YMCA CAMP FULLER Van to Rye, NY (incl. Changeover): $125 There are limited seats so we require a minimum of 4 and a maximum of 9 campers per trip, parents will be notified within a week of the date of transport if any cancellations occur Sunday July 2 (end of Session 1) Sunday July 23 (end of Session 2) Sunday August 6 (end of Session 3) *Saturday August 20 (end of Session 4) $75 * No Changeover Van to TF Green Airport (PVD): $65 Date (mm/dd) Flight # Airline Departure Time Arrival Time and City Will camper be flying as an Unaccompanied Minor? YES NO Van from Train Station in Kingston: $40 Date (mm/dd) Train # Arrival Time Departure Time and City Van to Train Station in Kingston: $40 Date (mm/dd) Train # Departure Time Arrival Time and City TOTAL AMOUNT ENCLOSED: Credit Card # Name on card Check # Expiration date Signature YMCA Camp Fuller 619 Camp Fuller Road I Wakefield, RI I I campfulleroffice@gpymca.org I