CALVERT COUNTY PARKS & RECREATION CALVERT COUNTY SHERIFFS OFFICE

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1 CALVERT COUNTY PARKS & RECREATION together with CALVERT COUNTY SHERIFFS OFFICE Teamwork, Activities, Demonstrations, Swimming All squeezed into one week of Camp! Date: July 10 14, 2017 Time: 8:00 a.m. 4:00 p.m. Ages: 6 th 8 th grade (must be starting middle school 2017/2018) Location: Cove Point Park Pavilion (days with inclement weather Southern Community Center)

2 CAMP JR SHERIFF Information CAMP JR SHERIFF provides a safe and positive environment for middle schooler s in grades 6 th 8 th to interact with peers, law enforcement officers and volunteers in a criminal justice setting. Our mission is to teach our youth the importance of discipline, selfrespect, integrity, and teamwork. This will help them to become dynamic members of our community. Our Camp will engage campers, both physically and mentally, through activities and presentations given by agency personnel, such as pushups, running, core stretching, relays, swimming, etc. Demonstrations will be given by the Sheriff s Office K-9 Unit, Community Action Team, DARE and Special Operations Team. CAMP JR SHERIFF is such an incredibly low cost to all youth through the generous support of several organizations. Camp starts at 8:00 a.m.; all campers must arrive no later than 8:15 a.m. as this is camp requires participation by all campers. Camp concludes at 4:00 p.m. and all campers must be picked up promptly. Campers must be signed in and out of daily, this is required. On days that it is raining or other weather related reasons, Camp will be held at the Southern Community Center. Transportation will be provided. Camper s will be swimming Monday Thursday afternoons and will need to bring their bathing suit, towel, and sunblock. The Camp will be staffed by Calvert County Sheriff s Deputies, Explorers and other qualified adult volunteers. Camp includes a t-shirt, water bottle and swimming. All campers must bring a packed lunch daily and it should be packed in a bag or cooler. Please be sure to pack extra drinks and snacks! LIVE PLAY SWIM

3 CAMP JR SHERIFF S RULES AND REGULATIONS 1. Campers may NOT be dropped off prior to 8:00 a.m. 2. Campers must be picked up by 4:00 p.m. ($10 will be charged for every 15 minutes late) 3. You MUST sign your child in and out of camp each day. 4. Camper must arrive to Camp between 8:00 8:15 a.m. If camper is going to be later than that, prior arrangements must be made. If you do NOT make prior arrangements camper may NOT attend that day. It causes too much disruption to the Camp. 5. No weapons!! (toy guns and look-alikes included) 6. No fighting or pushing! 7. No spitting, teasing, name-calling or foul language. 8. No non-prescription drugs, illegal substances, tobacco, or alcohol permitted. 9. Campers may not share snacks or lunch. (This is due to the number of allergies other children may have) 10. No fraternization (no kissing or hugging). 11. No electronic devices allowed. 12. No refunds will be given if a child is suspended. 13. Disrespect to staff will not be tolerated. 14. Disruptive campers will be dismissed from Camp (parents will be called to pick-up their child). 15. Criminal acts will be dealt with accordingly (i.e. - stealing, vandalism / destruction of property, etc.). 16. Staff is not responsible for campers money or personal belongings. 17. Campers must wear appropriate gym attire and athletics shoes. No sandles or flip flops. Baseball caps are suggested. 18. Campers will be required to pass a swim test (must be able to swim the width of the pool without stopping and/or touching the bottom). Back Flips are not permitted! Bathing suit, towel, and sunblock should be labeled with campers initials. 19. Have a rewarding and fun week! REMEMBER TO THINK BEFORE YOU ACT!! "T.E.A.M. = Together Everyone Achieves More!"

4 CAMP JR SHERIFF CAMPER REGISTRATION Camp Location: Age/Grade of Camper: Child s Name: Last First Middle Date of Birth: Address: City: State: Zip: Parent/Guardian Name: Home Phone: Work Phone: Cell Phone: Parent/Guardian Name: Home Phone: Work Phone: Cell Phone: WAIVER RELEASE I HEREBY GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN ALL ACTIVITIES AND ATTEND ALL TRIPS SPONSORED BY THE CALVERT COUNTY DIVISION OF PARKS AND RECREATION. IN CONSIDERATION OF THE DIVISION'S ACCEPTING MY CHILD INTO THIS PROGRAM, I AGREE TO WAIVE AND FOREVER DISCHARGE CALVERT COUNTY, ITS EMPLOYEES AND AGENTS HARMLESS OF & FROM ANY INJURIES SUSTAINED BY MY CHILD WHICH OCCURS WHILE ENROUTE TO OR FROM OR PARTICIPATING IN ANY ACTIVITY SPONSORED BY THE AFOREMENTIONED PARTIES. NOTE: This release does not obligate your child to attend any or all scheduled trips or activities. SIGNATURE OF PARENT OR GUARDIAN DATE SIGN OUT RELEASE UPON DROPPING OFF AND PICKING UP MY CHILD FROM THE CAMP, I AGREE TO INFORM THE SUMMER CAMP STAFF AND SIGN THE APPROPRIATE FORM, INCLUDING DATE AND TIME I DROPPED OFF AND PICKED UP MY CHILD. IN THE EVENT, I AM UNABLE TO PICK UP MY CHILD, I AGREE TO CALL THE SCHOOL/ CENTER AND INFORM THE DIRECTOR WITH THE NAME OF THE INDIVIDUAL I AUTHORIZE TO PICK UP MY CHILD. I AGREE TO PROVIDE THE PARKS AND RECREATION DIVISION WITH THE NAMES OF INDIVIDUALS I AUTHORIZE TO PICK UP MY CHILD WHEN I AM UNABLE TO DO SO MYSELF. (SEE NAMES LISTED BELOW.) I REALIZE IT IS MY RESPONSIBILITY TO KEEP THIS LIST UPDATED AND ACCURATE. SIGNATURE OF PARENT OR GUARDIAN DATE AUTHORIZED PERSONS FOR PICK-UP NAME PHONE NUMBERS UNAUTHORIZED PERSONS FOR PICK-UP NAME PHONE NUMBERS Please notify Parks and Recreation Staff of any changes or additions immediately OFFICIAL USE ONLY DATE RECEIVED: STAFF INITIALS:

5 Camp JR Sheriff 2017 Checklist I understand that by signing and returning this document that I have carefully and completely read and agree to the following: I have read completely and understand the rules and regulations regarding summer camp. I have discussed the rules and regulations and explained their ramifications to my child/children who will be attending the camp. I understand that all requested medical, immunization, and all related camp information / paperwork must be supplied and completed at the time of registration. My child: will not require prescription medication while attending camp. will require prescription medication while attending camp, and I understand that all medical forms will be completed by the start of camp. I will follow the Maryland State Certification guidelines regarding prescription medication for my child/children. I understand that certification includes that any prescription sent to camp for my child/children MUST BE IN THE ORIGINAL CONTAINER FROM THE PHARMACIST and ONLY A SINGLE DAY S SUPPLY OF MEDICATION IS PERMITTED TO BE SENT TO CAMP DAILY PER CHILD. My child will be dropped off (signed in) and picked up (signed out) by an authorized adult at the appropriate times. Camp Only: Between 8:00 a.m. and 4:00 p.m. I understand that CCPR is not responsible for items my child/children bring to camp. CCPR contracts for use of Calvert County Public School buses for trip transportation. I understand that I am responsible for providing appropriate materials and supplies for field trips as directed (example: Bag lunches only. No coolers!). Child must wear appropriate clothing and footwear when attending camp. See camp information packet for details. Staff may apply sunscreen to my child if my child asks for assistance. My child can swim and can pass the required swim test. Swim test Must be able to swim the entire width of the pool without stopping and/or touching the bottom. In the event of any informational changes I will notify CCPR staff immediately. By signing below I signify that I agree to follow, abide, and adhere to all camp rules and regulations at all times. Child s Name Camp Location Guardian s Signature Date ****CCPR Staff Signature Date ****

6 CAMPER HEALTH HISTORY Child s Name: The following information is required: 1 st Emergency Contact (Parent or Legal Guardian): 2 nd Emergency Contact (Other than Parent Above): Child s Physician: Phone: Phone: Phone: HEALTH INFORMATION: 1. Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware? NO YES, Explain: 2. Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child s camp experience is positive? NO YES, Explain: IMMUNIZATION INFORMATION: For campers who reside within the United States, a United States territory, or the District of Columbia: 1. State/territory in which child resides: 2. Is this child exempt from any immunizations? [ ] NO [ ] YES, List them: OR For campers who reside outside the United States, a United States territory, or the District of Columbia: 1. Country in which child resides: 2. Attach Department form DHMH-896 (record of vaccination or immunity) Parent or Legal Guardian s Signature: Date:

7 CALVERT COUNTY DIVISION OF PARKS AND RECREATION AUTHORIZATION FOR PRESCRIPTION MEDICATION Does the child require prescription medication during summer camp hours? Yes No If YES, child's physician MUST complete the following: Camp: Child's Name: a.) Condition: Medication: Dosage / Schedule: Special Instructions: Side Effects / Toxic Effects: b.) Condition: Medication: Dosage / Schedule: Special Instructions: Side Effects / Toxic Effects: Only Only those those medications prescribed and and listed listed by by the the physician will will be be accepted. Medications must must be be in in the the original pharmaceutical container and and labeled with with the the camper s s name, name, name name of of medication, dosage, schedule, prescription number, date date filled, and and prescribing physician's name. name. Date of Order: Duration of Order: (If duration is less than current camp program, renewal of order may be necessary.) I hereby authorize the camp staff to dispense these medications as prescribed. Printed Name of Physician Phone Number Signature of Physician Date 35

8 CALVERT COUNTY DIVISION OF PARKS AND RECREATION MEDICATION RELEASE FORM PARENT OR LEGAL GUARDIAN: PLEASE COMPLETE AND SIGN IF THE CAMPER REQUIRES MEDICATION DURING CAMP HOURS. I,, the parent/guardian of hereby request that identified members of the camp staff be caretakers of medication and administrators of prescribed medication for the camper named above and as prescribed by my physician Physician's Name Physician s Phone Number I understand that members of the camp staff will be instructed to take any medication from the camper upon arrival at the camp and secure it in a safe location. I understand that at a prescribed time, a staff member will retrieve the medication and hand it to the camper in the container. The staff member will then watch the camper take the medication. I also understand that the staff who will administer this medication are medically untrained. I hereby state, without reservation that I will not hold the Calvert County Division of Parks and Recreation, or any of their employees and volunteers liable for any harm or injury which may be incurred by the camper in connection with this medical assistance, or damage/loss of medical equipment. Signature of Parent/Guardian Date

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