Summer Day Camp. Camp Sea Gull and Camp Seafarer are branches of YMCA of the Triangle

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1 Summer Day Camp 2017 Camp Sea Gull and Camp Seafarer are branches of YMCA of the Triangle 2015

2 Our Staff Camp Sea Gull and Camp Seafarer are committed to providing skilled staff. We proudly recruit staff that come highly recommended and are true role models to the children within our own community. It is of the utmost importance that our staff exemplify the YMCA character traits of caring, honesty, respect, responsibility and faith in God. All staff attend training sessions to prepare and provide the tools needed to facilitate safe, fun and growing experiences for each camper. Our Program As we strive to provide more opportunities for furthering skill development and building character, day campers will follow a daily activity schedule that more closely aligns with that of our traditional resident campers. Day campers will have designated swim instruction each day and will also be given the freedom to choose the activities that interest them. Additionally, they will be given Blue and Green Rank Books to help guide them in meaningful skill development through our progressive Rank System at each activity. This includes learning how to drive a motorboat, sail a Sunfish and even try waterskiing. History has shown us that a longer session provides the optimal skill development environment, therefore we are offering two-week sessions for rising 2nd-8th graders. In an effort to strengthen our commitment to serve our neighbors in Pamlico County, we are reserving 40 of the 50 total spots in each session for Pamlico County residents. The other 10 spots will be available for out-of-pamlico County residents. Approximately one month before the start of each session, if spaces are still available, we will begin notifying and accepting applicants on the wait list to fill the spaces. If you have questions about our programs contact our Camp office,

3 Summer Day Camp 2-week sessions / Rising Grades 2-8 Camp Sea Gull and Camp Seafarer place emphasis on quality staff and safe programs that help to develop strong character, skill and leadership. The Summer Day Camp program offers 2-week sessions where campers play on camp activities, receive swim instruction on a daily basis, participate in assemblies, and have daily devotions with the day camp group. Typical Daily Schedule 7:30-8:30 a.m. Rides In 8:30-9:00 a.m. Opening Assembly 9:30-10:30 a.m. Swim Instruction 10:30-12:30 p.m. Morning Activities & Snack 1:00-1:30 p.m. Lunch* 1:30-4:30 p.m. Afternoon Activities 4:30-5:00 p.m. Change/Pack, Snack 5:00-5:30 p.m. Closing Assembly 5:30-6:15 p.m. Rides Out *Lunch and an afternoon snack are provided by Camp. Please send one snack and a drink with your camper each day. Camp Activities Athletics Zipline Assemblies Riflery Shark Tooth Hunting Nature Arts & Crafts Golf Field Games Tennis Swimming Archery Canoeing Water Slides Fishing Sailing Swim Instruction Motorboating

4 Camp Sea Gull and Camp Seafarer 2017 Day Camp Application Please complete and enclose $25.00 application fee and mail to: Camp Seafarer c/o Day Camp 2744 Seafarer Road Arapahoe, NC Please select the session(s) you are interested in attending: 2-Week Summer Day Camp, Rising Grades 2-8, $ 250 Res* $ 300 Non Res Session 1 June 19 June 30 Session 2 July 3 July 14 Session 3 July 17 July 28 Session 4 July 31 August 11 *Residents of Pamlico County: Resident pricing and placement is available ONLY to families whose primary residence is in Pamlico County OR the children are enrolled in Pamlico County schools, the Arapahoe Charter School, and/or S.W. Snowden Elemantary in Aurora. q My child will need financial assistance in order to attend camp. Please send information. I understand that with this application a $10.00 per session deposit is required when applying for financial assistance. Appropriate fees must accompany sessions indicated above. Up to 3 sessions only. I may apply for financial assistance for 1 session ONLY. Camper s name (first/middle/last) ID# Name called Grade in Fall 2017 School Birth date / / mm dd yy Age at Camp: Years Months q Male q Female Previous Seafarer camper? q No q Yes If Yes, how many years at Camp? Mother/Guardian s name (Dr. Mrs. Ms.) ID# Birth date / / q Former Camper q Former Counselor mm dd yy year or range of years year or range of years (For Office Use Only) (For Office Use Only) Home address City State ZIP Mailing address City State ZIP Occupation Home ( ) Name of Business Cell ( ) Work ( ) Father/Guardian s name (Dr. Mr.) ID# Birth date / / q Former Camper q Former Counselor mm dd yy year or range of years year or range of years (For Office Use Only) Home address City State ZIP Mailing address City State ZIP Occupation Home ( ) Name of Business Cell ( ) Work ( ) Parents are: q Married q Separated q Divorced q Single q Re-married q Widowed Primary contact: q Mother q Father q Other SUPPORT OUR CAMP ANNUAL FUND Program fees only cover 90% of the cost of our programs. Please help us bridge this gap and meet our current and emerging needs by supporting the Camp Annual Fund. YES! I wish to make a tax-deductible donation in addition to my child s registration fee: q $1000 q $750 q $500 q $250 q Other $ Check payment method: q Credit card provided below q Check enclosed q Bill me later q Other PAYMENT OPTIONS: Please see 2017 Youth Program Policies for additional payment/refund terms. Check enclosed (payable to Camp Sea Gull and Camp Seafarer) Please have someone contact me to charge my credit card. q I agree that from Camp Seafarer may be sent to any of the addresses I have supplied on this form. Signature of Parent/Guardian

5 Camper s Name 2017 Health History Form To be completed by parent or guardian Camper s Date of Birth / / Camper s Age at Camp Primary Contact Name: Weight: Height: Mother s Name: Father s Name: Home Phone: ( ) Home Phone: ( ) Work Phone: ( ) Work Phone: ( ) Cell Phone: ( ) Cell Phone: ( ) In the case of separation or divorce, both sets of information are required. If neither parent can be reached, in case of emergency notify Relationship Home Phone: ( ) Work Phone: ( ) ext. Cell Phone: ( ) HEALTH HISTORY: Please check and attach a separate statement regarding potential problem areas: Recurring Strep Throat Heart Disorder Serious Injuries Frequent Ear Infections Sleep Walking Severe Headaches/Migraines Chronic Cough Bed Wetting Hepatitis Asthma/Wheezing Fainting Infectious Mononucleosis Chronic Constipation Seizures Tuberculosis ADD/ADHD Learning Disabilities Kidney Problem/Urinary Tract Infection Chicken Pox - Date of Disease Other Allergic Reactions: (Please give details) Insect Stings Poison Ivy/Oak Drugs Food Other Has your child been evaluated or received treatment or counseling by a psychologist or physician for an emotional or behavioral problem, including hyperactivity? No Yes If yes, on a separate statement, please help us understand how to effectively address these concerns. Are there other special concerns regarding your child s medical history? (attach a separate statement if necessary) NOTE: Please write or call the Camp if your child is exposed to or has contracted any potentially serious communicable diseases (such as chicken pox, hepatitis, meningitis, etc.) during the three weeks prior to Camp attendance. In order to complete the registration process, this form (no substitutions) must be received one month prior to program start date for physician s review. Final acceptance is subject to review by the Camp Medical Committee and the Director reserves the right to rescind enrollment based upon recommendation of medical staff. PLEASE ATTACH A COPY OF THE FRONT AND BACK OF YOUR HEALTH INSURANCE CARD PERMISSION TO EXAMINE, PRESCRIBE MEDICATION AND TREAT: I hereby give permission to the Registered Nurse or Physician selected by the Camp Director to perform routine tests and treatment for the health of my child. In the event of an emergency or other acute event where time will not allow me to be reached, or I cannot be reached, I hereby give permission for the Camp Physician to secure necessary consultative care for my child, including hospitalization, anesthesia, surgery, and other medical treatment. PERMISSION TO DISCLOSE INFORMATION: I agree to allow the Camp Physician or Health Clinic Director to speak with the Camp Director and Camp personnel living or working with my child, regarding any medications my child is taking, as well as specific medical or psychological conditions that may impact my child s daily living. PERMISSION TO RELEASE RECORDS: I authorize the Camp Physician or Health Clinic Director to release any health records related to my child as may be necessary for treatment, referral, billing, or insurance purposes. Signature of Parent/Guardian Date *DTP / DTaP/ DT (circle which) **dt/tdap *Polio (IPV/OPV) ***Hib ****Hepatitis B *MMR (combined doses) *****Chicken Pox Pneumcoccal *Required by State law **Required by State law if child is 11 years old ***Required by State law for children born on or after 10/01/88 ****Required by State law for children born on or after 07/01/94 *****Required by State law for children born on or after 04/01/01 Recommended immunizations in addition to those above required Miningoccal HPV Hep A BCG/IPPD Date of most recent PPD (Mantoux) Test Test results (if indicated by the guidelines published in the most recent Center for Disease Control Redbook)

6 Camper s Name 2017 Behavior Expectations and Discipline Policy It is important that staff maintain good order and discipline in all programs. Top objectives in all Camp programs are safety and a positive atmosphere for learning and developing social skills. Camp Sea Gull and Camp Seafarer make every effort to help children understand clear definitions of acceptable and unacceptable behavior. The Camps do not condone and will not permit: 1. Corporal punishment. 2. Ridiculing, threatening, using inappropriate loud voice. 3. Leaving children unattended. 4. Use of profanity. A child s behavior is expected to be consistent with the following: 1. Use appropriate language at all times. 4. Maintain a positive attitude. 2. Cooperate with staff and follow directions. 5. Stay in program areas running away is not acceptable. 3. Respect other children and staff, equipment and facilities, and 6. Participate successfully within the Camp s staff-child ratios yourself. specific for Day Camp. The Discipline Policy: 1. If a child is unable to comply with the behavior expectations, the Camp Director will hold a conference with the child. The parent(s)/guardian will be notified. 2. If after the above meeting, the child is still unable to comply with the behavior expectations, the Camp Director will set up a conference with the parent(s)/guardian. A behavior contract will be established and signed by the child (if appropriate), parent(s)/guardian and the Camp Director. 3. If the child s behavior continues to be dispruptive and/or unsafe, the child will be subject to suspension or dismissal. 4. Failure of the parent(s)/guardian to attend conference(s) and cooperate will subject the child to suspension or dismissal. Behaviors, which may result in immediate dismissal, include but are not limited to: 1. An action that could threaten or pose a direct threat to the 4. Vandalism or destruction of Camp property or property physical/emotional safety of the child, other children or staff. of others. Prohibited conduct may include, but is not limited to, abusive 5. Sexual misconduct. jokes, insults, slurs, threats, name calling, bullying 6. Possession of or use of alcohol or controlled substances or intimidation. unless under the prescription of a physician. 2. Fighting. 7. Running away. 3. Possession of a weapon of any kind. 8. Biting. Special Circumstances Camp Sea Gull and Camp Seafarer are committed to providing children an opportunity for full and equal enjoyment of the camping experience. If your child appears to have any serious behavioral problems, or special circumstances involving physical, medical, or psychological concerns, the Director should be notified of this now, so reasonable modification can be considered. Children cannot be accepted that do not have the promise of interacting cooperatively, compatibly, and safely with other children. Camping is designed to be a strong influence in the lives of children it serves and typical problems are overcome. Camp Sea Gull and Camp Seafarer recognize that most children s problems are quite normal and correctable through a program of high expectations and positive motivation. However, children with serious behavioral problems should have special guidance concerning their readiness before going to Camp. These problems should be discussed with the Director and the advisability of accepting the child can be determined at this time. The Director reserves the right to decline the application of any child, or send home any child who, according to the Director s discretion, is not a desirable associate for the other campers. If a camper is dismissed due to behavioral/social issues the tuition is not refundable. I have read, understand and agree with the policies stated in this document and have discussed the expectations of behavior with my child. Signature of Parent/Guardian Date

7 Child s Name 2017 Youth Program Policies Waivers/Permissions: 1. I permit my child to participate in activities planned by the Day Camp Director and staff. 2. Field Trips I permit my child to leave Camp on authorized trips under the supervision of the Camp staff. I may review a written schedule of activities to be conducted off the Camp premises. 3. Photography I permit Camp Sea Gull and Camp Seafarer to utilize video-tape, audio or photography materials of myself or dependent children, for the purpose of promotional materials for Camp Sea Gull and Camp Seafarer programs and services. This includes any printed material, broadcast and print advertising, promotional videos and our Camp website which are produced or published by Camp Sea Gull and Camp Seafarer. I understand that my child s name is not published. 4. Transportation I understand and agree that Camp Sea Gull and Camp Seafarer programs will provide transportation for my child 1) to a Camp program from a pre-designated pick up location 2) from a Camp program to a pre-designated drop off location. Camp Sea Gull and Camp Seafarer s liability for my child begins when the child boards a YMCA vehicle and ends when the child exits the vehicle. Under some circumstances, Camp Sea Gull and Camp Seafarer s liability will continue if my child is exiting the YMCA vehicle to participate in a Summer Day Camp Program. Pick up and drop off points will be determined prior to my child attending the Summer Day Camp Program. If the staff encounter circumstances that they perceive as dangerous at the location where my child is scheduled to exit a YMCA vehicle, my child will not be permitted to exit. Medical Treatment Policies: 1. Accident Insurance Participants are responsible for their own accident insurance when using the Camps and when participating in Camp programs off-site. 2. Medication Camps do not normally administer any medication and will do so only when directed in writing by the child s parent(s) or guardian. However, in the event of an emergency in which the parent cannot be contacted, Emergency Medical Staff and Camp Staff may take appropriate action in the best interest of the child. A doctor s prescription must accompany any medications or nutritional supplements. 3. Blood Borne Pathogen Exposure I understand that, while my child is in the care of Camps, if a child is exposed to a body of fluid on broken skin or mucous membrane (e.g. splashing in mouth or eye), from another child, the Camps will contact the parents of both children. They will explain what has occurred, and then provide the names of the attending physician of the source child to the parents of the exposed child. If a staff member has a blood or body fluid exposure from a child, the Camps will provide the name and telephone number of the child s attending physician to the staff member. I have read and agree with the statement and specifically authorize the Camps to release the name and telephone number of my child s physician, and a description of the event to the parent(s) or guardian of any child who is exposed to blood or body fluid or any staff member who experiences such exposure from my child. Program Policies: 1. Babysitting Policy Camp Sea Gull and Camp Seafarer strive to employ the very best staff possible in all of our programs. During staff timeoff or after they are no longer employed with us, these persons are private citizens and are no longer subject to our employment rules and procedures. Camp Sea Gull and Camp Seafarer cannot and do not endorse or recommend its present or former staff members as babysitters to any parent or guardian of any child in any of our programs. Any babysitting arrangements with present or former staff of Camp Sea Gull and Camp Seafarer is separate and independent from any other programs and must be based on the independent investigation, responsibility and judgment of the parent or guardian. I agree that Camp Sea Gull and Camp Seafarer shall not be responsible and will be held harmless from any claims or liability in connection with such babysitting activities. 2. I understand that Camp Sea Gull and Camp Seafarer are not responsible for articles of clothing or personal belongings damaged or missing in transit, loss or theft. Children should not bring money to camp. 3. It is policy of Camp Sea Gull and Camp Seafarer to consider applications and operate programs and facilities in a nondiscriminatory manner. 4. I understand that there are increased levels of risk with any adventure-based program. These programs at Camp Sea Gull and Camp Seafarer include the zipline, giant swing, climbing wall, alpine tower and challenge course elements. My signature below gives my child permission to participate on the activities. Payment/Refund Policies: 1. I understand that a refund of all fees paid (less a $25 processing fee) will be made if Camp receives written notification of cancellation by June 1, 2017 for Summer Day Camp Programs. Thereafter, the fees are not refundable 2. I understand that the total payment of fees for an applicant on the waiting list is refundable if space does not become available. I have read, understand and agree with the policies stated in this document. Signature of Parent/Guardian Date

8 Camp Sea Gull and Camp Seafarer Summer Day Camp Transportation Information Location Rides In (camper drop off) Rides Out (camper pick up) Camp Seafarer Day Camp Area 7:30 a.m. 8:30 a.m. 5:30 p.m. 6:15 p.m. Bus Transportation Options Camp will provide transportation for pre-registered campers at the following locations and times: Departure Arrival Reelsboro Pinedale Food Mart 7:15 a.m. 5:45 p.m. Bayboro Pamlico County High School Cafeteria 7:30 a.m. 5:50 p.m. Oriental Town and Country 8:00 a.m. 6:20 p.m. Aurora Plaza Parking Lot (1st & 3rd sessions) 7:45 a.m. 6:00 p.m. Mesic Mt. Olive Church (2nd & 4th sessions) 7:15 a.m. 5:45 p.m. * Two weeks prior to each session a minimum of 5 participants must be signed up for a drop off and pick up location to confirm that bus stop. You will be notified if a change is made. Traveling by Bus In order to ensure everyone s safety on the bus, the following guidelines are to be followed: A camp staff member will be aboard each bus for supervision. The staff member will check campers on and off the bus; campers must remain on the bus until their ride arrives. Campers are expected to remain seated while the bus is in motion and to exhibit appropriate behavior while on the bus. Please notify our office should your child s plan change regarding bus transportation or if you have any questions CAMP OFFICE (252) or DAY CAMP MOBILE PHONE (252) Our office will be open at 7:00 a.m. and remain open until all campers have been picked up in the afternoon. Please complete the bottom of this form and return to: Camp Seafarer c/o Day Camp 2744 Seafarer Road Arapahoe, NC daycamp@seagull-seafarer.org Summer Day Camp Transportation Camper Name Sessions Attending q Session 1 q Session 2 q Session 3 q Session 4 Please include all adults (18 or over) including parent/guardian, who have permission to pick up your camper. All adults, including parents/guardians, must show a photo ID. Authorized Pick-up: Relationship: Cell/Day Phone: Authorized Pick-up: Relationship: Cell/Day Phone: Authorized Pick-up: Relationship: Cell/Day Phone: Location (please check the location you will drop off and pick up your child) Camp Seafarer Bayboro Oriental Aurora Reelsboro Mesic Bus Transportation (please check all the appropriate times your child will ride the bus) Monday Tuesday Wednesday** Thursday Friday Bus transportation home will not be provided on this day. ** Family Night will be on Wednesday, August 2 at Camp Seafarer. Bus transportation home will not be provided on this day.

9 Summer Day Camp RISING GRADES 2-8 $ 250 Resident $ 300 Non-Resident Session 1 June 19 - June 30 Session 2 July 3 - July 14 Session 3 July 17 - July 28 Session 4 July 31 - August 11 Transportation Transportation to and from central locations in our community are available for those campers who pre-register. In order to ensure everyone s safety, we have camp staff on board each bus for supervision. A minimum of 5 participants must be signed up for a drop off and pick up location to confirm that bus stop. You will be notified if a change is made. Registration Please return the following forms by May 15th to: Camp Seafarer c/o Day Camp, 2744 Seafarer Road, Arapahoe, NC or at daycamp@seagull-seafarer.org. q Application q Health History Form / Insurance Card (copy) q Behavior and Discipline Policy q Youth Program Policies q Transportation q $25 Application Fee You will be notified about your child s enrollment status after we receive his/her completed application packet. Upon acceptance, additional information will be mailed. Financial Assistance Available We believe that every child should have an opportunity to come to camp. Our philanthropic mission is to make Camp Sea Gull and Camp Seafarer experience possible for families from all financial communities. Financial assistance is available for each program offered (Summer Day Camp) and is awarded based on need. Priority is given to Pamlico County and Richland township area residents. For more information on camperships, contact our Camp Development office at