GROWING GREAT KIDS Summer Camp Brochure YMCA CAMP LAKEWOOD. REFERRAL PROGRAM SAVE $100 OFF CAMP (see page 9 for details) Find us online!

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1 NONPROFIT ORG. U.S. POSTAGE PAID ST. LOUIS, MO PERMIT NO GROWING GREAT KIDS YMCA Mission: To put Christian principles into practice through programs that build healthy spirit, mind and body for all. REFERRAL PROGRAM SAVE $100 OFF CAMP (see page 9 for details) YMCA CAMP LAKEWOOD State Highway AA Potosi, MO A United Way Agency Find us online! 2015 Summer Camp Brochure YMCA CAMP LAKEWOOD

2 WELCOME TO YMCA CAMP LAKEWOOD! YMCA Camp Lakewood is where kids come in the summer time to have fun, learn new skills, make new friends, and to simply be kids. Your camper will forget all about television, video games, and smart phones while discovering the ultimate childhood experience, all within a safe and trusted environment. Camp Lakewood provides a wellrounded experience for campers and gets them outdoors to connect with nature. With a 360acre lake, over 5,000 acres of forestcovered hills, caves, creeks, and more, there are many opportunities for natural exploration and experiential learning. Whether it s campfires, swimming, archery, climbing tower, zip line, sports, canoeing, cookouts, fishing, kayaking or a multitude of camp games, every camper delights in waking up with a renewed sense of excitement as to what new activities each day at camp will bring. We welcome boys and girls of all nationalities and denominations, and pride ourselves on the cultural diversity of our campers and counselors. Camp Lakewood counselors are chosen for their maturity, skills, patience, enthusiasm and desire to nurture the potential of the children and teens who participate in the Y s long tradition of summer residential camping. The health and safety of each camper is our primary concern. All staff are trained in skills that emphasize safety, youth development and group dynamics. Each counselor is trained in CPR and first aid, and all waterfront activities are closely supervised by waterfront staff who are lifeguard certified. A medical professional is always available in our wellequipped camp infirmary, and our local physician is on call to assist in emergencies. What does it mean when everyone at Camp Lakewood says it s, My Camp!? It means every one of our campers has a home away from home. It means every one of our campers has a special place where they can try new things without being judged. It means every camper knows a place where they have friends, where they feel safe, happy, and wanted. It means every one of our campers has a camp, their camp, and they know the camper sitting next to them feels the exact same way. It means they are an important part of YMCA Camp Lakewood. So when asked, Whose camp is this? we are so happy to hear them say... My Camp! 2015 OPEN HOUSE DATES AT YMCA CAMP LAKEWOOD YMCA Camp Lakewood is located 75 miles south of St. Louis between Potosi and Steelville, Missouri. Sunday, March 29, 2015 from 14 p.m. Sunday, April 12, 2015 from 14 p.m. Sunday, April 26, 2015 from 14 p.m. Sunday, May 3, 2015 from 14 p.m. Did you know that YMCA Trout Lodge is just next door? Ask us about staying at Trout Lodge during our Camp Lakewood Open House weekends.

3 4DAY SUMMER CAMP PROGRAMS Page 2 RANCH CAMP (4day, 3night) Coed ages 1316 Come to the Triangle Y Ranch for 4 days of handson equestrian training! Ranch Campers will form their own special cabin group and spend all day, everyday at the ranch working with our highly experienced staff. Participants will advance riding skills while learning advanced horse care, history and ranch management. Campers will spend one night out under the stars. MINI CAMP (4 days, 3 nights) Coed ages 68 Days at Mini Camp are filled with games, pony rides, arts and crafts, nature, swimming and more. It is a closely supervised introduction to camping with lots of individual attention for firsttime campers. Cabin groups experience many of camp s activities together, but kids also have the opportunity to choose a few activities on their own. We maintain a ratio of at least one counselor per four campers. Understanding this is possibly a child s first time away from home, our caring staff keeps the new camper safe and happy. Since these programs are shorter, they have their own unique, individual schedules tailored to the needs of the age group. Campers may experience some of the clinics and activities offered for their age group, but not all will be provided. TWEEN CAMP (4 days, 3 nights) Coed ages 910 Tween Camp is a fun, exciting and safe way to introduce your camper to a residential camp experience. Swimming, archery, arts & crafts, and campfires are just a few of the activities your camper will enjoy. Tween Camp is designed for the 910 year old first time camper to try Camp Lakewood for just 4 days. All campers are the same age so every activity is geared for them. PRETEEN CAMP (4 days, 3 nights) Coed ages 1112 Has your camper ever wondered what s on the other side of the lake or heard the legend of the 97 stairs? Well now they can find those answers out for themselves as they enjoy a taste of East Camp and all the excitement across the lake. Your camper will stay in the original camp cabins located on East Camp Hill, complete with bathhouse, pavilion and the throwback camping we all loved as kids ourselves. This is a great introduction to East Camp for preteen campers.

4 TRADITIONAL SUMMER CAMP PROGRAMS Page 3 MAIN CAMP (1week) Coed ages 812 Main Campers have the opportunity to choose from so many great camp activities, such as archery, arts & crafts, canoeing, caving, fishing, flag football, floor hockey, outdoor living skills, singing, snorkeling, soccer, yoga, cabin and unit games, and so much more. Upon their arrival each camper is welcomed by our caring staff and introduced to their cabinmates for the week. Campers gather as a cabin each day to play, learn, bond, and make lifelong friendships. Main campers lodge in climate controlled cabins with indoor plumbing. Each cabin group will also venture into the outdoors for an overnight where they sleep under the stars and cook a meal over a campfire. EAST CAMP (1 week) Coed ages East campers days are filled with lots of camp games and activities, friendship, and fun, while under the watchful eye of the Camp Lakewood staff. Our goal is to help campers grow into great individuals while learning about the core values of character development. Although this is a time to make an impact on a teenager s life, it is also a time to relish the joys of being carefree and young. Campers have the opportunity to have as much fun as they possibly can. Your teen will stay in the original rustic camp cabins and use a centralized bathhouse with restrooms and showers. Each cabin will also venture into the outdoors for an overnight where they sleep under the stars and cook a meal over a campfire. page 3

5 ADVENTURE PROGRAMS Page 4 JUNIOR RANGER (1week) Coed ages 1012 The Junior Ranger program is a wonderful program for campers who enjoy spending all of their time outdoors, have experience in camping outside, or are a returning camper who wants to try something new. Junior Rangers learn campfire cooking, shelter building, how to work as a team and many more outdoor living skills. A majority of the Junior Rangers time is spent learning their ranger skills away from the everyday life of traditional camp, but they do get to experience a tiny bit of camp by choosing two clinic options for the week (see clinics on page 7). Junior Rangers spend each night of camp sleeping under the stars. RANGER (1week) Coed ages 1315 The Ranger program is designed to help campers gain valuable wilderness skills in their brand new Ranger Village. Each camper is taught to cook over an open fire, build shelters and travel as part of a team. Rangers explore the outer limits of camp, basics of group travel, trip planning, and Leave No Trace outdoor ethics under the guidance of our experienced staff. Ranger campers spend each night of camp under the stars.

6 TRAILBLAZER PROGRAMS Page 5 HIKING THE OZARK TRAIL (1week) Spend a week with our experienced staff exploring the Missouri wilderness along the Ozark Trail. Campers will learn the basics of wilderness hiking, including the proper technique for packing a backpack, planning a menu, outdoor cooking, and Leave No Trace outdoor ethics. The group will then set out on a 4day, 3night hike on the Ozark Trail in southern Missouri. Campers will be surrounded by the natural beauty of the foothills of the Ozark Mountains. This trip is a great way to explore our natural world and make some great friends along the way! CANOEING IN MISSOURI (1week) Explore the beautiful and scenic waters of one of Missouri s finest rivers. Spend a week exploring the river in canoes while learning paddling techniques, Leave No Trace outdoor ethics, cooking over a campfire and making new friends. With plenty of excitement and natural splendor, this trip is a great way to explore the hidden adventurer within us all. ROCK CLIMBING IN SOUTHERN ILLINOIS (1week) This weeklong adventure trip with our professional staff will lead campers through the basics of rock climbing. Campers will learn simple knot tying, camping gear basics and wilderness skills while at base camp. Then they will travel to beautiful Southern Illinois to experience some of the Midwest s best climbing. Campers will use Giant City State Park as a base camp for bouldering, rock climbing and rappelling. They may use their own harness or belay gear, and may bring climbing shoes and chalk bags. Coed ages 1517 Trail Blazer Trips take our campers to new locations for unique experiences in the outdoors.

7 LEADERSHIP PROGRAMS Page 6 COUNSELORS IN TRAINING (CIT) (4 weeks) Coed, must have completed your junior year of high school The CIT program offers our oldest campers the opportunity to get a head start on training skills they will need to someday become a summer camp counselor. The 4week course begins with a week of intensive child care skill training, followed by a week of program training, and ends with two weeks of shadowing camp s best counselors in our youngest cabins. This is a highly rigorous program, and all interested campers must complete an application, interview and reference checks to be considered for the program. Applications are available for download at under Camp Programs. Note: Applications are due by April 1st. Last day for an interview is on April 8th. Announcements about acceptance in the program will be ed to parents/guardians on April 10th. Going through this program does not guarantee hire for next summer as a cabin counselor. LEADERS IN TRAINING (LIT) (3 weeks) Coed, must have completed your sophomore year of high school The LIT program is a challenging camp experience designed for campers looking to become better leaders and to build skills in cooperation, problem solving and communication. The program encourages teens to discover their personal potential and emphasizes the importance of selfreliance. The threeweek experience begins with training and teambuilding, a hiking trip in the second week, and during the third week, campers will put their new skills to the test as they take leadership roles back at camp and complete a service project for camp. page 7

8 CLINICS Page 7 Campers choose four learning activities called clinics during a oneweek stay. Each clinic runs for about an hour, five days a week. Some activities count as two clinics. Through these activities, we coach sportsmanship, courage, healthy risktaking, independence, goal setting, flexibility, responsibility, and selfdiscovery. We aim to nurture the potential of every camper. Some activities are restricted by age, height or swimming ability. Camp has more activities than a camper can visit in a session. Due to factors such as age, weather and program choices, your camper will have an active week, but will not do every activity listed below. There will always be something to look forward to during their next summer at camp CLINIC ELECTIVES FOR YMCA CAMP LAKEWOOD The clinics listed below are examples of usual clinics offered each summer. Clinics change depending on staff skills and popularity from session to session. AGES 810 Archery Arts & Crafts Basketball Canoeing* Cricket Drama Drawing Fishing Flag Football Floor Hockey Friendship Bracelets Frisbee GaGa Nature Outdoor Living Skills Poms Singing Snorkeling AGES 1112 Soccer Spelunking/Caving Swimming Tennis Volleyball Yoga * denotes an activity requiring a camper to demonstrate a certain level of swimming ability necessary for safe participation All activities listed for 810 plus: Climbing Riflery Kayaking* Rugby AGES 13 AND UP All previously listed activities plus Windsurfing*

9 ELECTIVES Page 8 Electives are additional, specialized clinics that campers may choose to attend everyday during their stay. Campers are given time for four clinics per day, and elective programs run through two of those daily clinics. Even if a camper chooses an elective program, they will still have time everyday to participate in other clinics such as canoeing, sports, swimming, etc. Note: There is an additional charge for electives. Equipment will be provided by camp. Campers are not required to choose an elective. ANIMATION CAMP (1week) Coed ages This special elective meets during two of the four clinic periods each day as campers learn the basic techniques of digital filmmaking through stop motion animation. Participants will create their own stories which they then shoot and edit, all under the supervision of experienced digital film makers. Every camper will complete at least two short films by the end of the week! Finished products can be viewed at HIGH ADVENTURE CAMP (1week) Coed ages Available only to East Camp campers East Campers can reach for new heights with this elective program. Taking advantage of many high adventure courses YMCA of the Ozarks has to offer, participants will spend two clinics every day testing their climbing skills under the supervision of our Teamworks staff. Campers will learn climbing knots, advanced climbing techniques, rappelling, and belay skills, and even some night climbing as they navigate our courses and reach for the sky. High Adventure Camp meets two clinic periods a day and still allows campers to choose two additional clinics. HORSEMANSHIP (1week) Coed ages 1016 This elective meets during two of the four clinic periods each day. Grooming, saddle, bridle, anatomy of the horse and Western riding are all taught in this introduction to horses and their care. Learn about breeds and characteristics, riding positions, commands, walking and trotting. There is an additional charge for Horsemanship. Campers who participate in Horsemanship are still active in the Camp Lakewood experience. SNAG (Starting New At Golf) (1week) Coed ages SNAG is a golf instruction program that is sweeping the nation. Suited for all starting players, SNAG teaches players the basic skills needed to enjoy a lifetime of golfing. Campers will work with professional golf instructors from Fourché Valley Golf Course and will receive two periods of instruction each day. NEW ELECTIVES FOR 2015 ADVANCED ARTS & CRAFTS (1week) Coed ages 8 16 Calling all crafters! Be crafty and creative while you unleash your inner artist in Advanced Arts & Crafts! Each camper will get to paint two ceramic pieces, make two candles, create two tie dye shirts, construct a stepping stone, and design jewelry pieces. Advanced Arts & Crafts meets two clinic periods a day and still allows campers to choose two additional clinics. DIGITAL JOURNALISM (1week) Coed ages Do you like making videos, doing interviews or writing scripts? During this special elective, campers will spend their time working as a production team to write, shoot, edit and produce Camp Lakewood s very first daily news show. Whether your camper is interested in being behind or in front of the camera, there s an opportunity to learn each part and develop their skills. Each camper will produce at least two segments by the end of the session. Digital Journalism meets two clinic periods a day and still allows campers to choose two additional clinics. PAINTBALL (1week) Coed ages Available only to East Camp campers This funfilled, adrenalinepumping special elective will focus on individual/team tactics and strategies, problemsolving, group communication and team building. Whether you re brand new to paintball or an expert, this program offers a wide variety of different games guaranteed to ensure everyone has a great time. We provide paintball markers, paint and protective equipment. This special elective meets for two of the four clinic periods.

10 DAILY SCHEDULE Page 9 7:00 a.m. Wake Up 7:50 a.m. Flag and Morning Watch 8:00 a.m. Breakfast 8:40 a.m. 1st Clinic 9:40 a.m. 2nd Clinic 10:40 a.m. Cabin Activity /Swim Time /Unit activity 12:00 p.m. Lunch 12:40 p.m. Siesta 1:40 p.m. Smorgasbord* /All Camp Game /World Service Carnival 3:00 p.m. Pop Stop** 3:45 p.m. 3rd Clinic 4:45 p.m. 4th Clinic 5:50 p.m. Flag and Evening Watch 6:00 p.m. Dinner /Overnights 7:00 p.m. Unit Activity /All Camp Game /Cabin Activity 9:00 p.m. Lights Out for Main Camp 10:00 p.m. Lights Out for East Camp *Smorgasbord is a time during the day when campers choose from an array of activities offered by staff, allowing them to experience more than their four clinic choices. Swimming is always an option during this time except during RECRUIT NEW CAMPER FOR SUMMER 2015 AND RECEIVE $100 OFF YOUR RETURNING CAMPER S PROGRAM FEE! inclement weather. WOW **Pop Stop is snack time when campers have the option of getting one drink and one snack from the Trading Post. page 10 New camper cannot be in the same household. New camper has to list only your camper on the Referred By line when signing up. Credit only applies toward cost of program fees. Discount will not be applied until new camper has registered and listed your camper on the referral program line of their registration form. Credit will not be extended beyond the value of your child or children s program fee. Referral credit will be awarded on a firstcome basis; if two families refer the same camper, credit will be awarded to the family whose form is received first at the camp office. Credit will be split for forms that arrive in the mail on the same day. Credit cannot be transferred to children of other families. What a great savings!

11 REGISTRATION INFORMATION Page 10 PRICING TIERS We realize families have differing abilities to pay, so we offer a voluntary threetiered pricing program for Traditional Main Camp and Traditional East Camp. The price you choose in no way influences the quality of experience each child receives. The Actual Cost to send a child to camp includes direct expenses and longterm wear and tear. The Partially Subsidized rate is available for families who can pay a little more and more accurately accounts for the true direct cost of camp. The Subsidized Rate does not reflect the true cost of camp. As always, we still offer scholarships to those who qualify to ensure that all children have this wonderful opportunity. PROGRAM PRICING Please review the pricing descriptions above before selecting your pricing option. Y members receive a $45 discount from the listed prices. Program Traditional Main Camp Traditional East Camp Mini Camp Tween Camp PreTeen Camp Ranch Camp Junior Rangers Ranger Trail Blazer Trips Leaders In Training (LIT) Counselor In Training (CIT) Actual Cost $625 $625 $335 $335 $335 $335 $625 $625 $725 $1200 $1200 Partially Subsidized $575 $575 $575 $575 $675 Fully Subsidized $525 $525 $525 $525 Animation Elective Sessions: 1 5, 8 10 (optional for Explorer and East Camp ages 1116)... $ 99 Advanced Arts & Crafts Elective Sessions: 1 5, 8 10 (optional for Main, East Camp, Jr. Rangers ages 816)... $ 99 Digital Journalism Elective Sessions: 1 5, 8 10 (optional for Explorer and East Camp ages 1116)... $ 99 High Adventure Elective Sessions: 3, 8 (optional for East Camp only ages 1316)... $149 Horsemanship Elective Sessions: 1 5, 8 10 (optional for Main, East Camp, Jr. Rangers ages 1016)... $149 Paintball Elective Sessions: 1 5, 8 10 (optional for East Camp ages 1316)... $200 SNAG (New at Golf) Elective Sessions: 1 5, 8 10 (optional for Main, East Camp, Jr. Rangers ages 1116)... $ 60 SESSION DATES Session 1... May 31 June 6 Session 2... June 7 13 Session 3... June Session 4... June PROGRAMS Traditional Main Camp (ages 812) 1week sessions: 1, 2, 3, 4, 5, 8, 9, 10 Traditional East Camp (ages 1316) 1week sessions: 1, 2, 3, 4, 5, 8, 9, 10 Mini Camp (ages 68) 4day session: 6, 7 Tween Camp (ages 910) 4day session: 11 Session 5... June 28 July 4 Session 6... July 5 8 Session 7... July 8 11 Session 8... July PreTeen Camp (ages 1112) 4day session: 6 Junior Ranger (ages 1012) 1week sessions: 1, 3, 5, 9 Ranger (ages 1315) 1week sessions: 2, 4, 8, 10 Ranch Camp (ages 1316) 4day session: 6, 7 Session 9... July Session July 26 August 1 Session August 2 5 Trail Blazer Trips (ages 1517) Climbing trip 1week session: 5 Hiking trip 1week session: 3 Canoeing trip 1week session: 8 Leaders In Training (LIT) Must have completed sophomore year in high school 3week program: 2/3/4, 8/9/10 Counselor In Training (CIT) Must have completed junior year in high school 4week program: 1/2/3/4, 67/8/9/10

12 REGISTRATION INFORMATION Page 11 CONFIRMATION As soon as your registration form (which is included in this brochure and can also be found on our website at ) and deposit are received and processed, we will mail or you a Parent Packet. Registrations are processed in the order they are received. If the session you prefer is filled, we will contact you to determine if you ll enroll in another session or be placed on the waiting list. If you register for camp online, your letter will arrive electronically. PARENT INFORMATION PACKET You will receive health forms (doctor s signature required), personal information forms, and a clothing list for each child registered for YMCA Camp Lakewood. You will also receive our Parent Handbook, which will provide you with useful information regarding your child s camping experiences. If you register for camp online, your packet will arrive electronically. Forms can also be found on our website at parentpacket. Please return your forms at least three weeks prior to your camper s session to ensure the smoothest checkin possible. FINANCIAL ASSISTANCE To ensure that any child can attend camp regardless of financial limitations, YMCA Camp Lakewood provides assistance through our Endowment Funds and the YMCA Strong Community Campaign. For information on receiving financial assistance, contact your local branch of the YMCA of Greater St. Louis or the Camp Lakewood office. To contribute to our scholarship fund, please contact the camp office at ext ELECTIVES Costs for electives are in addition to regular camp fees. INCLUSION SERVICES The YMCA welcomes and encourages individuals of all abilities to experience Camp Lakewood. Our Inclusion Services Department takes applications and conducts assessments. This process provides us with the information needed to allow us to arrange for appropriate staffing or other reasonable accommodations. Parents/guardians must notify Camp Lakewood by May 1 st to ensure that the YMCA has time to evaluate and prepare appropriately for your camper s visit. Providing accurate information regarding a child s needs is an important part of the application process. Any inaccuracies or omissions on the application will put the camper s participation in YMCA programs in jeopardy. Because of the generous donations to our Capital Campaign, Camp Lakewood s cabins and lounge are more accessible than ever for children with disabilities. Call the Lakewood office at ext. 572 for more information. TIPS FOR A SMOOTH REGISTRATION PROCESS We do not have a registration deadline, but you should register early space is limited and sessions fill quickly. Online registration is the quickest method you can use. We do not take registrations over the phone. Sending all required forms in early makes the checkin process go very smoothly. In order to get your child s health form in on time, make sure you schedule your child s physical early! Your child will need a physical within 12 months of attending camp. The YMCA is an inclusive, familyfriendly organization. We expect all our members, program participants and guests to model our core values caring, honesty, respect, responsibility, faith in their conduct and language. The YMCA has the right to deny applications for individual or family memberships or participation in programs and to terminate or suspend existing individual or family memberships or participation in all YMCA programs or activities at our sole discretion if actions or behaviors are not deemed to be in the best interests of the organization. If a membership or program is terminated or suspended, all fees already paid will be forfeited. The YMCA has sole discretion to reinstate members and participation privileges in YMCA programs and activities. page 11

13 2015 REGISTRATION FORM Page 1 Page 12 Please print legibly. You may also register online at. 1 CAMPER INFORMATION Last Name: First Name: M.I.: Nickname: Sex (circle one): M F Birth date: Years at Camp Lakewood including Summer 2015: Home Address: City: State: Zip: School attended in : Grade: Is camper a YMCA Member? q Yes q No If Yes, which branch? (In order to receive member discount, you must enclose a copy of membership card or letter from YMCA branch as proof of membership.) How did you hear about Camp Lakewood? Referral Program (see page 9) Who referred you?: (Please provide camper s name) 2 PARENT/GUARDIAN INFORMATION How would you prefer to be sent the Parent Packet? q Via (The packet will be sent to the 1st parent address.) q Via postal mail 1st Parent/Guardian s Name: Relationship: Home #: ( ) Work #: ( ) Cell #: ( ) 2nd Parent/Guardian s Name: Relationship: Home #: ( ) Work #: ( ) Cell #: ( ) With whom does the child reside? 3 CABINMATE REQUEST Last Name: First Name: Only ONE cabinmate request is allowed. TO GUARANTEE the request, the campers must request each other, be within one year of age, be the same gender, and enrolled in the same program and session. NOTE: If there are 10 or 12 children who would all like to be together, ask about the possibility of booking an entire cabin. 4 BUS INFORMATION All buses pickup and return campers to the South County YMCA in St. Louis. q Round Trip Bus $60 q Bus to Camp Only $30 q Bus from Camp Only $30 q No Bus

14 2015 REGISTRATION FORM Page 2 Page 13 5 INCLUSION SERVICES AVAILABLE YMCA Camp Lakewood welcomes participation by children of all abilities. All children with any type of diagnosis and/or specialized documents will be referred to the Inclusion Services Department for assessment. For more information, contact YMCA Inclusion Services at Has your child been diagnosed with (please check): q ADD/ADHD q BiPolar Disorder q Down s Syndrome q OCD q Rett s Syndrome q Asperger s q ODD q Cerebral Palsy q Fragile X q Tourette s q Autism q DD q MR/ID q PDD q Other: Are there any behavioral medications or psychological issues of which the camp should be aware? q Yes q No If yes, please describe: Are there any physical limitations that might hinder the camper s participation in camp events? q Yes q No If yes, please describe: Does your child have an IEP, Section 504 Student Accommodation Plan, or Behavior Management Plan? q Yes q No Does your child currently use YMCA Inclusion Services? q Yes q No If so, which branch? *Please note, you MUST submit a current IEP/BMP/Section 504 Student Accommodation Plan with this registration form and complete and return the Inclusion Information Forms before program participation is authorized. Forms must be received by the camp office at least 4 weeks prior to participation. Enrollment will NOT be considered final until all required processes have been met and reviewed. Although every effort is made to provide reasonable accommodations, there may be instances where a child s needs may exceed the parameters of the scope of our program. All camp forms are available to download at under Summer Resident Camp, Parent Forms. 6 ALLERGIES Does your child have any allergies? q NO KNOWN ALLERGIES q THIS CHILD IS ALLERGIC TO: Describe here what the camper is allergic to and the reaction seen: 7 DIET Check those which apply. We can work effectively with most medically prescribed diets but cannot cater to individual food preferences. Please call if you have a question about diet. q This camper eats a regular and varied diet q This camper is lactoseintolerant of this type (select one): q This camper uses a product like Lactaid and/or can selfmanage the intolerance q This camper needs lactosefree diet that includes no lactose in baked items (ie. breads, cookies, etc.) q This camper is a vegetarian of this type (select one): q Semivegetarian (no pork or beef) q Lactoovo (no beef, pork, chicken, seafood or fish) q Pesco (no pork, beef or chicken) q Vegan (no meats, eggs or dairy) 8 MEDICATIONS The medications listed below, stocked in the YMCA Camp Lakewood TLC, are used to manage illness or injury, and dispensed as directed by our medical protocols. Check those which your camper should NOT be given: q Acetaminophen q Aleve q Aloe Vera After Sun q Benadryl q Caladryl q Calamine Lotion q Chloraseptic Throat Spray q Generic Cough Drops q Generic Cough Syrup q Ibuprofen q Immodium AD q Ivy Dry q Maalox q MultiSymptom Cold Tablets q Mylanta q Nighttime Cold Formula q Pepto Bismol q Silvadene (burn cream) q Sudafed q Swimmer s Ear q Tinactin q Triple Antibiotic Cream q Tums

15 2015 REGISTRATION FORM Page 3 Page 14 9 CHRONIC CONCERNS q This camper has NO chronic health concerns and is capable of full participation in this program q This camper has the following chronic health concerns (select all that apply): q Asthma/Wheezing/Shortness of Breath q Sleepwalking q Frequent ear infections q Diabetes q Headaches q Menstrual Cramps q Frequent colds q Bedwetting q Other (describe): Provide information about supportive health care needed for each checked item: 10 PARTICIPANT AGREEMENT / REFUND POLICY I verify to the best of my knowledge that everything on the registration is correct and the child is capable of such an experience. I recognize failure to disclose, falsification or deliberate omission of information will result in termination of services. I agree to pay the balance of the program fees by May 1. The deposit is not refundable or transferable under any circumstances. Fees are not refundable without a doctor s authorized medical reason (this excludes behavioral or psychological issues). No refunds will be issued unless cancellations are made at least four weeks prior to arrival. I understand that no refunds are given if a child leaves early because of home sickness or for disruptive behavior as determined by the Director. I grant permission for the camper to participate in all planned program activities including outofcamp trips by van or bus, hiking or horseback riding, understanding that competent leadership is provided. In case of accident or illness, the YMCA is authorized to secure emergency medical treatment. Prudent attempts will be made to contact parents immediately. I understand the related expenses for this medical attention will be (my) the camper s responsibility. The YMCA is not responsible for lost, stolen or damaged personal articles. I also authorize the YMCA to have and use photographs, slides, or video tapes of the camper named on this registration for promotional purposes and web site session photos (if you do not wish your child to be photographed, please check the box below). I agree to waive any claims against the YMCA, its staff, and volunteers for injuries or damages that may result from the conduct of other persons including participants in YMCA programs. Parent/Guardian Signature: Date: q I do not wish my child to be photographed. (Note: No pictures of your child will appear when camp photos are taken and uploaded) 11 SESSION CHOICE Please enroll camper in the following session (if enrolling in more than one session, please include both sessions & programs): Session #: Program: Session #: Program: If camper is attending consecutive sessions, will they be staying over between sessions? q Yes q No (If yes, please add $50 for each stay over) 12 ELECTIVE CHOICE (Optional) q Animation Elective Sessions: 1 5, 8 10 (optional for Explorer and East Camp ages 1116)... $ 99 q Advanced Arts & Crafts Elective Sessions: 1 5, 8 10 (optional for Main, East Camp, Jr. Rangers ages 1116).. $ 99 q Digital Journalism Elective Sessions: 1 5, 8 10 (optional for Explorer and East Camp ages 1116)... $ 99 q High Adventure Elective Sessions: 3, 8 (optional for East Camp only ages 1316)... $149 q Horsemanship Elective Sessions: 1 5, 8 10 (optional for Main, East Camp, Jr. Rangers ages 1016)... $149 q Paintball Elective Sessions: 1 5, 8 10 (optional for East Camp ages 1316)... $200 q SNAG (New at Golf) Elective Sessions: 1 5, 8 10 (optional for Main, East Camp, Jr. Rangers ages 1116)... $ TRAIL RIDE Valley Trail Ride is a onemile ride designed to show off our beautiful hardwood forest. The trail winds through the peaceful forest and crosses the Fourche Renault Creek. The ride is approximately 30 minutes (depending on the size of the group and weather permitting). Requirements: Ages 7+, at least 44 tall, weight limit of 250 lbs. Not available sessions 6, 7, q $15

16 2015 REGISTRATION FORM Page 4 Page PAYMENT INFORMATION If registering prior to May 1, you may choose to pay the entire balance or a nonrefundable deposit of $100 for each week requested to hold space. The deposit is applied to the total camp fee. If your deposit is paid by credit card, the balance will automatically be charged to your card on May 1. If the entire balance is not paid by May 1, the reservation may be cancelled and the deposit forfeited. If you are registering after May 1, the entire balance is due upon registration. Program Price $ Elective Fee (if applicable) $ Bus Fee (if applicable) $ Trail Ride (if applicable) $ Stay Over Fee (if applicable $50) $ Donation to help send an underprivileged child to camp (optional) $ Multiple Child Discount (if applicable $35 will be applied toward the balance for your 2nd, 3rd, etc. child) $ YMCA Member Discount (if applicable $45 will be applied toward the balance for YMCA members) $ Total Amount Due $ Less Deposit Amount Enclosed ($100 for each week requested) $ Balance Due Before May 1 $ Method of Payment: q Check enclosed, payable to YMCA of the Ozarks. Please include driver s license number and camper s name on check. (A $25 charge will be applied for returned checks.) q Visa q MasterCard q Discover q AmEx Amount to be charged: $ Acct #: Exp.Date: Signature: 15 REGISTRATION INFORMATION Register in one of the following ways (you should receive a confirmation in 710 days): Register online at: registration form with credit card information to: camplakewood@ymcastlouis.org Mail registration form and deposit to: YMCA Camp Lakewood State Hwy AA Potosi, MO Fax registration form with credit card information to: Bring to your local St. Louis YMCA (locations listed at Registrations are processed in the order received in the Camp Lakewood office. For information, call or The Parent Packet with all necessary Camp Lakewood forms can be found online at under Summer Residential Camp. Branch Use: Date Received: Branch: Amount: Receipt #: Initials: Camp Use: Date Received: Check #: Amount: Session #: Initials: