SUMMER CAMP - CAMP STOUGHTON Central Street, Stoughton, MA

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1 SUMMER CAMP - CAMP STOUGHTON campstoughton@oldcolonyymca.org 445 Central Street, Stoughton, MA Text alerts now available! Financial assistance available, ask today!

2 ACTIVITIES Swimming Archery Rope Challenge Arts & Crafts Additional fee LEGO Engineer Theme Days Sports & Games Science Old Colony YMCA Summer Day Camps teach self-reliance, foster a love for nature and the outdoors, and encourage the development of attitudes and practices that build character and leadership...all amidst a fun and creative learning environment. WHEN IS CAMP? HOURS: 9AM-4PM We also offer extended child care from 7-9am and 4-6pm Week 1: 6/18-6/22 Week 2: 6/25-6/29 Week 3: 7/2-7/6 Week 4: 7/9-7/13 Week 5: 7/16-7/20 Week 6: 7/23-7/27 Week 7: 7/30-8/3 Week 8: 8/6-8/10 Week 9: 8/13-8/17 Week 10: 8/20-8/24 TYPES OF CAMP Camp Age/Grade Little Voyager 4 yrs old 1/2 Little Voyager 4 yrs old Pioneer K Navigator 1 Explorer 2 & 3 Adventurer 4 & 5 Maverick 6 & 7 Trailblazer 8 & 9 Counselor In Training 10 Day Trippers 6-9 LEGO Club Add-on For full detail visit us online! WHATS INCLUDED? Bus Transportation from surrounding towns (Except week 10) Recreational Swim & Swim Lessons Arts & Crafts, Library, Science Natures Playground Ropes Course Archery Family Nights Camp T-shirt (Per camper) Outdoor Adventure AND MORE! WANT TO STAY CONNECTED? Text the keyword OCYSUMMER to and opt-in to receive text alerts, news, and promotions about summer camp. By signing up, you agree to receive automated text alerts, news, and promotions from Old Colony YMCA. Consent not required for purchase. Up to 15 messages per month. Reply STOP to cancel, reply HELP for help. Message and data rates may apply. For Terms and Conditions or Privacy Policy visit us online.

3 REGISTRATION FORM A SKIP THE LINE AND REGISTER ONLINE! VISIT Please complete the entire Registration packet for each camper and return it with your non-refundable deposit to: Old Colony YMCA - Stoughton Branch, 445 Central Street, Stoughton, MA <PLEASE NOTE THAT OUR PRIMARY METHOD OF COMMUNICATION IS VIA > CAMPER AND FAMILY INFORMATION Camper s First Name: Camper s Last Name: Date of Birth: / / Age: Grade (as of Fall 2018): Male Female Address: City: Zip Code: School Name/Town: / <PREFERRED COMMUNICATION> *Phone: *We now offer texting communication, sign up with our keyword (see page 2) or sign up on our website! Parent/Guardian 1 Name: DOB: / / Phone 1: Relationship to Camper: Parent/Guardian 2 Name: DOB: / / Phone 1: Relationship to Camper: CUSTODY INFORMATION Is there a court order in regard to the child s custody? Yes No Is there a restraining order in regard to who may have contact with the child? Yes No If you answered yes to either question, a copy of the court order is needed for the child s file. Please attach it to the registration form Attached ARRIVAL & DEPARTURE INFORMATION (Please indicate only one option for each): MORNING ARRIVAL: AM Extended Care (7:00-9:00am) Parent Drop Off at Camp (8:50-9:00am) Arrival by Bus Bus # Stop AFTERNOON DEPARTURE: Parent Pick-up from Camp (4:00-4:15pm) PM Extended Care (4:00-6:00pm) Departure by Bus Bus # Stop Please note: A photo ID will be required by any individual who wishes to pick up or sign out your camper. Please indicate below those persons to whom your child may be released to for dismissal or in case of illness or injury. Your camper will not be released to any persons other than parents/guardians or those indicated below (unless otherwise notified in writing). In cases of emergency or illness, we will call the following contacts in the order they are listed below. TRANSPORTATION/EMERGENCY CONTACTS (in addition to parents/guardians) Contact Person: Preferred Phone 1: Relationship: Preferred Phone 2: Contact Person: Preferred Phone 1: Relationship: Preferred Phone 2:

4 REGISTRATION FORM B Bus schedule Camper s First Name: BUS SCHEDULE Must be 5 years to use camp transportation **Please note, there will be no transportation for week 10 Bus #1 Easton/Holbrook/Brockton A Shaw s Plaza (Depot St.) Easton 8:00am 5:05pm B Tedeschis (Washington St.) Easton 8:10am 4:50pm C Westgate Mall (Modells) Brockton 8:20am 4:40pm D Holbrook High School Holbrook 8:30am 4:25pm E Avon High School Avon 8:40am 4:15pm YMCA 9:00am 4:10pm Bus #2 Randolph/Canton A Randolph High School Randolph 8:00am 5:05pm B Randolph Middle School Randolph 8:10am 4:50pm C Hansen Elementary (Canton) Canton 8:20am 4:40pm D Canton High School Canton 8:25am 4:30pm E Cobbs Corner (Rite Aide Lot) Canton/Sharon 8:30am 4:25pm F West Elementary Stoughton 8:40am 4:15pm YMCA 8:50am 4:10pm Camper s Last Name DROP OFF / PICK-UP Parents/guardians have the option of dropping off or picking up their child to and from YMCA Camp. No child under 12 years old is allowed to walk to/from camp or the bus stop without supervision. Children 12 years and older may walk to and from camp or the bus stop unsupervised after they have provided a signed note from a parent or guardian stating such to the Camp Director. EARLY DISMISSAL: Please send a note with the time you will arrive to dismiss your child. We will gladly ensure that your child has left his/her activity, has gathered his/ her belongings and is waiting for you at the camp office. No camper will be dismissed through the camp office between 3:15-4:00 PM. BUS INFORMATION Bus Transportation is available for all campers 5 years old and up and is included with your camp fee (unless otherwise noted). YMCA Camp provides a bus monitor on each bus. Campers must be supervised by an adult at pick-up and drop-off locations. If an adult is not present, your child will be brought back to the YMCA for pick-up. Please note: Bus routes are subject to change. Bus accommodations will not be confirmed until camp payment is received in full. Please indicate your preferred stop and bus number on the registration form. Busing services are not guaranteed if registration or payment is late. Bus times are approximate. Please allow 10 minutes in the morning and afternoon. Drop off is in reverse order and the departing time from camp is 4:00pm. Bus routes depend on enrollment and are therefore subject to change. If your bus time changes, you will be notified prior to your camp session. BUS PICK UP LATE FEE AGREEMENT: Buses will remain at each stop no longer than 5 minutes. I understand that if I or another person designated as a transportation contact on Form A is late picking up at a stop, I will be charged a fee of $20 per child. I also understand that if I or another transportation contact is late picking up a second time, my child(ren) will no longer be eligible for bus transportation. Parent/Guardian

5 REGISTRATION FORM C ALL PAYMENTS ARE DUE BY 6/16 OR UPON *Space subject to availability REGISTRATION THEREAFTER Camper s First Name: Camper s Last Name CLEARLY PLACE AN X IN THE APPROPRIATE BOX TO INDICATE YOUR CAMP SELECTIONS CAMP 18 AGES WEEK 1 WEEK 2 WEEK 3 6/19-6/22 6/25-6/29 7/2-7/6 WEEK 4 7/9-7/13 WEEK 5 WEEK 6 7/16-7/20 7/23-7/27 WEEK 7 7/30-8/3 WEEK 8 8/6-8/10 WEEK 9 WEEK 10 8/13-8/17 8/20-8/24 MEMBER FEE PER WEEK* YOUTH DEVELOPMENT CAMPS Little Voyager 4 yrs old $250 $285 Little Voyager 4 yrs old $150 $185 1/2 day (9am-1pm) Pioneer Navigator Explorer Adventurer Maverick Trailblazer Counselor-in-Training Day Trippers LEGO Club Add On ON-MEMBER FEE PER WEEK* K $250 $285 Grade 1 $250 $285 2 & 3 $250 $285 4 & 5 $250 $285 6 & 7 $250 $285 8 & 9 $250 $ Four weeks ($450 mem/$550 non) Four weeks ($450 mem/$550 non) N/A N/A 6-9 $350 $425 $85 up-charge TOTAL NO. OF WEEKS TOTAL AMT. DUE BEFORE & AFTER CAMP EXTENDED CARE Extended Care AM $55 Extended Care PM 5-12 yr olds $55 Extended Care AM & PM $85 CAMP APPAREL (Please indicate desired size. All campers receive a free t-shirt) T-shirts Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large PAYMENT POLICY All payments are due in full by June 16th or upon registration thereafter. Prior to June 16th, if you are not paying in full, a $60/week per child deposit is required. At that time, you will be asked to set up auto charge payments. If this is not desired, please keep in mind, the remaining balance is due on June 16th. Please note that your child will not be able to attend camp until all of the required documents and payment in full has been collected. See parent handbook for full payment policy. HELP A CHILD DISCOVER SUMMER! Give a child an opportunity to climb new heights. I WOULD LIKE TO DONATE TO SEND A CHILD TO CAMP Camp Donor $20-99 Camp Benefactor $ Camp Friend $ Camp Supporter $1,000+ DONATION PAYMENT METHOD Please enclose a separate check made payable to Old Colony YMCA. To pay by credit card or set up a recurring donation, please contact, Danielle Kucinski, Camp Director at PAYMENT OPTIONS CHECK ALL THAT APPLY I have a voucher (please attach) Pay in Full I am applying for a campership Deposit Only: (attach completed application) ($60 per camper/per week) Check Enclosed I will pay by credit card at the camp (Note: Do not enter your credit card number on this form) Auto Charge (All payments must be received by 6/16) Choose the billing option that works for you! Pay your balance in weekly or even monthly installments you have chosen until 6/16! *First payment will be required at point of sale. TOTAL DONATION AMOUNT: $ First & Last Name: : Date: STAFF USE ONLY! Copy of information sent to Mission Advancement Office Member # Date Staff Initial TOTAL AMOUNT DUE LESS DISCOUNTS / DEPOSITS Sibling Discount $15/week per additional child Buy 4 weeks of camp, and receive 20% off additional weeks (per child; full-pay only by 6/16) *Week 1 must be a full week Gift Certificate / Coupon / Other Please attach and submit. TOTAL BALANCE DUE Date $ - $ - $ - $ $

6 REGISTRATION FORM D PLEASE NOTE: You must include your child s current immunization / physical records signed by a physician. HEALTH INFORMATION/MEDICAL INFORMATION & EMERGENCY CONTACT INFORMATION Please indicate which session(s) camper will be attending: Camper s First Name: Camper s Last Name: Date of Birth: / / Age (as of 9/1/18): Grade (as of Fall 2018): Male: Female Parent/Guardian 1 Name: Parent/Guardian 2 Name: Preferred Daytime Phone (1): Preferred Daytime Phone (1): Preferred Daytime Phone (2): Preferred Daytime Phone (2): Camper lives with: both parents parent/guardian 1 parent/guardian 2 Family Physician (to be contacted): Phone: Do you have medical insurance? Carrier: Policy/Group #: MEDICATION/HISTORY Will camper be taking medication(s) while at camp? Yes No (Medications include epi-pens, inhalers, prescriptions, over-the-counter, vitamins, etc.) If marked Yes, which medications? If yes, please be prepared to provide the medications (in original containers) with the Authorization to Administer Medication to Camper Form. Asthma Epilepsy Diabetes Autism Hyperactivity/Behavioral Frequent Headaches Ear trouble Mental Health Other: Please comment on indicated history: Please note: You may be asked to meet with the camp director or camp nurse to discuss your child s history to better server your camper. None Known Food(s) : Insect bites/stings: Poison Ivy/Oak: Medication(s) : Other: Please explain reaction and treatment for the above allergies: If medication will be provided to the camp nurse, please fill out the Authorization to Administer Medication to Camper Form (found online at or at your camp/branch) OTHER Is your child on an IEP or 504 plan? Yes No If yes, please provide a copy of the plan. Please explain any special dietary needs/restrictions: Please explain any limits or restrictions to physical activity while at camp: Any other conditions the camp directors or nurse should be aware of: Does your child attend a YMCA After School or Early Education program? If yes, where? Are there any accommodations or services that we can provide to make the summer as successful as possible? Please share any information that would help Summer Staff best serve your child: This health history is correct so far as I know, the person herein described has permission to engage in all prescribed camp activities except as noted. EMERGENCY AUTHORIZATION I hereby give my permission to the medical personnel selected by the Old Colony Y to order x-rays, routine tests, and treatment for my child, in the event I cannot be reached in an emergency. I hereby give permission to the physician selected by the Old Colony Y to hospitalize, secure proper treatment for, and to order injections and/or anesthesia and/or surgery for my child as named above. This form may be photocopied for use out of camp. I understand that the Old Colony Y is not responsible to provide health and accident insurance, and all charges occurred will be paid by the parent/guardian. of Parent/Guardian: Date: *If you cannot sign this due to religious reasons, the camp should be contacted for a legal waiver which must be signed for attendance.

7 REGISTRATION FORM E WAIVERS & LIABILITY FORM I, the undersigned (legal relationship to student, e.g., parent, guardian ) of (name of student) ( my child ), a minor, do hereby consent to my child s participation in voluntary athletic or Recreation programs of the Old Colony YMCA I also agree to forever release the Old Colony YMCA, to all their employees, agents, board members, volunteers and any and all individuals and organizations assisting or participating in voluntary athletic or recreation programs of the Old Colony YMCA ( the Releasees ) from any and all claims, rights of action and causes of action that may have arisen in the past, or may arise in the future, directly or indirectly, from personal injuries to my child or property damage resulting from my child s participation in the Old Colony YMCA voluntary athletic or recreation programs. I also promise, to indemnify, defend, and hold harmless the Releasees against any and all legal claims and proceedings of any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly, arising from personal injuries to my child or property damage resulting from my child s participation in the Old Colony YMCA voluntary camping, athletic, or recreation programs. I further affirm that I have read this Consent and Release Form and that I understand the contents of this Form. I understand that my child s participation in these programs is voluntary and that my child and I am free to choose not to participate in said programs. By signing this Form, I affirm that I have decided to allow my child to participate in Old Colony YMCA s camping, athletic, or recreation programs with full knowledge that the Releasees will not be liable to anyone for personal injuries and property damage my child or I may suffer in voluntary Old Colony YMCA or recreation programs. Date Guardian of Date A. Medical Liability I understand that health and accident coverage for my child is my responsibility as parent or guardian. I will not hold Camp Yomechas, the Old Colony Y, its representatives, counselors or staff liable for any injury incurred by my child. I hereby give my approval for her/his participation in the program. In an emergency, I hereby give permission to the physician selected by the Old Colony Y to hospitalize, secure proper treatment for and to order injection and/or anesthesia and/or surgery for my child as named above. B. Photo Waiver It is understood and agreed that the Old Colony Y reserves the right to take and utilize pictures, likenesses, videos, and testimonials of participants for promotional purposes including, but not limited to; reports, publications, brochures, s, our website, and other instances of online presence. *If you do not approve, please write DO NOT PHOTO and attach a current photo of your child to ensure s/he does not appear in any media. C. Sunscreen/Bug Spray I understand the following bug spray/sunscreen policy of Old Colony Y: We recommend that all campers and staff wear sunscreen with a SPF of at least 15 on all exposed skin, including lips, even on cloudy days. We recommend that all campers and staff use bug spray with DEET according to recommendations on product label. Parents/Legal Guardians will be responsible for providing their child with enough sunscreen and bug spray (in sealed containers) to take with them for applications throughout the day. Please include one container of each per child, labeled with your child s name. Camp staff will be responsible for ensuring thorough follow-up applications after one hour in the water, after two hours of activity in the sun (due to perspiration), and/or any other times as needed. Please note, this will mean your child may have sunscreen and bug spray applied to them by the camp staff. Please explain this to your child prior to camp. TO DISCUSS ANY QUESTIONS OR CONCERNS REGARDING THIS AGREEMENT, PLEASE CONTACT THE YMCA AT >I ACKNOWLEDGE THAT I AM OVER THE AGE OF EIGHTEEN (18) YEARS. I ACKNOWLEDGE THAT I HAVE CAREFULLY AND COMPLETELY READ AND UNDERSTAND THE TERMS CONTAINED IN THIS RELEASE AND WAIVER OF LEGAL LIABILITY. I UNDERSTAND THAT MY SIGNATURE ON THE LEFT, DEMONSTRATES ACCEPTANCE OF THE ABOVE TERMS IN THEIR ENTIRETY. IMPORTANT FAQs What should my child bring to camp? Every day, campers should bring a bathing suit, towel, a non-perishable bag lunch, sunscreen, bug spray, and a water bottle. What is the staff to camper ratio? For ages 6 years and under, the ratio is 1 staff per 5 campers. For ages 7 years and older, the ratio is 1 staff per 10 campers. What type of training does the staff have? All staff undergo a minimum 3 day orientation that covers a variety of topics that include counseling skills, team building, programming, conflict resolution, and sensitive issues such as child abuse and neglect. Aquatic staff are certified lifeguards and undergo a 3 day training specific to our facility. Senior and specialty staff are CPR and First Aid certified. Rope directors are certified by trained professionals. Archery instructors are also certified by trained professionals. What happens if my child gets sick at camp? The care of mildly ill campers, administration of medications, and emergency care is overseen by a registered nurse who is on-site daily. A pediatric physician is available during camp hours to provide consultation or emergency care. Based on the emergency contact information provided, a parent or guardian will be contacted if the child needs to leave camp because of sickness. What happens when it rains or it is extremely hot and humid? In the case of thunder, lightning and torrential downpours, all campers are brought inside. In the case of light rain or extreme heat, we try to continue all activities outdoors utilizing the pavilion and tent areas, however ropes course, archery and other activities may be closed and campers moved to alternate activities/ locations. We do request that you prepare your camper with clothes/gear for all weather. Camp leadership staff will make decisions during inclement weather to ensure safety for all campers.

8 CAMP HAPPENINGS! CAMP REUNION 2/19 TBD SPINATHON 3/10 ALL DAY OPEN HOUSE 4/7 10am - 1pm HEALTHY KIDS DAY 4/21 ALL DAY OPEN HOUSE 5/19 10am - 1pm STAFF MEET & GREET 6/8 5:30pm - 7pm 20% OFF ENDS 4/30 Purchase 4 weeks of camp, and receive 20% off each additional week (per child, must pay in full by 5/1.) OLD COLONY YMCA ASSOCIATION OFFICE 320 MAIN STREET BROCKTON, MA NONPROFIT ORGANIZATION U.S. POSTAGE PAID Brockton, MA PERMIT NO % OFF ENDS 6/6 Purchase 4 weeks of camp, and receive 10% off each additional week (per child, must pay in full by 6/16.) GET $50 OFF REFER A NEW CAMPER FOR 2 SESSIONS CONTACT Camp Director Danielle Kucinski dkucinski@oldcolonyymca.org SIBLING DISCOUNT $15 OFF per week, per additional child. Must be the same week of camp.