SUMMER CAMP PROGR AMS

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1 SUMMER CAMP PROGR AMS Online Registration Available at Registration Begins March 4 Camp locations are subject to change. Register for any camp on this page/shown below by April 17, and receive $5 off per week/per session! Summer Camp Campnastics! Arts and crafts, fun sport competitions, organized games, and special events with guest presenters. Kids enjoy a trip to the local pool for recreational swimming and a special event or field trip for each of the six weekly sessions. Bring bag lunch and drink daily (if in extended care, please bring a daily snack). Before care begins at 6:30 a.m., after care ends at 6 p.m. Closed Friday, July 3. Weekly fee includes field trips, guest presenters, and swimming fees. A specialized camp offering gymnastics instruction for vault, ropes, trampoline, bars, dance, balance beam, and the outrageous pit. Nine weekly sessions with a weekly trip to the pool! Daily activities include creative arts, special events, and organized games. Bring a bag lunch, drink, and snack each day. Before Care starts at 6:30 a.m.; After Care ends at 6 p.m. Closed Fri, July 3. Campers must be minimum age listed by first day of camp; and no older than the maximum age listed by the first day of camp. Jun 22-Jul 31 Resident Fee: /week; Non-Resident: $125 $35 Before OR After Care; $45 Before AND After Care Locations & Age Requirements Age: 6-9 Age: 6-14 Age: Wade, Waldorf Hanson, Waldorf Henson, Indian Head Somers, La Plata Mattawoman, Waldorf Campers must be minimum age listed by first day of camp; an no older than the maximum age listed by the first day of camp. Elite Gymnastics & Recreation Ctr. (Waldorf) Age: 6-14 Jun 22-Aug 21 Weekly Resident Fee: $140; Non-Resident: $145 $35 Before OR After Care, $45 Before AND After Care Junior Campnastics All Star Sports Camp Campers are introduced to a variety of sports through basic drills, activities, games and fun sport competitions to better their athletic skills. Sports: basketball, volleyball, soccer, baseball/ softball, tennis, flag football, swimming, track and field, and more. The focus is on promoting FUN while instilling teamwork, sportsmanship, lifelong physical fitness, and personal health. Includes sports-themed field trips and daily swimming. Bring bag lunch and drink daily. Before and after care are not available for this camp. Our popular gymnastics camp is now offered as a half-day experience for younger children and gymnasts. Camp includes basic gymnastic instruction and activities, games, and arts and crafts. Children must be toilet trained. Camp T-shirt is provided, campers should bring a morning snack. Elite Gymnastics & Recreation Ctr. (Waldorf) Age: 4-6 Session A JuL 6-10 Session B Jul Session C Aug 3-7 Session D Aug Resident Fee: $85; Non-Resident: $90 Age: 8-14 Resident Fee: $140/wk; Non-Resident: $145 Location to be determined. (La Plata area) Session 1: Session 2: Jul 6-10 Jul Davis Recreation Ctr. (Waldorf) Session 1: Session 2: Jul Jul Camps listed on this page include a T-shirt in the fee. Shirts are issued one time per child; not weekly per camp. Additional shirts or lost shirts can be replaced at a cost of $7.

2 Sports Camps Tightline Basketball Camp Former CSM Head Coach, Todd Fong, helps improve basic skills through individual instruction with special attention to specifics and techniques. Everyone receives a T-shirt. Register early, space is limited. Before and after care are offered for Session 1 only at Hanson Community Center, located directly behind J.P. Ryon. Staff will escort campers to and from J.P. Ryon each day. Before Care Starts at 7 a.m.: $35 After Care Ends at 6 p.m.: $35 Before AND After Care: $45 Session 1 Age: 5-8 J.P. Ryon Elementary (Waldorf) Half Day Camp Z1 Jun Z2 Jun p.m. Resident Fee: $85/session; Non-Resident: $90 Full Day Camp Z3 Jun a.m.-4 p.m. Resident Fee: $170/session; Non-Resident: $175 Session 2 Age: 9-17 North Point High School (Waldorf) ZZ Jul a.m.-4 p.m. Resident Fee: $170/session; Non-Resident: $175 Goal Keeping Academy Learn technical development: catching, handling, collapse diving, tipping, punching, and breakaways. Learn positioning, stopping, crosses, restarts, anticipation, and defense. Athletic clothing required. Goalie gloves and shin guards recommended. Must bring soccer ball and water daily. Instructor: Andy Gretton, professional goalkeeper coach. Resident Fee: $80; Non-Resident: $85 Session 1: Jun Milton Somers Comm. Ctr. (La Plata) Age: SO 5:30-7 p.m. Age: SO 7-8:30 p.m. Session 2: Jul 6-10 Hanson Comm. Ctr. (Waldorf) Age: HA 5:30-7 p.m. Age: HA 7-8:30 p.m. Sensible Soccer Camp Qualified British coaches follow an age-appropriate curriculum that integrates coaching, health and fitness evaluations, and innovative learning through homework exercises. Space is limited. North Point High School (Waldorf) Age: N1 Jul a.m.-4 p.m N2 Jul a.m.-4 p.m. Resident Fee: $170; Non-Resident: $175 Mike Bozeman Co-Ed Basketball Academy Camp features skill stations, week-long competition, 1 vs 1 and 3 vs 3, and guest speakers. Lunch available for purchase. Before care starts at 7 a.m.; after care ends at 6 p.m. Details: Wendy Bozeman, , or North Point High School (Waldorf) Age: 7-14 Jul Registration Fee: $175 Before or After Care: $30; Before AND After Care: $50 Swim/Aquatics Camps Junior Lifeguard Camp Camp is for youths who have the desire to learn about the responsibilities and duties of a lifeguard. This is NOT a lifeguard training class. The Junior Lifeguard Program is designed to teach students basic rescue skills, first aid, CPR, and water safety. Upon completion students will have a certification in first aid and American Red Cross Junior Lifeguard Completion certificate. Campers receive a camp T-shirt and are required to bring bathing suit, two towels, change of clothes, tennis shoes, and a bag lunch and drink. Participants must be able to swim one length of the pool (25 yds), tread water for 1 minute, and swim underwater for 10 yards. No Before or After Care. Age: Resident Fee: $180; Non-Resident: $185 North Point Pool (Waldorf) NP, Jul Camp Splash Focuses on water safety, swimming skills, diving skills, and other aquatic games. Campers will also participate in soccer, basketball, tennis, and other activities. Weekly fee includes a field trip and T-shirt. Campers are required to bring a bathing suit, two towels, change of clothes, tennis shoes, and bag lunch with drink. Participants must be able to swim one length of the pool (25 yds) and tread water for 30 seconds. No Before or After Care. Age: 8-13 Resident Fee: $175; Non-Resident: $180 Lackey Pool (Indian Head) LK, Jul North Point Pool (Waldorf) NP, Aug 3-7 Special Populations Camp Co-Op Designed for Charles County students with significant cognitive delay who are receiving special education services. Activities include arts and crafts, swimming, games, sports, life skills, and special field trips. Camp operates for six, one week sessions. Enrollment: 40/session. Sessions are filled on a first-come, first-serve basis. Transportation available at designated areas (based on need). Registration packet required. No camp July 3. La Plata High School Age: 5-21, Jun 22-Jul 31 9 a.m.-2:30 p.m. Fee: $180/wk Charles County Dept. of Community Services: 8190 Port Tobacco Rd, Port Tobacco, MD MD Relay: 711 Relay TDD: Equal Opportunity County

3 Specialty Camps Inspiration LEGO Camp Camp provides an opportunity to design and build LEGO creations working either individually or in groups and participate in challenges, group competitions as well as free build time towards the end of the course. LEGO curriculum provides an opportunity to build Ancient Egyptian Pyramids and a Lego city and bring it to life with batteries, wires and bulbs, design & build bridges, sky scrapers, LEGO animals-creatures, moving vehicles, a Lego Marina-Yacht, UFO aircraft, creations of their choice, and re-create iconic symbols using Legos. Session 1 Age: 5-12 Davis Recreation Ctr. (Waldorf) Half Day Camp D1 Jul D2 Jul 6-10 THEATER CAMP FOR KIDS Lights, Camera, Action! Learn basic acting techniques, fundamentals of public speaking, improvisational skill, how to prepare for an audition, cold readings, and other skills to ignite the acting bug. Camp sessions end with a final presentation for family and friends. Bring a lunch, drinks, and snacks each day. Mattawoman Community Ctr. (Waldorf) 1-4 p.m. Resident Fee: $140/ea; Non-Resident: $145 $35 Before or After Care: 6:30-8 a.m. / 4-6 p.m. Resident Fee: $85/session; Non-Resident: $90 $45 Before AND After Care Full Day Camp D3 Jul 6-10 Age: , Jul 6-10 Age: , Jul a.m.-4 p.m. Resident Fee: $170/session; Non-Resident: $175 Session 2 Age: 5-12 Port Tobacco Recreation Ctr. (Port Tobacco) Half Day Camp P1 Aug P2 Aug p.m. Resident Fee: $85/session; Non-Resident: $90 Full Day Camp P3 Aug a.m.-4 p.m. Resident Fee: $170/session; Non-Resident: $175 Innovative School of Performing Arts Radio Broadcasting Camp! Kids create their very own radio program by being the radio personality and host. Segments include a kids round table discussion on topics like: bullying, fitness, and nutrition. Kids receive their very own completed radio show CD. Hanson Community Ctr. (Waldorf) Age: Weekly Resident Fee: $140; Non-Resident: $145 Before or After Care: $35/wk Before AND After Care: $45/wk Session A1 Jul 6-10 Session A2 Jul Session A3 Jul Save Time, Register Online! NEW! Counselor-In-Training Camp The Counselor-in-Training Summer Camp Program (CIT) is a two week training program designed to offer young adults an opportunity to train and prepare for positions as camp counselors, managers, or recreation leaders. Participants will receive special training in what it takes to be a camp counselor by learning teaching techniques, going on field trips, working with special needs campers, and becoming CPR and First Aid certified. Participants must possess a genuine interest in working with youth, display high energy and enthusiasm, and display a positive attitude. CIT participants will need to provide their own lunch, snacks, and drinks daily, and dress appropriately for the day's activities. Open to Students in Grades 9-12 Somers Community Ctr. (La Plata) Training, July 6-July p.m. Job Shadowing, July 13-July p.m. Resident Fee: $300 Non-Resident: $325 Registration Code: S1

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5 Charles County Camp registration Form Camper Data Sheet ONE FORM PER PARTICIPANT PLEASE PRINT No child permitted to camp without a fully completed PARENT/GUARDIAN INFORMATION Please Print Camper Data Sheet. Parent/Guardian Address Mailing Address City State Zip County Phone #'s Home Work Cell Parent/Guardian Address Phone #'s Home Work Cell Camper Information First Name Last Name Nickname Age Date of Birth Sex (circle) M F Emergency Contacts (other than parent/guardian) Name: Phone: Name: CAMPER HEALTH HISTORY Physician s Name: Does your child require medication: No Yes If yes, medical consent form is required. Phone: Does your child have asthma or any 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: Are there any health problems including: physical, psychiatric, or behavioral problems which we need to be aware? No Yes If yes, please explain Please list any activities your child may not participate in, or any problems which may require special attention: Has your child been exempted from any immunizations? No Yes Please explain: Last school attended: State If your child attends a school in Maryland, he/she has received all required immunizations unless exempt for medical or religious reasons. If out of state, please provide a copy of immunization record. Swimming Release Please check which level best describes your child s swimming ability: All pools are 3 1/2 ft deep at the shallow end, and anywhere from 9-11 ft at the deep end. No wading pools are available at any pool location. My child is not allowed in the pool (ALL children will be transported to the pool. Children not allowed in the pool will be provided with alternate activities at the pool site.) Non swimmer/allowed in the pool: Must use U.S. Coast Guard approved flotation vest (no floaties or swimmies). Learning to Swim Swimmer Any changes to a camper s swimming permission must be made in writing. Transportation RELEASE In addition to parent/guardian, my child will be picked up by the following authorized individual(s). For the safety of all campers, parents and authorized individuals must show identification every day when signing out a camper. Name Name Name Relationship Relationship Relationship I understand that transportation will be provided for all necessary camp field trips, and my signature below authorizes my child to be transported accordingly. If you wish for your child to arrive or depart by WALKING, RIDING A BIKE, or OTHER MEANS, written parental permission is required. You must provide an explanation, time to be dismissed, and identify the alternate form of transportation in your correspondence. Charles County Government is not responsible for program cancellations due to Charles County Public Schools programming. I agree to participate or to allow my child to participate in these programs knowing that safety precautions will be taken but realizing that the Charles County Government does not have accident insurance for participants. I do hereby release and hold harmless Charles County, Maryland, its officials, employees, instructors, and volunteers from any and all liabilities arising from any injuries that might occur during the supervised programs. I also authorize the Charles County Government to take photographs of me/my child for promotional and/or educational purposes. I hereby state and declare that this information is freely, willingly, and voluntarily made. FORMS WITHOUT SIGNATURE WILL NOT BE ACCEPTED I acknowledge that I have read and understand the Summer Camp Packet, including the refund policy. I understand that if my child forgets his/her camp T-shirt on a field trip, I will purchase one that day for the fee of $7. By signing this form, I acknowledge the above and give permission to Charles County Government in the event of a MEDICAL EMER- GENCY, to transport this child to the nearest hospital emergency room to receive medical treatment. Signature Date charles county department of community services summer camp programs

6 CHARLES COUNTY CAMP REGISTRATION FORM Non-Residents: Add $5 per camp/per session. Camper Name: REMINDER: SIGNATURE REQUIRED ON SIDE 1 OF FORM (CAMPER DATA SHEET) Before care and after care are only available for Summer Camp, Tightline Basketball, Radio Broadcasting, Theater Camp, and Campnastics Campers must be minimum age listed by first day of camp; and no older than the maximum age listed by the first day of camp. * A COMPLETED Camper Data Sheet must accompany EACH child on the FIRST day of camp! No Exceptions. Week 1: June *Summer Camp Loc: Tightline Basketball A.M. $85 Tightline Basketball P.M. $85 Tightline All Day $170 Goal Keeping (5-12) $80 Goal Keeping (Age 13-17) $80 TOTAL DUE: Week 1 Week 5: July * Summer Camp Loc: *Junior Campnastics $85 *All Star Sports Camp $140 Radio Broadcasting Camp $140 Theater Camp $140 Junior Lifeguard $180 TOTAL DUE: Week 5 Week 2: June 29-July 2 (closed July 3) *Summer Camp Loc: After care $35 Before & After care $45 TOTAL DUE: Week 2 Week 6: July * Summer Camp Loc: *All Star Sports Camp $140 Camp Splash $175 TOTAL DUE: Week 6 Week 3: July 6-10 *Summer Camp Loc: *Junior Campnastics $85 *All Star Sports Camp $140 *Counselors In Training $300 Lego Camp A.M. $85 Lego Camp P.M. $85 Lego Camp All Day $175 Goal Keeping (5-12 $80 Goal Keeping (Age 13-17) $80 Radio Broadcasting Camp $140 Theater Camp $140 After care $35 TOTAL DUE: Week 3 Week 7: August 3-7 *Junior Campnastics $85 Camp Splash $175 TOTAL DUE: Week 7 Online Registration Available! Week 4: July * Summer Camp Loc: * Campnastics $140 *All Star Sports Camp $140 Tightline Basketball All Day $170 Radio Broadcasting Camp $140 Sensible Soccer $170 TOTAL DUE: Week 4 Week 8: August Before Care $140 TOTAL DUE: Week 8 Week 9: August *Junior Campnastics $85 Lego Camp A.M. $85 Lego Camp P.M. $85 Lego Camp All Day $175 TOTAL DUE: Week 9 Help Send a Kid to Camp Code: ZZ I would like to help contribute to sending a kid to camp that otherwise would not be able to attend. I have included the following amount in my payment: $5 $10 $15 Other: $ (Indicate Amount) T-SHIRT ORDER ONE T-Shirt is included in the fee. Campers are required to wear T-shirt for Summer Camp, Campnastics, All Star Sports Camp, and Camp Splash for field trips. Shirts are issued one time per child; not one per camp week. Lost shirts or additional purchases are $7. Circle requested size. Selecting the proper shirt size is the responsibility of the parent. SIZES MAY RUN SMALL Additional or lost shirts are $7 each. Child Sizes Adult Sizes S M L XL XXL Fully completed CAMPER DATA SHEET must be provided at time walk-in, faxed, or mailed in registration. Mail-in payments only accepted at: Refund Policy: A request for a refund must be received in writing 7 days prior to the start of a program. Once the program has begun, a prorated refund based on participation may be approved if requested in writing and with medical verification. This written request must be received prior to the end of the program. A $10 administrative fee per child per session will be deducted for the total refund, regardless of circumstances, unless the program has been canceled. No refunds will be considered after a program has ended. T-shirt and late pick-up fees are non refundable. Transferred registrations are non-refundable Community Services Attn: Registration Office 8190 Port Tobacco Road Port Tobacco, MD Registration Packets may be faxed to: OFFICE USE ONLY Make checks payable to: Charles County Commissioners Cash M/O Check M/Cd VISA DISC Name on check/card Ck/Card # Expiration Sec # Household #

7 MEDICATION CONSENT FORM I. CAMP OPERATOR This form must be completed fully in order for youth camp operators and staff members to administer the required medication or for the camper to self-administer medication. A new medication administration form must be completed at the beginning of each camp season, for each medication, and each time there is a change in dosage or time of administration of a medication. Prescription medication must be in a container labeled by the pharmacist or prescriber. Nonprescription medication must be in the original container with the instructions for use. Nonprescription medication includes vitamins, homeopathic, and herbal medicines. An adult must bring the medication to the camp and give the medication to an adult staff member. II. CAMP INFORMATION YOUTH CAMP NAME PHYSICAL ADDRESS Charles County Department of Community Services 8190 Port Tobacco Road CITY Port Tobacco STATE MD ZIPCODE III. PRESCRIBER S AUTHORIZATION CHILD S NAME DATE OF BIRTH CONDITION FOR WHICH MEDICATION IS BEING ADMINISTERED: EMERGENCY MEDICATION [ ] YES [ ] NO MEDICATION NAME DOSE ROUTE TIME/FREQUENCY OF ADMINISTRATION IF PRN, FREQUENCY IF PRN, FOR WHAT SYMPTOMS KNOWN SIDE EFFECTS SPECIFIC TO CHILD MEDICATION SHALL BE ADMINISTERED (NOT TO EXCEED 1 YEAR) PRESCRIBER S NAME/TITLE FROM TO This space may be used for the Prescriber s Address Stamp TELEPHONE FAX ADDRESS CITY STATE ZIPCODE PRESCRIBER S SIGNATURE (Parent cannot sign here) (ORIGINAL SIGNATURE OR SIGNATURE STAMP ONLY) DATE IV. PARENT/GUARDIAN AUTHORIZATION Completion of the Medication Consent Form relieves the Charles County Government, its agents, employees, or representatives of any responsibility for ill effects resulting from the administration of the medicine. I request the authorized youth camp operator/staff to supervise the camper in selfadministration if authorized as prescribed by the above prescriber. I certify that I have legal authority to consent to medical treatment for the child named above, including the administration of medication at the facility. I understand that at the end of the authorized period, an adult must pick up the medication, otherwise it will be discarded. I authorize camp personnel to communicate with the prescriber as allowed by HIPAA. PARENT/GUARDIAN SIGNATURE DATE HOME PHONE # CELL PHONE # WORK PHONE # V. AUTHORIZATION FOR SELF ADMINISTRATION AND SELF CARRY I consent that the child named above is able to self-administer the medication listed. I authorize self-administration of the above listed medication for the child named above under the supervision of an authorized youth camp operator/staff member. The child named above may self-carry emergency medication if indicated below. Campers may ONLY carry labeled albuterol inhalers, epipens, and oral glucose on their person during camp if there is a specific physician order that states the medication must be on their person and this form is signed below. If a camper MUST carry one of these medications, it must be in a fanny pack attached to their person at all times. PRESCRIBER S SIGNATURE PARENT/GUARDIAN S SIGNATURE SELF CARRY EMERGENCY MEDICATION (Check One) [ ] YES [ ] NO [ ] Not emergency medication SELF CARRY EMERGENCY MEDICATION (Check One) [ ] YES [ ] NO [ ] Not emergency medication DATE DATE Department of Community Services * 8190 Port Tobacco Road * Port Tobacco, MD 20677* * Fax MD Relay Service: 711 * Relay TDD: * Equal Opportunity County *

8 SUNSCREEN CONSENT FORM The Office of Environmental Health and Food Protection no longer considers sunscreen a medication requiring a prescriptive order. Appropriate sunscreen use is important to prevent skin damage and skin cancer in children. The Maryland Department of Health and Mental Hygiene and The Department of Community Services, encourages the appropriate use of sunscreen during summer activities. At the same time, sunscreen can cause allergic reactions in a small number of children, and parents will need to be involved in decisions regarding sunscreen use for their child. Authorization by parent/guardian is needed in order for your child to apply/use sunscreen. Campers Name: Camp Location: Parents must supply and label all listed sunscreen Sunscreen: Required Field Check only one box: My child is allowed to apply sunscreen directly. No assistance from staff is necessary. Staff is allowed to assist my child applying sunscreen. Completion of the Sunscreen Consent Form relieves the Charles County Government, its agents, employees, or representatives of any responsibility for ill effects resulting from the administration of the medicine. Parent/Guardian Signature: Date: Parents are still encouraged to apply sunscreen to their child before the child attends camp for the day. Department of Community Services 8190 Port Tobacco Road Port Tobacco, MD MD Relay Service: 711 Relay TDD: Equal Opportunity County Say No To Drugs