CHOOSE YOUR ADVENTURE

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1 LOUISVILLE AREA YMCA SUMMER DAY CAMP 2018 CHOOSE YOUR ADVENTURE WHO: Campers entering K-8th Grade WHERE & WHEN: AM/PM Care: Louisville Area YMCA- Monday-Friday 6:30-9AM & 4-6PM YMCA Camp: Louisville Middle School Monday-Friday 9AM-4PM DATES: June 4, 2018 August 17, 2018 The completed registration packet and payment for the first week must be received before your child may attend. ALL OUTSTANDING BALANCES MUST BE PAID IN FULL before your child can be registered for Summer Day Camp. Please return this completed packet to the Louisville Area YMCA as soon as possible and allow three days to process. K CAMP (Entering Kindergarten) MEMBER (per week) NON- MEMBER PT $100 PT $120 FT $120 FT $140 *Walking Trips Only* JR & DAY CAMP (Entering 1st-4th Grade ) MEMBER NON- MEMBER PT $105 PT $125 FT $125 FT $145 CAMP MID (Entering 5th - 8th) MEMBER NON- MEMBER PT $110 PT $130 FT $130 FT $150 * Weekly rate includes cost of field trip, snacks, and all activities! **Camp Staff are CPR, First Aid, Communicable Disease & Child Abuse Prevention Certified. CONTACT: Courtney Haines Childcare Director Call: Chaines@ymcastark.org

2 WHAT TO BRING Packed Lunch and Water Bottle No refrigeration or microwave available. AM and PM snack provided daily. Proper Clothing Campers will be active and may get dirty. Please dress your camper appropriately and leave an extra set of clothes in their bag. Camp Shirts must be worn on trip days! Swimsuit and Towel Campers will swim or participate in water activities almost daily. Please provide each day. Closed- Toed Shoes Please have campers wear closed toed shoes every day. Sandals or flip flops can be sent for water activities only * Please make sure all items your camper brings are visibly labeled. Sunscreen Applied Before the Child Arrives Camp staff will re-apply sunscreen throughout the day. SUMMER UNPLUGGED Summer Day Camp allows campers to focus on the development of friendship, accomplishment and belonging. In order to do this, we are UNPLUGGED, which means please leave the following things at home and we will provide the fun! Cell Phones Personal Gaming Devices Toys Cameras Money (unless otherwise instructed for special occasions) What are we doing? WEEK THEME TRIP #1 June 4-8 JUNGLE JUNCTION Akron Zoo #2 June GIZMOS & GADGETS Great Lake Science Center #3 June WHO S GET SPIRIT?! Fire Station & Aljancic Park #4 June SURVIVE IT! North Canton Skate Center & Boettler Park #5 July 2-6 RED, WHITE, AND BOOM Clear Water #6 July 9-13 AROUND THE WORLD Chuck E Cheese & Boettler Park #7 July ANIMATION NATION Movies 10 & Jackson Bog #8 July SHIPWRECKED Massillon Rec #9 July 30-Aug. 3 MESSTIVAL FESTIVAL Pump It Up & Quail Hollow State Park #10 August 6-10 COLOR ME CRAZY Hot Pots & Huston Brumbaugh Nature Center #11 August WET-N-WILD Uhrichsville Waterpark

3 CHILD S INFORMATION YMCA of CENTRAL STARK COUNTY SUMMER DAY CAMP REGISTRATION 2018 Child s Name (first/last) Home Phone # Address City State ZIP Male Female Birth date / / Age Grade (School year 2018/2019) Membership Status (Please circle one): Member Akron/Western Stark Y Member Non-Member 1 st Parent Birthdate Contact Phone # 2nd Parent Birthdate Contact Phone # Parent Marital Status: Married Separated Divorced Single Custody/Contact restrictions: (Equal access to the center and child will be granted to each parent in the absence of a Court order, which must be provided to the YMCA, specifying otherwise). Please list the persons permitted to pick-up your child: (Parent/Guardians listed above are already included on pick up list) Phone # Relationship Phone # Relationship Phone # Relationship Phone # Relationship Phone # Relationship T-Shirt Size (circle one): XS (2-4) YS (6-8) YM (10-12) YL (14-16) AS AM AL Child s Camp: K Camp (Entering K) Jr Day Camp (Entering Grades 1-2) Day Camp (Grades 3-4) Camp Mid (Entering Grades 5-8) PLEASE PUT AN X ON EACH WEEK YOUR CHILD WILL AT- TEND CAMP BELOW: (If the camper will be attending part time that week, please circle the days of attendance) 1 6/4-6/8 2 6/11-6/15 3 6/18-6/22 4 6/25-6/29 5 7/2-7/6 6 7/9-7/13 M T W H F M T W H F M T W H F M T W H F M T H F M T W H F 7 7/16-7/20 8 7/23-7/27 9 7/30-8/3 10 8/6-8/ /13-8/17 M T W H F M T W H F M T W H F M T W H F M T W H F

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6 Louisville Area YMCA

7 YMCA of Central Stark County - Schedule and Tuition Agreement Louisville Area YMCA Summer 2018 Child s Name Start Date Are you responsible for entire tuition payment? YES NO (If no please explain) Are you receiving assistance through Ohio Jobs and Family Services? YES NO Copay? PLEASE CIRCLE YOUR TUITION SCHEDULE BELOW: Program Y Member Non-Member Y Member Non-Member 1-3 days 1-3 days 4-5 days 4-5 days K CAMP $100 $120 $120 $140 JR DAY CAMP & DAY CAMP $105 $125 $125 $145 CAMP MID $110 $130 $130 $150 PLEASE PUT AN X ON EACH WEEK YOUR CHILD WILL ATTEND CAMP BELOW: (If the camper will be attending part time that week, please circle the days of attendance) 1 6/4-6/8 2 6/11-6/15 3 6/18-6/22 4 6/25-6/29 5 7/2-7/6 6 7/9-7/13 M T W H F M T W H F M T W H F M T W H F M T H F M T W H F 7 7/16-7/20 8 7/23-7/27 9 7/30-8/3 10 8/6-8/ /13-8/17 M T W H F M T W H F M T W H F M T W H F M T W H F PAYMENT OPTIONS: 1. Bank Draft (Please include a voided check) Account Type: Weekly Bi-Weekly Checking Savings Bank Bank Address/City/State/Zip Transit & Routing # Account # 2. Credit Card Draft Weekly Bi-Weekly Credit Card Debit Card MasterCard VISA Discover American Express Issuing Bank Name Name on Card Exp. Date Account # 3. Online Payments available at

8 Camp Payment Policies Please initial beside each of the following: Camp fee payment is due one week in advance of attendance. Accounts that have a balance of 2 weeks or more will be considered delinquent Y staff will contact the responsible parent to reconcile the balance and keep the account current. If a payment agreement is not reached or payment is not made, camp services may be suspended. Payments/Refunds will be applied to any outstanding Y balances first then to current programming fees. The [BRANCH] Day Camp closes at 6:00PM. A $1 per minute per child late fee is charged after 6:00PM. I understand I will be charged for the program and rate for which I signed up my child. I understand that weekly tuition is not adjusted for days missed due to illness unless child is hospitalized. A 2 week written notice is required for any change in camp schedule, otherwise the account will be charged based on the schedule for which you signed up. Failure to communicate with Y staff for 10 business days may result in termination of services. I will be paying by : Bank Draft Credit Card Draft On-line Check Parent/Guardian Signature Print Name Date Staff Initials Date

9 FIELD TRIP PERMISSION CAMPER NAME JR, DAY, MID BIRTH DATE By initialing & signing below, I hereby grant permission to the Louisville Area YMCA for my child to travel by foot or by First Student Busing from the Louisville Area YMCA to the following locations for summer field trips on the dates indicated. Y N I give permission for my child to participate in swimming activities both on field trips and at the Louisville Area YMCA on a routine basis. *** My child is a swimmer non-swimmer *** WK DATE FIELD TRIP TIMES 1 6/7/18 2 6/14/18 3 6/21/18 4 6/28/18 4 6/29/18 5 7/5/18 6 7/12/18 7 7/20/18 8 7/25/18 8 7/25/18 9 8/2/ /10/ /17/18 Akron Zoo** (500 Edgewood Ave Akron, OH ) Great Lake Science Center (601 Erieside Ave, Cleveland, OH 44114) Fire Station & Aljancic Park (215 Mill St., Louisville, OH 44641) North Canton Skate Center & Boettler Park ** (5475 Whipple Ave NW North Canton, OH ) (5300 Massillon Rd North Canton, OH 44720) Character Olympics (428 King Church Ave SW Uniontown, OH 44685) Clearwater Park*** (12712 Hoover Ave NW, Uniontown, OH ) Chuck E Cheese & Boettler Park ** (6370 Strip Ave. NW North Canton, OH ) (5300 Massillon Rd, North Canton, OH 44720) Cinemark Movies 10 & Jackson Bog ** (6284 Dressler Rd NW North Canton, OH ) (7984 Fulton Dr NW, Massillon OH 44646) Massillon Recreation Center *** (505 Erie St. N Massillon, OH ) DAY CAMP ONLY Camp Tippecanoe** (81300 Stewart Rd, Tippecanoe, OH 44699) Pump It Up & Quail Hollow State Park ** (13480 Congress Lake Ave, Hartville OH 44632) (1135 W Maple St. Hartville OH 44632) Hot Pots & Huston Brumbaugh Nature Center ** (1828 W State St. Alliance. OH ) (16146 Daniel St NE. Minerva, OH 44657) Uhrichsville Waterpark*** 9AM-4PM 8AM- 4:30PM 9AM-3PM 9AM-4PM 9:30AM- 3:30PM 9AM- 4:30PM 9AM-4PM 9AM-4PM 9AM- 4:30PM 8 AM 6 PM 9AM-4PM 9AM-3PM 10AM- 4:30PM (401 E. 12 th St. Uhrichsville, OH ) I give permission for my child to walk outside of the YMCA Program building with the staff for the occasional walking trip. Any trips requiring a specific permission slip would be provided including the exact nature of the activity, destination, transportation being used, specific time period, time of departure and return to the center. I give permission for my child to walk to Metzger park (1420 South Nickelplate) and Aljancic park (711 Broad Street.) one to two days each week they attend between the dates of June 4th August 17th to utilize the park playground and to participate in planned activities. PARENT INITIALS

10 *Field Trip schedules are subject to change based on extenuating circumstances. ** Water with a depth greater than 18 inches will be present on the grounds of this trip. *** Child will be swimming in water 18 inches or more in depth The YMCA will provide one additional staff member for every 18 children when we are offsite and one additional staff member per 10 children for swimming fieldtrips and routine trips. I understand that field trips will leave promptly each day. All children who go will participate in the activities planned on that trip. I understand that swimming will be part of some of these activities. I understand my child must be at the Louisville Area YMCA by time listed above on field trip days or he/she may miss transportation to the field trip location. If this happens, the YMCA will not provide care for my child that day. We will return from trips by time listed above unless extenuating circumstances arise. Parent/Guardian Signature Date

11 ADDITIONAL PERMISSION CAMP MID ONLY CHILD S NAME DOB These trips will be additional for Camp Mid only. Additional paperwork will be given at a later date for the overnight trip to Camp Tippecanoe. By initialing & signing below, I hereby grant permission to the Louisville Area YMCA for my child to travel by foot or by First Student bussing from the Louisville Area YMCA to the following locations for summer field trips on the dates indicated. WK Date Field Trip Times Parent Initial 2 6/15/18 Park Center Lanes & Fazoli s (7313 Whipple Ave NW, North Canton, OH 44720) (3929 Everhard Rd NW, North Canton, OH 44709) 6 7/13/18 Uhrichsville Water Park*** (401 E. 12th St. Urichsville, Ohio 44683) 10:30AM -3PM 11AM 3PM 7 7/17/18 7/18/18 Camp Tippecanoe Overnight *** (81300 Stewart Rd, Tippecanoe, OH 44699) 8AM Tues. 5PM Wed. 8 7/27/18 Skyzone & Boettler Park** (4381 Whipple Ave NW Canton, OH 44718) (5300 Massillon Rd North Canton, OH 44720) 10 8/10/18 Caddie Shack & Silver Park** 10AM-4PM 9AM-5PM (12175 State St. NE, Alliance, OH 44601) (2930 S. Union Ave. Alliance, OH 44601) I give permission for my child to walk outside of the YMCA Program building with the staff for the occasional walking trip. Any trips requiring a specific permission slip would be provided including the exact nature of the activity, destination, transportation being used, specific time period, time of departure and return to the center. *Field Trip schedules are subject to change based on extenuating circumstances. ** Water with a depth greater than 18 inches will be present on the grounds of this trip. *** Child will be swimming in water 18 inches or more in depth The YMCA will provide one additional staff member for every 18 children when we are offsite and one additional staff member per 10 children for swimming fieldtrips and routine trips. I understand that field trips will leave promptly each day. All children who go will participate in the activities planned on that trip. I understand that swimming will be part of some of these activities. I understand my child must be at the Louisville Area YMCA by time listed above on field trip days or he/she may miss transportation to the field trip location. If this happens, the YMCA will not provide care for my child that day. We will return from trips by time listed above unless extenuating circumstances arise. Parent/Guardian Signature Date

12 ADDITIONAL PERMISSION CHILD S NAME Specialty Camps DOB These camps can be included at no additional cost to the campers experience here at the Louisville Area YMCA. Please initial below indicating what (if any) Specialty Camp your child would like to participate in. Week Specialty Camp Times Parent Initial #1 June 4-8 Cooking with Kids Each day will focus on a different lesson and menu, and kids will dine on their own culinary creations. #3 June Olympic Training Camp Olympic day just turned into a week. Gear up for classic Olympic events! #4 June Lacrosse Camp Outplay, Outwork, Outlast! #8 July Flag Football Camp Punt, pass, & kick your way into football fun! #9 July 30- Aug. 3 Baseball Camp Bringing baseball back to the basics! Kids will brush up on their throwing, hitting, and base running. #10 August 6-10 Cardboard Creations Let the races begin! Spend the week building cardboard boats that will lead to the big race in the pool! #11 August Lego Camp Blocks, blocks, and more blocks! Put your mind to the test while engineering and building creations out of Legos! I give permission for my child to walk outside of the YMCA Program building with the staff for the occasional walking trip. Any trips requiring a specific permission slip would be provided including the exact nature of the activity, destination, transportation being used, specific time period, time of departure and return to the center. 9:30-11:30AM 9:30-11:30AM 9:30-11:30AM 9:30-11:30AM 9:30-11:30AM 9:30-11:30AM 9:30-11:30AM Parent/Guardian Signature Date

13 Child s Name: Child s Date of Birth: Y N I give permission for my child to be included in publicity pictures connected with the program, including those used in online media such as on our website and Facebook page. Y N My child is up to date on all vaccinations required by the Department of Health. His/her last tetanus vaccination was received on / /. I, the undersigned parent/guardian, do hereby accept all responsibility for, and assume the risk of any injury or damage to my person or dependent children which might arise directly or indirectly as a result of, and/or participation in a YMCA of Central Stark County program. I hereby expressly release, discharge and hold harmless from any liability whatsoever the YMCA, the various branches and subdivisions expressly including but not limited to the Board of Trustees of the YMCA, except for injuries caused intentionally, or by willful misconduct. I certify that I am familiar with the contents of the release, that I have read and understand the same, and that it is my intention by signing this release that the same be binding not only on me, but my heirs, administrators, executors, successors, and assigns. The YMCA of Central Stark County is not responsible for misplaced or stolen items. PERMISSION TO TREAT: IN CASE OF MEDICAL ILLNESS OR INJURY, I hereby give permission to YMCA Day Camp personnel to provide routine health care, first aid, medication or treatment as determined by medical personnel. IN CASE OF MEDICAL EMERGENCY or medical care beyond the scope of camp facilities, I understand that every effort will be made to notify listed contact(s). I authorize YMCA Day Camp personnel to act on my behalf and secure emergency medical treatment and grant permission to the attending physician to secure proper treatment for the named camper. Parent/Guardian Signature Date Grant and United Way Information Agencies like the United Way allocate funds to the YMCA every year. We use this money to help with financial assistance to those who need it which in turn keeps fees lower. Please fill in the information requested below to help the Child Care Programs with our funding requests. Child s Gender (circle): Male Female American Indian/ Asian Black/African American Alaska Native Hispanic/Latino Native Hawaiian/Pacific Islander White Other Child s Ethnicity (please circle one below): Family Size (please circle one): Household Income Level (please check one): $0-$9,999 $30,000-$39,999 $10,000-$19,999 $40,000-$49,999 $20,000-$29,999 $50,000+ Thank you for completing the information above. It is greatly appreciated and will be very beneficial in our grant application process.

14 YMCA of Central Stark County Summer Day Camp BEHAVIOR GUIDANCE/MANAGEMENT POLICY Our goal is to set guidelines to develop a feeling of self-worth and competence for each child that results in social and emotional growth. The Y has developed a set of expectations that are developmentally appropriate for their group of campers. The Camp Director/Counselors will review these rules with the groups and they will be posted. YMCA rules are expected to be followed both in and outside of the Y building and at all times the child is in the Day Camp program. Our disciplinary steps are based on an understanding of the individual child s needs and stage of development as well as each individual situation. It is our desire to help each child develop self-control, and respect for the rights of others. Please provide staff as much information as possible about your child at the beginning of camp and throughout their time in the program to help inform this process. When behavior management problems arise, staff will use a problem-solving approach to support children in resolving conflicts. Staff will approach the situation calmly, stopping any hurtful actions or language. When the situation is calm, staff will gather information from the children involved and any others that witnessed the incident. Staff will also ask the children for ideas for a solution and how to properly handle the situation next time. At no time will any form of corporal punishment or shaming be used. Children are never deprived of food as a form of discipline. The entire group is not punished for the actions of one or a few. Children are not restricted from activities for extended periods of time. Behavior Management Reports and Procedure: When a behavior concern arises, staff will utilize the Behavior Management Report to document the incident and report to parents/guardians. This form addresses the following behaviors with room for additional situations. Refusal to follow rules/cooperate with staff Leaving the group or staff without permission Continuous disruptive behavior Stealing/damaging of property Use of profanity, vulgarity or obscenities Endangering the health and safety of self, other children and/or staff Teasing/bullying of other children or staff Fighting of any kind Staff will follow the below procedure for these incidents with campers: First Report: Written warning and parent/guardian will be contacted. Second Report: The student will be sent home and serve a suspension. Parent/Guardian will be contacted and must discuss with Director. Third Report: The student will be sent home and serve a suspension. Child cannot return until parent/guardian meets with a director to develop a specific behavior management plan. Fourth Report: The student will be removed from the program and services will no longer be provided. When there are recurring problems, sufficient attempts to follow the above steps have failed, and/or the behavior involved may result in unsafe conditions for the child, others or the program environment, immediate removal from the program may be necessary. These situations will result in an immediate pick-up and the child care director will determine the most appropriate next step. Each YMCA location reserves the right to skip steps in this process as deemed necessary. If removed from the program, campers will not be re-admitted to any child care program with YMCA of Central Stark County, unless specific exception is made at the time of the request. Please initial each statement and sign below: I understand that in a crisis situation, my child may be physically held to prevent bodily harm to self and/or others, or the destruction of property. Physical holding shall be utilized for the minimum frequency and duration possible and shall not be used as punishment, convenience for staff, or as a means for compliance with behavioral expectations. Abusive language or actions of parents may result in immediate dismissal of the child from programming. I have read and understand the above Behavior Guidance/Management Policy. SIGNATURE DATE (Parent or Guardian)

15 Louisville Area YMCA June 4 - August 17, 2018 N/A - Swim time from 1-2PM N/A - Swimming on Site

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