2017 Houchens Day Camp

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2 2017 Houchens Day Camp Registration Deadline: May 15, 2018 Limited to first 100 paid registrations Location: Houchens Program Center on Barren River Road, Bowling Green, Kentucky Dates: June 11-14th with optional overnight on the evening of the 14th Times: Monday through Thursday 8:30-3:15 Cost $80 for registered Girl Scouts** $120 for non-registered Girl Scouts Scouterships offer full or partial assistance based on income for all registered Girl Scouts. Please visit for more information or contact your troop leader What is included in the cost? Camp usage fee Program supplies Daily snacks One camp t-shirt A unit colored bandana A 2018 camp patch All badges earned during the course of camp Thursday night dinner and s mores Breakfast for campers participating in Thursday overnight **Campers attending with a full time parent volunteer are offered a 75% discounted rate of $20 this year. This cost is to cover the cost of t-shirts for both camper and parent, as well as all badges and patches.

3 How To Register Online: By Mail Please mail fees and completed registration and health history forms to Whitney Smith 410 Old Dearing Road, Alvaton, KY Checks or money orders made payable to Houchens Day Camp. Please note on the form is you are waiting on Scoutership response Using Kentuckiana Credits Kentuckiana credits (Formerly GSK Rewards) can be used to pay for camp! If you have not received your Kentuckiana Credit Card yet, please indicate on the registration form how much you estimate to be paying in credits and include payment for any difference. When Kentuckiana Credits are received, an image of the card (front and back) must be sent via mail or to Registrations pending Kentuckiana credits and not received by May 15 will be notified and canceled if not paid in full. Refunds Refunds for camper fees will be made on a case by case basis for illness and family emergencies. Please contact camp registrar Whitney Smith at HouchensDayCamp@gmail.com for more information. Refunds will not be issued after May 15th. Welcome to Camp Information Letters A letter will be sent at the end of May with information on what campers should bring to camp each day, what unit they will be assigned to, and other important information. Daily Drop-off and Pick-up Times Camp gates open at 8:00 each day. Please be mindful of traffic directors as the driveway is only wide enough for one vehicle in some areas. Campers should be dropped off by 8:15. Pick up begins at 3:15 daily and runs until 3:30 Monday through Wednesday. Pick up will run as usual for Daisies on Thursday. Friday morning pick up begins at 10:30. Our camp is staffed completely by volunteers! Please be considerate when picking up by arriving on time. Parents who are consistently late (after 3:30) will be assessed a baby-sitting fee.

4 Do you have some time you can give to camp? This camp is staffed by volunteers who give their time freely so that all interested girls may attend camp. We are looking for adults to help provide this wonderful experience for girls. To accommodate all the girls who want to attend camp, lots of adults are needed. No previous experience is required! All volunteers receive training for their job and support from other adults. Volunteering at camp is a unique opportunity to positively impact your camper and have a great time doing it! Volunteers are needed to work directly with units and also to offer special programs such as crafts, photography, environmental activities, and so on. In fact, almost any skill or interest you can share can probably be used! Archery Fire Building Nature Education Sketching Bicycling Whittling Canoeing Outdoor Cooking Storytelling Camp Craft Games Dramatics First Aid/CPR Weather Nature Crafts Pioneer Crafts Hiking Singing Help us protect you and your camper! Here at GSK, the health and safety of our girls is our top priority. All camp volunteers must be members of the Girl Scouts and complete a criminal background check. To volunteer, please visit our website at and click on the Volunteer button below the picture. Membership is $25 and expires on September 30 th of the current troop year. Once you complete your membership registration, you will receive an with directions on how to submit your criminal background check. This background check costs $8 and is good for three years. Who May Attend Any girl may attend camp; however, she must join the Girl Scouts. Visit our website at and click on Join. Membership is $40 and expires September 30 th of the current troop year. However, we suggest taking advantage of the new Extended Troop Year! Starting May 1 st, a girl can sign up to be a girl scout, pay $50 and her membership will not expire until September 30 th of the NEXT troop year. This saves the family $30 and ensures her girl scout experience continues past camp! Website More information about camps can be found on the GSK website Just follow the Camps link and then Day Camps & Camporees. Resident Camp Fun! Resident camp is the heart and soul of the summer camp experience. Caring Counselors guide girls to make life long memories, new friends, and discover the pleasure of the outdoors. Girls will be challenged to try new things and will come back a more courageous and confident girl of character. Register via MyGS by May 31 st. Troop Camping Is Here! If your troop is looking for an extra camping experience this summer bring them to Troop Camp Plus at beautiful Camp Pennyroyal! Your troop chooses the length of your stay, participates in council led programming from 10-5, and night activities are completely up to you! Register through MyGS starting April 1 st! Girl Scouts of Kentuckiana:

5 Camp Registration Form - Youth Complete one for each youth camper and mail to your camp registrar. Please PRINT clearly and legibly. Camp Name: Houchens Day Camp 2018 Dates of Camp June 11-14, 2018 Camp Site Camp Houchens, Bowling Green, KY Camper Information Campers Name (Last, First, MI) Address (Street, City, State, Zip Birth Date Age Grade in Troop # Fall T-Shirt Size (check ): YS YM YL AS AM AL AXL AXXL AXXXL Request Placement with Other Scout Placement requests are not guaranteed. Girls must be in same Girl Scout grade level for consideration. Registration Type General Camper - $80 Non-Scout - $80 Plus $40 Girl Scout Registration Fee Teen Mentor Scout with volunteer parent - $20 Pixie - $20 Boy - $20 (Children of Volunteers Only) Transportation Preference Parent pick up and drop off Riding with a friend Carpool If car rider, who will the driver(s) be for your camper? Optional Overnight Will your camper plan to spend the night on Thursday? (check ): Yes No Restricted to campers who have finished first grade and who have completed a successful overnight without parents! Custodial Parent / Guardian Information Camper is in the custody of (check ): Both Parents Mother Only Father Only Other: Mother/Guardian Name Father/Guardian Name Mail To: Houchens Day Camp c/o Registrar 410 Old Dearing Road Alvaton, KY, Date Received Receipt Number For Registrars Use Only Amount Paid In: Cash Check Kentuckiana Credits Financial Assistance Total Paid

6 Camp Registration Form - Adult Complete one for each adult camper and mail to your camp registrar. Please PRINT clearly and legibly. Camp Name (not campsite) Houchens Day Camp 2018 Dates of Camp June 11-14, 2018 Camp Site Camp Houchens, Bowling Green, KY Camper Information Volunteer s Name (Last, First, MI) Camper s Name/Names Address (Street, City, State, Zip T-Shirt Size (check ): YS YM YL AS AM AL AXL AXXL AXXXL Girl Scout Membership / Trainings Are you currently a registered Girl Scout Yes No Please list the troop numbers that your camper belongs to Have you completed a Volunteer Application form within the last three years Yes No Check all that apply First Aid Certified CPR Certified Doctor, Nurse, or EMT Girl Scout Camping Trained Camp In Camp Out Level I II III IV (Circle Highest) Transportation Preference Car I will carpool with another adult and will not need a parking space. Mail To: Houchens Day Camp c/o Registrar 410 Old Dearing Road Alvaton, KY, Date Received Receipt Number For Registrars Use Only Amount Paid In: Cash Check Kentuckiana Credits Financial Assistance Total Paid

7 Health History Form Complete one for each youth and adult camper and mail to your camp registrar. Please PRINT clearly and legibly. Campers Name Birthday Emergency Information: Custodial Parents/Guardians Names Emergency Contact (if parent/guardian cannot be reached.) Name Relationship to Camper Camper s Physician Office Phone Insurance Carrier Policy # Group # If hospitalization is required, take camper to Allergies: Check those that apply, specify nature and if treatment requires the use of an Epipen, Benadryl, etc.) Allergy Nature of Allergy / Treatment Allergy Nature of Allergy / Treatment None Hay Fever Animals Medicine/Drugs Food Plants Insect Sting Other: Illnesses, Injuries or Health Conditions: (check those that apply) None Bed Wetting Headaches Motion sickness ADD/ADHD Bleeding/Clotting Disorder Heart disease/defect Seizures Asthma Diabetes Hearing Impairment Other: Immunizations Immunizations are up to date. Family chooses not to immunize. Date of last Tetanus shot: Health Supervisor Permission for Medications: (check those that apply) Camper may take acetaminophen (ex: Tylenol). Yes No Camper may take oral antihistamine (ex: Benadryl). Yes No Camper may take ibuprofen (ex. Advil) Yes No Camper may use topical antihistamine (ex: Benadryl). Yes No Camper may use antibiotic ointment (ex: Neosporin). Yes No Camper may use topical hydrocortisone (ex: Cortizone) Yes No If you checked yes to any illnesses, injuries or other health conditions, please attach a separate sheet of paper with explanation. Give nature, dates, period of any disability and results. Also, list any activities that should be restricted. Information about medications : Is camper taking any medication? Yes No If yes, attach a list of the camper s current medications to this form; send a list of any medication changes or updates the first day of camp. Medications for campers under the age of 18 must be kept in the possession of the health supervisor at all times (unless otherwise noted) Any medication to be dispensed should be indicated on the Health History Form. All medication, including over-the-counter products, should be in the original container and marked clearly with the participant s name and directions for use. Prescribed medications and over-the-counter products must be administered in the prescribed dosage by or in the presence of the health supervisor or as per the written instructions of a custodial parent, a guardian, or a physician. Medication can only be dispensed to the person named on the prescription container. As per the Safety-Wise chapter of Volunteer Essentials, medications, including over-the-counter products, cannot be dispensed without prior written permission from a girl s custodial parent or guardian. HEALTH INFORMATION PRIVACY STATEMENT FROM GSUSA The Health History Form is for health care concerns at this camp only. All medical records will be held in limited access by the health care supervisor of this camp. Minimally necessary information may be shared with camp staff/volunteers in order to provide adequate participant safety and health care. The health history form will be retained by GSK along with all forms/records with noted treatment for seven years past the age of maturity of the participant. Access to the information will be limited. I have read the above procedures for handling the health form information and I agree to the release of any records necessary for treatment, referral, billing or insurance purposes.

8 Parent s or Guardian s Statement & Signature - My camper has had a physical examination within the past 24 months and is in good health. I give full permission for my camper to attend camp and participate in all activities (except as noted on this health history.) The Girl Scouts of Kentuckiana is held harmless in the event of an accident. In the case of injuries, I give permission for medical treatment as deemed necessary. Permission is granted to use any pictures or video footage of my camper for Girl Scout promotional purposes. I agree that all information including immunizations is complete and up to date. Volunteer Statement & Signature - I am in good health and able to participate in all activities at camp (except as noted on this health history.) The Girl Scouts of Kentuckiana is held harmless in the event of an accident. In the case of an injury, I give permission for medical treatment as deemed necessary. Permission is granted to use any pictures or video footage of me for Girl Scout promotional purposes. Parent/Guardian or Volunteer Signature Date:

9 Fee Summary Complete this page and mail to your camp registrar. Please PRINT clearly and legibly. Make checks payable to Houchens Day Camp. Fees include camp registration, bus transportation, t-shirt, photo, patch, snacks, dinner for Wednesday overnight, breakfast and lunch on Thursday, and program supplies. Indicate name and amount due for each General Camper, Camper with Parent Volunteer, Pixie, and Boy (volunteer children only). If paying the Girl Scout Membership Fee, please fill out a Girl Scout Membership application and send with the camp registration form. If sending after May 15, add applicable late fees. Indicate any additional fees and any remaining balance due below. Items to Include: 1. Completed registration form for each person attending camp. 2. Completed Health History Form for each person attending camp. 3. Payment by check, money order, or Kentuckiana Credits. 4. Financial Assistance Request Form (if requesting assistance). 5. #10 self-sealing, self-addressed, stamped envelope for each person (with their name on it.) Forever Stamp, please. Fee Description Name Amount Notes Camper Fee (1) $ Camper Fee Camper Fee (2) $ General Camper - $80 Camper Fee (3) $ Camper with parent Pixie $10.00 Each $ volunteer - $20 Boy $10.00 Each $ Pixie - $20 Part Time Adult $10.00 Each $ Boy - $20 Girl Scout Girl Membership through September $ $40.00 Each -OR- Girl Scout Girl Membership through September $50.00 Each Girl Scout Adult $25.00 Each $ Girl Scout Background $8.00 Each $ Subtotal $ Total Camper Fees If Sending After May 15: Calculation of Late Fees Total # of Campers X $5.00 Each $ Total $ Subtotal Plus Late Fees Amount Enclosed $ Kentuckiana Credits Balance due (by 5/15) $ Financial Assistance Requested $ All Kentuckiana Credits must be sent as soon as it is available. Deadline for Kentuckiana Credits is May 15 th. Mail To: Houchens Day Camp c/o Registrar 410 Old Dearing Road Alvaton, KY, Date Received Receipt Number For Registrars Use Only Amount Paid In: Cash Check Kentuckiana Credits Financial Assistance Total Paid