Adventure Bound & Service Corps Supplemental Camper Forms The Check List Please use this check list to ensure that you have completed all of the necessary paperwork for you camper. This checklist is for your convenience and does not need to be returned. All other forms are due NO LATER THAN June 1, 2015 ALL campers in Adventure Bound AND/OR Service Corps must return the following: Signed Camper Social Contract Signed Off-Site Swimming Permission Form ONLY Adventure Bound Campers must return: Signed Acknowledgement of Risk form. Completed Menu Questionnaire Please note that ALL Camp Combe campers (regardless of program) must also return the Medication Instructions & Authorization Form (available on line). This form must be signed by both parent/ guardian & physician.
TEEN PROGRAMS Camper Social Contract As a participant in our Camp Combe YMCA teen programs, you have the opportunity to travel and interact with a variety of people. This is a unique chance for you to exercise a new level of autonomy and independence without immediate parental authority. It also means increased personal responsibility representing your town, the Camp Combe YMCA, and most importantly, yourself. Please read over the numbered rules below very carefully with your parents. When you are sure you understand these guidelines and the expectations and consequences associated with them, sign your name and the date at the end. Have your parents sign this as well and return it to the Camp Combe YMCA by June 1, 2015. 1. In keeping with the YMCA mission, appropriate behavior is expected of all participants in our summer camp programs. Behavior that conflicts with the YMCA core values of respect, responsibility, caring and honesty will be addressed in a nature appropriate to the disruptive behavior and is at the discretion of the YMCA staff and directors. 2. Appropriate and respectful interactions with program participants and YMCA staff are at the core of the YMCA mission and are essential to having a successful program experience. This is particularly true in Adventure Bound and Service Corps as program participants will be working closely together in teams to achieve a variety of goals in a wide range of settings. 3. Non-YMCA patrons will also be treated in a manner consistent with the YMCA mission. Similarly, as we are guests at the different locations these programs will be visiting, the physical setting and surrounding environment will be treated with care and respect. Our goal is to leave these settings cleaner and in better condition than we find them and to make a strong positive impression on the hosts and patrons of the sites we will be visiting. 4. The use or possession of alcohol, tobacco, weapons, or any controlled substances by any program participant will result in expulsion from the program for the remainder of the summer. Similarly, criminal behavior of any sort will not be tolerated. This includes the unauthorized use or theft of property belonging to Camp Combe program participants and staff as well as theft of and/or damage to program vehicles, equipment, or any site visited. Camper printed name: Camper signature: Date: Parent/Guardian signature: Date:
-TEEN PROGRAMS Off-Site Swimming Permission Form As a part of the Service Corps & Adventure Bound Programs, campers will be traveling to a variety of off-site locations. At some of these locations, campers will have the chance to swim. For example, during the Service Corps session involving the Regional Conservation Project, campers will have an opportunity to swim at FDR State Park. Similarly, on a variety of trips, Adventure Bound Campers will be able to swim at guarded beaches associated with the camp ground where they are staying. Specific trips where off-site swimming is part of the itinerary are listed below: Trip Week Swim Site Location AB: Northern White Water Rafting ADK Horseback Riding ADK Above & Below 1/2 1/2 7/8 Lewey Lake Lewey Lake, NY AB: MA White Water Kayaking 3/4 Savoy Mountain State Forest Florida, MA AB: Gunks Rock & Roll 3/4 North/South Lake Haines Falls, NY AB: CT Zip & Splash 5/6 Black Rock State Park Enders Falls Watertown, CT Granby, CT AB: RI Sand & Surf 5/6 Burlingame State Park Charlestown, RI AB: Vermonster Adventure/Service 7 Little River State Park Waterbury, VT AB: Lake George Sailing 7/8 Lake George Katskill Bay, NY SC: Regional Conservation Project TBD FDR State Park Yorktown, NY Health Department regulations require that we obtain signed parent permission for campers to swim off-site. In every case, these facilities have their own certified, on-site aquatics staff. However, as an added precaution, we will be bringing our own lifeguard(s) to supplement their staff and to ensure extra vigilance for our campers. As is standard procedure at our on-site program, campers will be assigned swimming buddies and our lifeguards will run regular buddy checks. In every case but Cape Cod trip (which is a beach), the swim areas are clearly defined with shallow and deep ends delineated. As is the case at camp, only those swimmers who have earned a black band (passed the deepwater test) will be allowed to swim outside of the shallow end. On the Cape Cod trip, only black band swimmers will be allowed to swim in the ocean. Horseplay and other unsafe behavior will be strictly prohibited on every trip. Please complete the lower portion of this form to indicate whether or not your child has your permission to swim at these offsite locations. If a signed form is not returned, we will assume that your child is NOT allowed to swim. If you have questions or concerns, please do not hesitate to call us at 845-526-0808. Child Name: (please print) YES! My child has my permission to participate in off-site swimming. NO! My child is NOT allowed to participate in off-site swimming Parent Signature Date
Camp Combe YMCA Adventure Trips Menu Questionnaire Adventure Groups Please complete and return this questionnaire no later than June 1 st, 2015 in order for our staff to prepare a menu with your tastes in mind. In general, most meals are vegetarian with meat added separately. Participant Name: Camp Trip(s) & Sessions: Check the following you will not eat: (mark all that apply) Meat Beef (sausage/burgers) Meat Pork (bacon/sausage/pepperoni) Chicken Fish (tuna) Cheese and Dairy Please check any of the following sample menu items you absolutely CANNOT eat: (feel free to add notes; be specific and circle specific items if there is only part of a category you cannot eat): Bread & Starches Tortillas (flour) Bread (wheat) Bagels Crackers (rye/wheat/sesame) Pita Bread Rice Potatoes/Hash Browns Pasta/Couscous/Wheat Grains Snacks Tortilla Chips & Salsa Granola Bars/Cereal Bars Crackers (Goldfish/pretzels) GORP (mixes of nuts, fruits, m&ms, crackers) Dairy Milk Cheese (American/Cheddar/Mozzarella/Parm) Cream Cheese/Sour Cream Eggs (in any form) Drinks Hot Cocoa/Tea Flavor Crystals (eg. Kool-Aid) Do you have any dietary restrictions or allergies +? No Yes (please indicate specifics): Soy Tree nuts* Peanuts* Gluten Dairy Shellfish/Fish Other: + You may be required to supplement your own foods. * Please indicate severity: ingestion, contact, or airborne (circle) Proteins Lunch Meat Hummus PB&J Tuna Summer Sausage Beans (refried/black/chili) Breakfast Sausage Links/Bacon (pork) Fruit & Vegetables Apples/Applesauce Oranges / Bananas Dried Fruits (Raisins, Apples, Apricots, etc) Carrots / Cucumbers Gr Peppers/Onions/Corn/Broccoli/Peas Breakfast Specifics Flavored Oatmeal Packets Granola Pancakes/French Toast/Syrup Dinner - General Flavorings Mexican (burritos/tacos/chili) Italian (spaghetti/pizza) American (burgers/mac & cheese/ grilled cheese/soup) Asian (stir fry/curry/peanut sauce)
Acknowledgement of Risks and Release of Liability Camp Combe programs incorporate activities that vary from games and initiatives, to strenuous challenges involving hiking, high ropes, sailing, and rock climbing. Participants may choose the level at which they wish to participate. They must understand that although safety is one of the highest priorities at Camp Combe, there are both physical and emotional risks involved. Certain risks cannot be eliminated without damaging the uniqueness of the activities. This form must be completed and signed prior to participation. I acknowledge that the following describes some, but not all of the risks involved in my participation on Camp Combe Camping, High Ropes, Initiative Course, Rock Climbing, Climbing Tower, Canoeing, Sailing, and other program activities: 1) Accidental slips; falls; cuts; bruises; injuries from animal or insect bites; injuries resulting from unforeseen forces of nature such as falling tree limbs, rock, or lightening; illness, or in extreme cases loss of limbs, paralysis, permanent trauma or death; 2) Risks associated with crossing, climbing, or down climbing routes, elements, and trails; 3) Misuse or failure of equipment, 4) The presence, actions, or falls of other participants in the outdoor environment; 5) The negligence of the staff; 6) Circumstances that may affect pre-existing medical conditions such as heart problems or pregnancy. I understand that this list is not complete and that other unknown or unanticipated risks may result in injury, illness, or death. I hereby authorize any medical treatment deemed necessary in the event of an emergency while under the supervision of Camp Combe staff. I either have appropriate insurance or, in its absence, agree to pay all costs of medical services incurred on my behalf. In consideration of services provided for myself and/or any minors for which I am a parent, legal guardian, or otherwise responsible do hereby release Camp Combe, it s directors, staff, and owner, from all liability and waive any claim for damage arising from any cause. I have read and understand the above acknowledgement of risks, release for medical treatment, and release of liability. Participant s Name (please print): Gender: Male Female Date of Birth: / / Participant Signature Date Parent Signature (required if participant is under 18 yrs old) Date Photo Release I give my consent for the use of any photographs, slides, or videotapes which may include me/my child to be used in Capital District YMCA promotional materials. Participant Signature Date Parent Signature (required if participant is under 18 yrs old) Date If you are a vegetarian, do you eat foods made with chicken broth/stock? No Yes If you are lactose intolerant, do you use milk substitutes? No Yes: Lactaid/soy/rice (circle) Can you eat foods with milk as an ingredient? No Yes If you are gluten-free, do you eat Quaker (dedicated line) oats? No Yes