SUMMER DAY CAMPWHITLEY COUNTY FAMILY YMCAYMCA OF GREATER FORT WAYNE

2015

Friendship, Accomplishment, Belonging.

BESTSUMMEREVER!

June 1st - August 7th

WELCOME!Dear Campers and Parents:

Welcome to the Whitley County Family YMCA Summer Day Camp, where every child is encouraged to use their imaginations, explore the outdoors, and create lifelong friendships! This summer will be filled with new adventures every day, from being a pirate, making duct tape crafts, to exercising boot camp style just to name a few! Join the fun, and fit in just for being you. This Y camp helps kids get more out of summer: more learning, more exploration, and more achievement.

A camp experience can be a powerful tool for personal growth. This is why we strive to offer the highest quality camps with the most diverse opportunities. We put a lot of effort into creating a fun, safe environment by carefully selecting staff through screenings, background checks, and thorough trainings (including first aid, CPR, risk management, character building etc.) Our staff are of the highest integrity, personal and spiritual maturity, and are enthusiastic about camp. You can depend on the Y to make sure that camp is well supervised.

We are excited to spend the summer getting to know you and your children while creating the best camp experience ever!

Jacie Stahl Program Director

WHY CHOOSE US?

• Variety of exciting programs that engage the spirit, mind and body.

• We help children learn the importance of health & wellness to improve eating habits and promote physical activity

• Our programs are designed to build character and give children the support they need to become successful adults

• Carefully screened and qualified staff receive training in camp safety and program quality

• Convenient hours• Affordable rates with financial assistance

available• Easy registration• Camp themes that change every week!

ACCOMPLISHMENTWhile being away from the routine back home, youth have a chance to learn new skills

and develop confidence and independence by taking on new responsibilities and challenges. They will celebrate success and learn from mistakes.

Most campers bring backpacks to camp that contain the following items:• Sack lunch & drink (no microwave-ables please) • One piece swimsuit & towel • Water bottle• Bug spray • Sunscreen• Plastic bag to hold wet swimsuit/towels • Gym shoes (no sandals or flip flops) • Comfortable clothing (dress for the weather)

TOYS/ ELECTRONICS FROM HOME: For the safety and protection of all children, please do not allow your camper to bring personal items such as electronic devices, cell phones, sharp objects, or anything that could be considered a weapon to camp. Campers are expected to keep track of their own belongings and respect the property of others. Any items found in a camper’s possession that conflict with the YMCA’s code of conduct will be removed by YMCA staff until parent pick up. The YMCA’s code of conduct can be found at fwymca.org.

READY! SET! PACK!

CAMP DETAILS

BELONGINGSummer camp is an unforgettable experience that will give each camper memories that will last a lifetime.

FEES: Full Time* (4-5 days/week): $110/week YMCA members$130/week program participants* When you are registered for Full Time, full fee is required, no matter how many days your child attends that week.

Part Time** (1-3 days/week): $72/week YMCA members$81/week program participants** You may go from part time to full time if needed.

The fee difference is expected to be paid at time of change.

FIELD TRIPS: Weekly field trips will be on most Wednesdays, though they may fall on a different day of the week based on scheduling. Information will be given to parents at Camp Open House and on Monday mornings.

Multiple Sibling Discount:Families with more than one child enrolled in camp are eligible to a sibling discount off the regular program fees. Full time $10 off; Part Time $6 off. This discount is only available to families not receiving any other forms of financial assistance.

8:30am - 4:30pm, Monday - Friday 950 E. Van Buren St.• Ages: Entering Kindergarten - 5th grade. • Extended care begins at 6:00am, ends at

6:00pm. Available for no extra charge.

The Leaders in Training program (middle school students) and Counselor in Training (high school students) will help your child become a role model by focusing on the YMCA’s mission and four core values: Caring, Honesty, Respect, and Responsibility. This program will encourage leadership development through shadowing counselors, planning activities, and engaging in community service projects; In order to secure a spot in our program, candidates must apply, submit two reference forms, be interviewed and accepted into the program.

FEES: LIT Program $72/week YMCA members$81/week program participants

CIT Program $50 One-time fee for the whole summer for YMCA member or program participant.

LIT/CIT: Leaders In Training/Counselor in Training8:30am - 4:30pm Tue, Wed, & Thurs.*950 E. Van Buren St.• Ages: LIT for campers entering 6th -8th,

CIT campers entering high school - 12th.• Training will be June 2-4, program

runs from June 9 - Aug. 6)• Extended care begins at 6:00am, ends at

6:00pm. Available for no extra charge.* Campers are welcome to join camp on Monday and Friday for an additional fee.

REGISTRATION:Registration begins March 28th at the Whitley County Family YMCA Member Services desk.

Join us at Registration Open Houses on Saturday, March 28th and Saturday, May 2nd from 9 am–12 pm

• Forms can be found at the Membership Services Desk.

• One registration form per child. • The Immunization Record form must

be signed by a health care provider. • Credit card payment are accepted in

person in the branch. • Drop off all completed forms with

your $25 per family registration fee ($50 after May 10th ) payable to:

Whitley County Family YMCAAttn: Jacie Stahl950 E. Van Buren StreetColumbia City, IN 46725

PAYMENT: Payment is due the Thursday prior to the week your child will be attending at time of drop off or pick up. There is a $5 late fee if paid on a Friday, $10 late fee if paid on Monday. Payment options include: Check (payable to Whitley County Family YMCA), cash, money order, credit card, or bank draft which will be drafted every other Monday. Payments may be made to a YMCA Counselor. A sibling discount is available: Full time $10 off; Part Time $6 off.

We offer financial assistance for member and program participants. Aid is based on need and is kept strictly confidential. We also accept CANI. Please stop by the Membership Services Desk for more information.

Have questions?Contact Jacie Stahl Jacie_Stahl@fwymca.org260.244.9622

Week 1: Highland Games (June 1-5)Let the games begin! Join us for a week of nonstop action as we explore the world of Highland games and the history behind it!

Week 2: Jedi Training (June 8-12)Greetings, initiate! Don the Jedi robe. Recite the Jedi Code. Close your eyes. Feel the Force. Become the Jedi. Deflect laser bolts, battle with light sabers, and use your mind powers to fulfill your destiny. If you love Star Wars, then you definitely belong in this week of camp!

Week 3: Boot Camp (June 15-19)Left...Left...Left - Right Left! This week campers will be involved in a military style boot camp and become camp recruits! They will complete exercises and drills that are sure to bring excitement and fun!

Week 4: Sticky business..Duct Tape week (June 22-26)We have all heard that you can fix anything with a little duct tape...but did you know that you can create and design your own wallet, neck tie, belt, ipod case, hair bows, and flowers with duct tape? The list is endless! We will be creating some amazing duct tape masterpieces this week!

Week 5: Once Upon a Time (June 29-July 3) Remember all of those great tales, like the Three Little pigs, Little Red Riding Hood, or Sleeping Beauty? Each day will bring a new fairy tale to life with different twists, turns, and wacky endings.

WEEKLY THEMES

Week 6: Anatomy Week (July 6-10)Did you know that it is nearly impossible to tickle yourself? That your bones pound for pound are four times stronger than concrete? And that similar to finger prints, you also have a unique tongue print? We will be exploring the human anatomy and learn some neat things about our bodies this week!

Week 7: Harry Potter Week (July 13-17)Calling all Muggles and Harry Potter fans! Practice Quidditch, find your perfect wand, let the Sorting Hat choose your “house” and study some perfect potions.

Week 8: CSI Week (July 20-24)Calling all sleuths...Sherlock Holmes has nothing on us! Grab your magnifying glass and put on your thinking caps to follow the clues through the mystery and wonder of the week!

Week 9: Pirate Week (July 27-31)Ahoy there matey, time to hoist the sails and prepare for rip roaring fun! Bring your best mates and jump aboard as we scavenge the seas for treasure and bounty!

Week 10: Summer Safari (Aug. 3-7) Jaguars, Monkeys, and Snakes...Oh My! Look out, it sure is a jungle there! Come and join us for our safari journey!

REALIZING PASSIONANEW

FRIENDSHIPAmidst the fun of camp games, songs and talent shows, campers meet new friends,

learn about diversity, and strengthen existing friendships, while being led by our positive role models who promote the mission and core values.

Our mission is to put Christian principles into practice through programs that build healthy spirit, mind and body for all.

This form must be returned in order to register your child. Please inform us of any changes in information as they occur. Name: ______________________________________________________________________________________________________________________________________________________________ (first) (middle) (last)

Birthdate: ________/________/________ Grade: ______________________ Gender: □ male □ female Race: _____________________________________

Address: _________________________________________________________________ City: ___________________________________ State: __________ Zip: _____________________   

Parent/Guardian Name: ______________________________________________________________________ Relationship: _______________________________________________ Address: _______________________________________________________________ City: ___________________________________ State: __________ Zip: _______________________ Place of employment: _________________________________________________________________________ Occupation: ________________________________________________ Home phone: ______________________________________ Cell phone: ______________________________________ Work phone: _______________________________________ E-mail: _____________________________________________________________________________________________________________________________________________________________ Parent/Guardian Name: ______________________________________________________________________ Relationship: _______________________________________________ Address: _________________________________________________________________ City: ___________________________________ State: __________ Zip: _____________________ Place of employment: _________________________________________________________________________ Occupation: ________________________________________________ Home phone: ______________________________________ Cell phone: _______________________________________ Work phone: ______________________________________ E-mail: _____________________________________________________________________________________________________________________________________________________________

Parent’s Marital Status: □ Married □ Single □ Divorced □ Mother remarried □ Father remarried Please state custody arrangements and provide court documentation. _____________________________________________________________________________________________________________ ______________________________________________________________________________________________________________

CHILD’S INFORMATION

PARENT/GUARDIAN INFORMATION

REGISTRATION FORM

I hereby give my consent for the following individuals to pick up my child from the YMCA Childcare Program. I understand that the YMCA of Greater Fort Wayne and Childcare Services are not responsible for my child once they have been signed out of the Childcare Program. In an emergency situation, the YMCA will always try to contact the parent(s)/guardian(s) first. In case the parent(s)/guardian(s) cannot be reached, we will contact the following emergency contacts. Please list at least two emergency contacts in order of preference for contact.

Authorized Pick Up: □ Mother □ Father □ Guardian(s)

Name: ____________________________________________ Name: ____________________________________________ Name: _____________________________________________ Relation to child: ______________________________ Relation to child: ____________________ __________ Relation to child: _______________________________ Hm #: _____________________________________________ Hm #: ____________________________________________ Hm #: ______________________________________________ Cell #: _____________________________________________ Cell #: ____________________________________________ Cell #: _____________________________________________ Wk #: _____________________________________________ Wk#: ______________________________________________ Wk#: _______________________________________________

□ Authorized Pick Up □ Authorized Pick Up □ Authorized Pick Up

□ Emergency Contact □ Emergency Contact □ Emergency Contact

My child has permission to participate in YMCA Childcare activities. Basic first aid and emergency treatment are authorized. I recognize and acknowledge that there are certain risks of physical injury, and agree to assume full risk of injuries, damages, or loss which said participant may sustain as a result of participating in any and all activities connected with or associated with such program. I authorize the YMCA to transport my child via emergency transportation should it be deemed necessary by the YMCA staff. I give my permission for my child to participate in field trips during Childcare program hours with the understanding that advance notice and details will be provided. I give the YMCA permission, without limitation or obligation, to use photography, video, or audio recordings of my child partici-pating in YMCA Childcare programs for the promotion or interpretation of the YMCA. I understand that my child cannot attend YMCA Childcare programs until all required forms are turned in to the YMCA. ____________________________________________________________ _____________________________________________ Parent / Guardian Signature Date ____________________________________________________________ Printed Name

AUTHORIZED PICK UP/ EMERGENCY CONTACTS (Must be 18 years or older)

PARENT/ GUARDIAN(S) CONSENT

This form must be returned in order to register your child. Please inform us of any changes in information as they occur. Name: ______________________________________________________________________________________________________________________________________________________________ (first) (middle) (last)

Birthdate: __________/__________/__________ Grade ____________ Gender: □ male □ female Race: _________________________________ IMPORTANT: Please notify YMCA Childcare if your child’s information changes. Please give approximate dates: Conditions Allergies Diseases

□Frequent Ear Conditions □Hay Fever □Measles _________________________________

□Heart Defect □Poison Ivy □German Measles ______________________

□Convulsions □Insect Stings □Mumps __________________________________

□Diabetes □Penicillin □Chicken Pox ____________________________

□Bleeding Disorders □Peanuts/nuts □Asthma _________________________________

□Other □Other □Other ____________________________________ Operations or serious injuries (please list dates)_________________________________________________________________________________________________________ Chronic or recurring illness ___________________________________________________________________________________________________________________________________ Is your child taking any medication? ___________ Name of Medication ________________________________________________________________________________ Dose __________________________________ Special instructions _________________________________________________________________________________________________ Any specific activities to be encouraged? _________________________________________________ Restricted? _______________________________________________ Special needs or restrictions (dietary, health, physical, psychological, or educational) for staff awareness: ______________________________ ______________________________________________________________________________________________________________________________________________________________________ IMPORTANT: Please notify YMCA Childcare if your child is exposed to any communicable diseases. Family Physician ___________________________________________________________________________________________ Phone ____________________________________________ Dentist/Orthodontist _____________________________________________________________________________________ Phone ____________________________________________ Medical Insurance Carrier ________________________________________________________________________________ Policy # _________________________________________

This health history is correct to the best of my knowledge and the child herein described has permission to engage in all prescribed activities except as noted. I hereby give permission to the physician selected by the director to order x-rays, routine tests and treatment for the health of my child, and in the event I cannot be reached in an emergency. I hereby give permission to the physician selected by the director to hospi-talize, secure proper treatment for and to order injection and/or anesthesia and/or surgery for my child as named above. ___________________________________________________________ _____________________________________________________________ ___________________________________________ Parent/ Guardian Signature Printed Name Date

CHILD’S INFORMATION

HEALTH INFORMATION

IMPORTANT: MUST BE COMPLETED FOR ATTENDANCE

HEALTH FORM

Date of last Tetanus shot ______________________________________________________________________________________________________ Child has documented history of Chicken Pox? ___________ No ___________ Yes If yes, age ________________________ Parent Comments: (Please indicate religious objections, if any.) _____________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Health Care Provider Comments: (Please list immunizations excluded for medical purposes.) _________________ ________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________

Signed __________________________________________________________________________________ Date____________________________________ Health Care Provider’s Signature Printed Name and Title _________________________________________________________________________________________________________

Hep B

DtaP/ DTP/ Td

Hib

MMR

IPV

Varicella (Chicken Pox)

PCV / Prevanar

TO BE COMPLETED BY A HEALTH CARE PROVIDER

Immunization Record This form must be completed prior to your child’s first day of attendance.

This form will be updated annually.

Child’s full name ____________________________________________________________ Birthdate____________/____________/____________ Parent/Guardian name_____________________________________________________ Phone __________________________________________ School attending ___________________________________________________________ Camp attending ______________________________

Please check the appropriate response: _____ Child has received age-appropriate immunizations. _____ Child is currently in the process of receiving age-appropriate immunizations.