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CROSS ISLAND YMCASummer Camp 2014

WE’RE REady foRa summER of gRoWth and fun!

Dear Parents/Guardians,

We welcome all of our returning and new campers to our 2014 Summer Camp Programs. We are excited to embark on another summer of fun and learning.

From sports and swimming to arts and culture, YMCA camps span a broad range of interests. We focus on developing young minds and bodies.

In 2013 the YMCA served over 10,000 campers in communities throughout New York City. We are proud that in Queens the Cross Island YMCA will be able to engage your child in a summer of new friendships, skills and exploration.

Thank you for choosing our Y summer camp. We look forward to getting to know your camper!

Sincerely, Cross Island YMCA

In 1885 the YMCA helped to invent summer camp to provide children with positive and fun experiences that build confidence and new friendships. YMCA camp staff have served as positive role models for generations of campers and helped build future leaders.

The centerpiece of YMCA camps are activities that will excite and engage your child and give them a summer of adventure. Whether learning a new sport, exploring arts and culture or exploring New York City, YMCA Summer Camps offer an opportunity to build lifelong memories and a feeling of community that will last beyond the summer.

Each of our camps is accredited by the American Camping Association (ACA) and our staff go through rigorous training to ensure the safety and positive experience of each child.

“She loves camp and doesn’t want to leave at the end of the day. I feel good knowing she is safe and happy while I am at work” - YMCA Day Camp Parent

PROGRAMS

Our YMCA camps have something unique to offer for every age group from our Kinder Camp Programs to Teen Camp. Our goal is to meet your child’s developmental needs and provide a foun-dation for continued learning during the summer months.

Alongside sports, swimming and arts programs the YMCA offers academic enrichment that is infused throughout the camp day. These programs include summer reading, journal writing and science activities.

Each session you will be given a schedule of activities so you can follow your child’s course of learning and adventure over the summer.

OUR CAMP LOCATIONS

The Cross Island YMCA Summer Day Camp operates out of PS 33 at 91-37 222nd Street, Queens VIllage. The Early Childhood Camp runs out of the Cross Island YMCA.

Our Summer Sleepaway Camp is for boys and girls ages 6-16 from all over the world and is located outside NYC in Huguenot, NY. There are two villages, McAlister (ages 6–12) and Talcott (ages 12–15), that are located on 1,150 acres of forests and lakes.

CONTACT US

Day Camp Director 718-551-9336Shonnell Batson 718-551-9309 [email protected] Hollyann Harper 718-551-9334 [email protected]

What PaREnts nEEd to KnoWaBout day CamP

DATES & HOURS OF OPERATIONCross Island YMCA Summer Day Camp is an eight-week

program that runs from June 30th - August 22nd.

Camp hours are from 9:00 am - 4:00 pm.

Extended Day hours are from:

7:00 am - 9:00 am 4:00 pm - 6:00 pm

DAY CAMP OPEN HOUSES• Saturday, March 1: 10 am - 3 pm• Saturday, April 26: 10 am - 3 pm• Saturday, May 17: 10 am - 3 pm

REGISTRATION MADE EASY• Submit $100 deposit per session you would like

your child to attend. This will hold your child’s spot for the designated sessions of camp.

• Take advantage of the 10% Early Bird discount by registering by May 17.

• Submit your child’s medical form completed with parent information and signature as well as the doctor’s information, signature and stamp as soon as possible. It’s a good idea to keep extra copies of the medical form for your records.

• Submit 2 passport size photos of your child along with registration forms.

• The YMCA accepts all major credit cards or you may sign up for automatic billing to ensure payments are made on time with no late fees incurred.

FINANCIAL ASSISTANCE

The YMCA of Greater New York awards scholarships to campers based on a parent or family’s annual income. The scholarship applications must be submitted by

May 31, 2014.

DAY CAMP DISCOUNTS• 10% Early Bird Discount for those who register

before the end of the day on Saturday May 17th and have paid in full.

• 10% Sibling discount is available for all siblings of the first child registered at full price.

• Discounts cannot be combined and are available only on the cost of camps per session, not on extended day or transportation fees.

GOVERNMENT & UNION VOUCHERS*We accept ACD, HRA, TWU Local 100, and 1199 SEIU vouchers. You must have your confirmation letter with you at the time of registration. (*Participation varies by

branch)

REFUNDS AND CREDITS If your child cannot attend camp for a period of time paid, you may submit a request for credit along with documentation to the Camp Director. Credits can be used for camp or other programs throughout the year. Any refund requests will be submitted to the Camp Director and will be granted under the discretion of the Youth and Family Director. All requests should be made

prior to the start of the session.

PARENT ORIENTATION (AGES 5.9-17)

Parent/Guardian orientation meetings are mandatory. The meetings will be held on the following dates and times: Friday, June 6 7pm—8pm Saturday, June 14 5pm—6pm Sunday, June 22 3pm—4pm Wednesday, June 25 7pm—8pmEarly Childhood Camp (Ages 2-5.8) Parent Orienta-tion dates on next page.

CAMP GEAR Each camper will receive 2 tee shirts and a camp bag. Swim caps will be provided during the camper’s first day of swim. Camp tee shirts must be worn every day. Additional shirts can be purchased for $10 each or 3 for $25. Swim gear must consist of a towel, swim-suit, change of clothing, water shoes and a plastic bag for

wet swim gear.

TRANSPORTATION Transportation to and from the Cross Island YMCA is available only to campers in Youth & Teen or Specialty Camps (not Early Childhood Camp) who attend regular hours (9am–4pm). We do not offer transportation for our extended hours campers. The registration deadline for transportation service is Friday, May 30. The Cross Island YMCA offers transportation within the following communities:ArverneBaysideBelleroseCambria HeightsDouglastonElmontFar RockawayFloral ParkFranklin SquareFresh MeadowsGlen Oaks

HollisJamaicaJamaica EstatesLaureltonLittle NeckNew Hyde ParkOzone ParkQueens VillageRichmond HillRochdaleRosedale

St. AlbansSpringfieldGardensValley Stream

EXPLoRE!PLay!gRoW!

EARLY CHILDHOOD CAMPAges 2 – 5.8Sunita Batra at 718-551-9313; [email protected] primary goal is for each child to develop a positive self-image. The staff is made up of carefully selected teachers and assistant teachers. They provide guidance and supervision so that each child can achieve self-confidence and awareness.

Our camp offers air-conditioned classrooms, outdoor playground, picnic area, indoor pool and gym. Children participate in a wide variety of activities, including arts & crafts, swim (3 years & up), gym, music, and organized games. Early Chilhood Camp Orientation Dates: Thursday, June 5 6-7pm; Saturday, June 14 4-5pm; Wednesday, June 25 6-7pmCheck camp offerings page (Ages 2-5.8) for prices

CROSS ISLAND DAY CAMPAges 5.9-11Traditional Day Campers will engage in activities that will enhance their social and emotional skills, help keep their academics on track, keep them physically active and challenge them to learn new things every day. They will have the opportunity to meet new friends and take exciting trips throughout New York City. Campers will participate in a wide range of sports, instructional swimming, arts and crafts, and weekly themed days such as Crazy Hat Day. They will engage in environmental science and more. Traditional day campers will be divided into age groups with children no more than 1-2 years apart in age.

Day camp activities are designed to help children retain and build upon the academic skills they have developed during the school year. Research has shown that children can lose a half grade of learning over the summer months. The YMCA offers programs such as Book of the Week which gives children the opportunity to read a book as a camp group and participate in related discussion. Journaling helps children to retain writing skills through writing exercises that connect with their camp experiences. Field trips are selected to maximize educational enrichment and include trips to local museums and science centers.*Cost per 2 week session:Member: $420 Non-Member: $430

CROSS ISLAND TEEN CAMPAges 14-16Teen Camp is for 14-16 year olds currently enrolled in high schools. Teen Camp motivates teens through hands on programming that fosters development of educational and career goals. Along with sports, arts and cultural programs teens will have the opportunity to participate in college and career readiness programs. Field trips will allow teens to explore some of New York City’s key landmarks and cultural institutions.*Cost per 2 week session:Member: $420 Non-Member: $430

LISA BETH GERSTMAN CAMP FOR CHILDREN WITH PHYSICAL CHALLENGESAges 6 – 14This camp is made possible through the generous support of the Lisa Beth Gerstman Foundation. Its donation has offset the expenses of equipment, transportation and staffing required to serve children with special needs. All children will receive wheelchair accessible transportation, one-on-one swimming instruction, adaptive physical activities and equipment. A nurse is also present both onsite and on field trips outside of the Y for children who require special care like catheterization and/or medication administration. Session A July 7 - July 25 Session B July 28 - August 15 Jean Dattner at 718-551-9325, [email protected] DiPeri at 718-551-9319, [email protected]*Cost per 3 week session:Member: $725 Non-Member: $725

INCLUSION CAMP Ages 5.9-14A special summer experience awaits those enrolled in the inclusion explorer camp. This camp brings an inclusive recreational experience to children with disabilities. This unique camp gives children with special needs the same experience as other campers. Children with disabilities and their peers who are typically developing come together to participate in recreational activities such as swimming, arts and crafts, educational activities, reading, physical fitness and more. Camp counselors will serve as shadows—one counselor to every 2 campers. *Cost per 2 week session:Member: $725 Non-Member: $735

summER day CamP

TEAM SPORTS CAMP Ages 5.9-12

Our Team Sports Camp is designed to enhance various sports skills and fundamentals in groups according to age. Baseball, Basketball, Soccer and Flag Football. Campers will learn basic fundamentals and rules for each of the sports. Each day of the week our staff will focus on one of the four sports. Our goal is to expose the children to a variety of sports. Camper should bring proper equipment for each sport. In addition, they will learn about teamwork, good sportsmanship and motivating each other to succeed. Camp staff have background in coaching sports.

*Cost per 2 week session:Member: $475 Non-Member: $485

BASKETBALL CAMPAges 5.9-12

Players will perfect their dribbling, passing, shooting, defense, and offense skills according to their level of expertise. Academics, team work, and life skills will be incorporated throughout the sessions in order to enhance each camper as a whole. Classes are based on appropriate age and level of play. All ability levels are welcomed. Offensive and defensive skills and team concepts develop the most complete basketball player possible.


GYMNASTICS CAMPAges 5.9-12

Our Gymnastics Camp emphasize Individual skill development in a safe, fun and supportive environment. Dance, conditioning, stretching and performance tips will focus on fun for gymnasts of every level. The last day exhibition will give gymnasts an opportunity to show their new skills.


TENNIS CAMPAges 5.9-12

The Tennis Camp offers drills and activities carefully designed for different developmental levels so each camper will have a successful learning experience. The camp will focus on positioning, court layout and rules and regulations. The campers will also learn about the basic fore-hand and back hand strokes and compete in both singles and doubles activities. Campers must bring a racket and a sun visor or hat.


PERFORMANCE ARTS CAMPAges 5.9-12

Performance Arts Camp participants experience a wonderful summer of dance, drama, music & art. Campers will learn the basics of choreography from lyrical to hip-hop. In addition, campers will learn the fundamentals of acting, character study, improvisation exercises, and even try script writing. Create, Play, have Fun! Each camp showcases their new skills and performs for their families at the end of the session.


CRAFTS CAMP Ages 5.9-12

Crafts campers experience a vast array of creative arts, including sculpture, painting, collaging, scrapbooking, drawing, and more. This project based camp will give young artists hands on experience trying new mediums. Campers will make different art projects weekly, learn new skills, and develop lasting friendships in Crafts Camp!


TEEN SPORTS CAMP Ages 13-15

Our progressive curriculum enhances various sports skills and fundamentals. Campers will learn the different rules of each game while practicing their techniques in mini games. In addition, they will learn about team work, sportsmanship, and motivating each other to succeed. The camp will also focus on teaching fitness and healthy lifestyles.


COUNSELOR–IN–TRAININGAges 16-17

Our Counselor In Training (CIT) program is for tomorrow’s leaders. Teens who are involved in this amazing program gain job readiness skills and work experience during the summer working along with experienced staff. CITs l receive training in program safety and a Community Service Award. The program will provide hands-on learning allowing teens to slowly work into responsible roles leading children. Staff will assist teens in developing their communication and organization skills. CIT candidates will be interviewed by our Camp Director.


TYPE OF EXAM: NAE Current NAE Prior Year(s)

Comments

REVIEWER:

Date Reviewed:

DOHMHONLY

PROVIDER I.D.

__ __ / ___ ___ / ___ ___

I.D. NUMBER

Health Care Provider Signature Date__ __ / ___ ___ / ___ ___

Health Care Provider Name and Degree (print) Provider License No. and State

Facility Name National Provider Identifier (NPI)

Address City State Zip

Telephone ( __ __ __ ) ___ ___ ___ – ___ ___ ___ ___

Fax ( __ __ __ ) ___ ___ ___ – ___ ___ ___ ___

Hep B __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Rotavirus __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

DTP/DTaP/DT __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

__ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Hib __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

PCV __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Polio __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

RECOMMENDATIONS � Full physical activity � Full diet

� Restrictions (specify) ___________________________________________________________________________

Follow-up Needed � No � Yes, for _________________________ Appt. date: __ __ / ___ ___ / ___ ___

Referral(s): � None � Early Intervention � Special Education � Dental � Vision

� Other ________________________________________________________________________

ASSESSMENT � Well Child (V20.2) � Diagnoses/Problems (list) ICD-9 Code

_____________________________________________________________ __ __ __ __ __

_____________________________________________________________ __ __ __ __ __

_____________________________________________________________ __ __ __ __ __

Health insurance � Yes(including Medicaid)? � No

Does the child/adolescent have a past or present medical history of the following?� Asthma (check severity and attach MAF/Asthma Action Plan): � Intermittent � Mild Persistent � Moderate Persistent � Severe Persistent

If persistent, check all current medication(s): � Inhaled corticosteriod � Other controller � Quick relief med � Oral steroid � None

� Attention Deficit Hyperactivity Disorder � Orthopedic injury/disability� Chronic or recurrent otitis media � Seizure disorder� Congenital or acquired heart disorder � Speech, hearing, or visual impairment� Developmental/learning problem � Tuberculosis (latent infection or disease)

� Diabetes (attach MAF) � Other (specify) ___________________

Explain all checked items above or on addendum

Birth history (age 0-6 yrs)

� Uncomplicated � Premature: ________ weeks gestation

� Complicated by _______________________________

Allergies � None � Epi pen prescribed

� Drugs (list)

� Foods (list)

� Other (list)

STUDENT ID NUMBEROSIS

CHILD & ADOLESCENT HEALTH EXAMINATION FORMNYC DEPARTMENT OF HEALTH & MENTAL HYGIENE — DEPARTMENT OF EDUCATION

Please Print Clearly

Press Hard

Child’s Last Name First Name Middle Name

Child’s Address

City/Borough State Zip Code

� Parent/Guardian Last Name First Name� Foster Parent

School/Center/Camp Name

Sex � Female � Male

Hispanic/Latino?� Yes � No

Race (Check ALL that apply) � American Indian � Asian � Black � White� Native Hawaiian/Pacific Islander � Other ____________________________

PHYSICAL EXAMINATION

Height ____________________ cm ( ___ ___ %ile)

Weight ____________________ kg ( ___ ___ %ile)

BMI ____________________ kg/m2 ( ___ ___ %ile)

Head Circumference (age ≤2 yrs) ______________ cm ( ___ ___ %ile)

Blood Pressure (age ≥3 yrs) _________ / __________

DEVELOPMENTAL (age 0-6 yrs) � Within normal limits

If delay suspected, specify below

� Cognitive (e.g., play skills) ____________________________

� Communication/Language _________________________

� Social/Emotional __________________________________

� Adaptive/Self-Help ________________________________

� Motor ___________________________________________

SCREENING TESTS Date Done Results

Blood Lead Level (BLL)__ __ / ___ ___ / ___ ___ _________ µg/dL

(required at age 1 yr and 2 yrsand for those at risk) __ __ / ___ ___ / ___ ___ _________ µg/dL

Lead Risk Assessment � At risk (do BLL)(annually, age 6 mo-6 yrs)

__ __ / ___ ___ / ___ ___ � Not at risk

Hearing � Pure tone audiometry � Normal� OAE __ __ / ___ ___ / ___ ___ � Abnormal

—— Head Start Only ——

Hemoglobin or __________ g/dLHematocrit (age 9–12 mo)

__ __ / ___ ___ / ___ ___ __________ %

Date Done Results

Tuberculosis Only required for students entering intermediate/middle/junior or high schoolwho have not previously attended any NYC public or private school

PPD/Mantoux placed __ __ / ___ ___ / ___ ___ Induration ______mm

PPD/Mantoux read __ __ / ___ ___ / ___ ___ � Neg � Pos

Interferon Test __ __ / ___ ___ / ___ ___ � Neg � Pos

Chest x-ray � Nl � Not(if PPD or Interferon positive)

__ __ / ___ ___ / ___ ___� Abnl Indicated

Vision

__ __ / ___ ___ / ___ ___

Acuity Right ___ / ___(required for new school entrants Left ___ / ___and children age 4–7 yrs) � with glasses Strabismus � No � Yes

General Appearance:

Nl Abnl Nl Abnl Nl Abnl Nl Abnl Nl Abnl

� � HEENT � � Lymph nodes � � Abdomen � � Skin � � Psychosocial Development� � Dental � � Lungs � � Genitourinary � � Neurological � � Language� � Neck � � Cardiovascular � � Extremities � � Back/spine � � Behavioral

Date of Birth (Month/Day/Year )__ __ / ___ ___ / ___ ___ ___ ___

Phone Numbers

Home _____________________

Cell ______________________

Work ______________________

TO BE COMPLETED BY PARENT OR GUARDIAN

TO BE COMPLETED BY HEALTH CARE PROVIDER If “yes” to any item, please explain (attach addendum, if needed)

CH-205 (5/08) Copies: White School/Child Care/Early Intervention/Camp, Canary Health Care Provider, Pink Parent/Guardian

Medications (attach MAF if in-school medication needed)

� None � Yes (list below)

Dietary Restrictions� None � Yes (list below)

Influenza __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

MMR __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Varicella __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Td __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Tdap __ __ / ___ ___ / ___ ___ Hep A __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Meningococcal __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

HPV __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Other, specify: ____________ __ __ / ___ ___ / ___ ___ ; _______________ __ __ / ___ ___ / ___ ___

IMMUNIZATIONS – DATES CIR Number of Child

Describe abnormalities:

District __ __Number __ __ __

2014 SUMMER EARLY CHILDHOOD HEALTH EXAM FORM (AGES 2 - 5.8)

a summER of fun

CHILD’S NAME: _________________________________________________________________________________________AGE:__________________________ CAMP SESSIONSSession Start Date End Date Payment Due Date Session 1 June 30, 2014 July 11, 2014 June 15, 2014Session 2 July 14, 2014 July 25, 2014 July 1, 2014Session 3 July 28, 2014 August 8, 2014 July 15, 2014Session 4 August 11, 2014 August 22, 2014 August 1, 2014

*CIRCLE ALL PRICES THAT APPLY TO YOU - CAMP FEES PER SESSION (every two weeks)

CAMP AGES SESSION 1 SESSION 2 SESSION 3 SESSION 4

DAY CAMP 5.9 - 8 & 9 -12 M: $378NM: $387

M: $420NM: $430

M: $420NM: $430

M: $420NM: $430

TEEN CAMP 13 - 15M: $378NM: $387

M: $420NM: $430

M: $420NM: $430

M: $420NM: $430

LISA BETH GERSTMAN CAMP

6 - 14SESSION AJuly 7 - July 25ALL: $725

SESSION BJuly 28 - Aug15ALL: $725

INCLUSION CAMP5.9 - 8, 9 -12

&13 -14M: $648NM: $651.50

M: $725NM: $735

M: $725NM: $735

M: $725NM: $735

TEAM SPORTS CAMP

5.9 - 8 & 9 -12 M: $427.50NM: $436.50

M: $475NM: $485

M: $475NM: $485

M: $475NM: $485

GYMNASTICS CAMP

5.9 - 8 & 9 -12 M: $427.50NM: $436.50

M: $475NM: $485

M: $475NM: $485

M: $475NM: $485

BASKETBALL CAMP

5.9 - 8 & 9 -12M: $427.50NM: $436.50

M: $475NM: $485

M: $475NM: $485

M: $475NM: $485

TENNIS CAMP 5.9 - 8 & 9 -12 M: $427.50NM: $436.50

M: $475NM: $485

M: $475NM: $485

M: $475NM: $485

CRAFTS CAMP 5.9 - 8 & 9 -12 M: $427.50NM: $436.50

M: $475NM: $485

M: $475NM: $485

M: $475NM: $485

PERFORMING ARTS CAMP

5.9 - 8 & 9 -12 M: $427.50NM: $436.50

M: $475NM: $485

M: $475NM: $485

M: $475NM: $485

TEEN SPORTS CAMP

13 - 15M: $427.50NM: $436.50

M: $475NM: $485

M: $475NM: $485

M: $475NM: $485

COUNSELORS IN TRAINING

16 - 17M: $234NM: $243

M: $260NM: $270

M: $260NM: $270

M: $260NM: $270

Extended Hours AM: $99PM: $99

AM: $110PM: $110

AM: $110PM: $110

AM: $110PM: $110

Transportation 6+AM: $135PM: $135

AM: $150PM: $150

AM: $150PM: $150

AM: $150PM: $150

Totals $ $ $ $

-Discount $ $ $ $

Grand Total $ $ $ $

2014 SUMMER DAY CAMP SESSIONS AND FEESCAMP OFFERINGS (AGES 5.9-16)

“she loves camp and doesn’t want to leave at the end of the day. I feel good knowing she is happy and safe while I’m at work.”

HEALTH RECORD FOR CHILDREN IN DAY CAMPS & AFTERSCHOOL & YOUTH CENTERS(This side to be filled in by parent before presentation to physician)

NAME OF PROGRAM

/ / M ❑ F ❑CHILD'S LAST NAME FIRST NAME BIRTHDATE SEX

Home Address: Phone:

Parent or Guardian: Phone:

Place of Employment: Father (Guardian) Phone:

Mother (Guardian) Phone:

In case of emergency, notify: Phone:

If Parent, Guardian are not available in an emergency, notify:

1. Phone:

or 2. Phone:

Important: Has this camper been exposed to any communicable disease during the three weeks prior to camp attendance: Yes ❑ No ❑ (If yes, state type of exposure: )

HEALTH HISTORY: (Check box if child has had afflictions, give appropriate dates)Allergies

❑ Rheumatic Fever ❑ Hay Fever

❑ Seizures ❑ Poison Ivy, etc.

❑ Diabetes ❑ Insect Stings

❑ Asthma ❑ Penicillin

❑ Chicken Pox ❑ Other Drugs

❑ Food

CONSENT FOR EMERGENCY MEDICAL TREATMENTI do hereby give authority to the Day Camp and Year Round Afterschool and Youth Center Program staff to obtain necessary

emergency medical treatment for my child with the understanding that the family will be notified as soon as possible.

Relationship Signature Date Tel.#

Department of Health and Mental Hygiene — The City of New York — Bureau of Food Safety and Community Sanitation

Other Past Illnesses

Operations or Serious Injuries (Dates)

Hospitalization (Dates)

Chronic or Recurring Illness

Any specific activities to be encouraged?

Conditions that require activity to be restricted?

Permission for all program activities unless otherwise noted by Dr.

Appliance worn (glasses, contacts, etc.)

Medication taken

Suggestion from Parent/Guardian

DCR 7 (Rev. 2/04)

2014 SUMMER DAY CAMP HEALTH EXAM FORM (AGES 5.9 - 17) PAGE 1

2014 SUMMER DAY CAMP HEALTH EXAM FORM (AGES 5.9 - 17) PAGE 2

PHYSICAL EXAMINATION(To be filled out by Physician – please note information on reverse side)

The purpose of this health record is to provide the staff with pertinent information which will help to serve the needsof this child in Day Camps and Afterschool and Youth Center programs.

IMMUNIZATION HISTORY – This is a record of dates of basic immunization and most recent booster doses.DTaP, DTP, DT, Td Date __________ Date __________ Date __________ Date __________ Date __________ Polio Date __________ Date __________ Date __________ Date __________ Date __________ MMR Date __________ Date __________ Date __________Hemophilus Influenzae type b (Hib) Date __________ Date __________ Date __________ Date __________Hepatitis B Date __________ Date __________ Date __________ Date __________Varicella Date __________ Date __________Pneumococcal Conjugate (PCV) Date __________ Date __________ Date __________ Date __________ Date __________Other _____________ Date __________ Other _________ Date __________ Other _________ Date __________

MEDICAL EXAMINATION – To be filled out by licensed physician.

Examination is acceptable when performed no more than 12 months prior to arrival at camp.

Code: S = SatisfactoryX = Not Satisfactory (Explain)0 = Not Examined

General AppearanceGenitaliaHeight Weight Blood Pressure Posture & Spine Throat - Tonsils Nose Teeth Abdomen Hernia Feet Lungs SkinHgb. Test (Date) Urinalysis (Date) Eyes Vision w/Glasses Extremities HeartEars Hearing Neurological FindingsDescribe Abnormal Findings and/or Handicapping Conditions

I have examined the person herein described, reviewed his/her health history and it is my opinion that he/she is physically able toengage in Day Camp/Year Round Afterschool and Youth Center activities, except as noted above.

M.D.EXAMINING PHYSICIAN (SIGNATURE)

PHYSICIAN'S NAME (PLEASE PRINT)

Telephone Address

Date of ExaminationZIP CODE

DCR 7 (Rev. 2/04)

Allergy: (Please specify)

Recommendations and restrictions while in camp:

Special DietSpecial Medicine (dose, route of administration, when should it be administered)Is parent/guardian sending special medicine?Activity RestrictionsSwimming Diving

General Appraisal:

safE.oVERnIght.adVEntuREs.

The New York YMCA Camp is located 86 miles outside of NYC on 1,150 forrested acres. We are a safe, inclusive, and diverse camp community. We are a place where children can develop friendships, lifelong skills, and cherished memories. Programs offered at New York YMCA Camp are Summer Sleepaway Camp, Specialized Summer Sports Camps (Gymnastics, Volleyball and Judo), Day Camp for Hudson Valley residents, Outdoor Education, customizable Retreat Groups, and Special Retreat Weekends (Women’s Wellness Weekend, Men’s Adventure Weekend, Family Camp). For more information on any of these programs please call 877-30-YCAMP or visit our website at www.nyycamp.org.

CROSS ISLAND SUMMER SLEEPAWAY CAMP Have an unforgettable summer at New York’s YMCA Camp! Our camp is for boys and girls ages 6 to 16 from NYC and all over the world. There are two villages, McAlister (ages 6 to12) and Talcott (ages12 to15). Just a sample of activities that we offer are swimming lessons, a wide variety of sports, arts and crafts, outdoor living skills, media program, canoeing, Wibit, and our ropes courses. We also offer specialty programs that include water skiing, horseback riding, and rafting trips for a small additional fee.

FAMILY CAMP Summer 2014 | August 29 –September 1 Winter 2014 | February 14 -17

Strengthen family bonds and have fun at our Summer or Winter Family Camps. Enjoy a weekend with sports, crafts, and special themed activities. In the summer, have fun in the sun on our beautiful beaches where families can swim, tube, and waterski. When winter gives us snow, XC-skiing, snow-shoeing, and snow-tubing are always family favorites.

Why three prices? New York YMCA Camp realizes that families have differing abilities to pay, so we offer a voluntary 3-tier pricing program. This is strictly an honor system; select the fee you feel is appropriate to what you can pay. The program is voluntary, and in no way influences the experience children receive.

Tier 1 – Is the actual cost of camp for a child to participate Tier 2 – Is our partially subsidized fee for temporary or minor financial need Tier 3 – Is our heavily subsidized fee for those in need of more financial assistance

*We offer need-based financial assistance.

Session 1 June 29 – July 4

Session 2 July 6 - 18

Session 3 July 20 - August 1

Session 4 August 3 – 8

Session 5 August 10- 22

Tier 1 Tier 2 Tier 3

1 Week 2 Weeks 1 Week 2 Weeks 1 Week 2 Weeks

$859 $1589 $759 $1389 $659 $1189

CRoss IsLand ysLEEPaWay CamPs

INTERNATIONAL JUDO CAMP For players of all ages | August 10 – August 16

We offer world class training for athletes from around the world. During daily practice and evening Randori, our coaches evaluate skills to develop an individualized, training program for every camper. Our focus is to support each child and adult to learn new skills and to perfect their existing ones.

Our camp includes Olympic quality Tami mats, 2 inch Swain flexi-roll mats, weightlifting and cardiovascular training equipment, trainers and medical staff on site 24/7.

Apply before July 1st: $629 Apply after July 1st: $679

WORLD VOLLEYBALL TRAINING CENTER Ages 10 to 18 We offer progressive training techniques for all skill levels, position specific training, and video training with personal feedback. We also offer plyometric and weight training opportunities for qualified campers. The Volleyball Select program is for advanced players looking to experience training on the collegiate level.

Our camp includes 6 indoor courts with all new sport court, 5 new outdoor grass courts, a training room, certified athletic trainers, and medical attention available 24/7. We offer team packages for full week and half week rates.

Session 1 July 20 – 25

Session 2 July 27 - August 1

Session 3 August 3 – 8

Team Mini Camp 1 July 20 - 23

Team Mini Camp 2 July 27 - 30

Team Mini Camp 3 August 3 – 6

Tier 1 Tier 2 Tier 3 Team Mini Camp Team Weekly Camp

$829 $779 $729 $395 $745

NATIONAL GYMNASTICS TRAINING CAMP Ages 7 to 17

We offer world class training for dedicated and determined gymnasts from around the world. Our focus is to support each gymnast to develop new skills and improve existing ones. Every gymnast has the opportunity to train closely with our world class coaches.

Our camp includes 16,000 sq feet of training space, 6 vault stations, 12 beam stations, 4 sets of competition bars, 2 full floor exercises, certified athletic trainers, and medical attention available 24/7, and more. Team rates are available.

Session 1 June 29 – July 4

Session 2 July 6 - 11

Tier 1 Tier 2 Tier 3 Team Camp

$999 $899 $7991 week 2 week

$889 $1779

OUTDOOR ADVENTURE TRIPS Ages 10 to 15

One or two-week adventure trips where campers experience safe, outdoor activities including mountain biking, hiking, camping, canoeing, whitewater rafting, kayaking, surfing, tubing, high-team adventure and so much more.

Trip Ages Date Fee

Delaware River Adventure 12-15 June 29 - July 4 $679

Empire State Adventures 12-15 July 6 -18 $1659

Southeast Adventures 12-15 July 20 - August 1 $1799

Introductory Adventures 10-12 August 3 - 8 $679

Great Lakes Adventures 12-15 August 10-22 $1799

RETREAT CENTERYear Round, Upstate New York

The Greenkill Retreat Center at the New York YMCA Camp is open year round with options for day trips, overnights, or multiple-night stays. From activity choices and breakout sessions to lodging, recreation, and meals, we work closely with each group to design a retreat that meets group goals.

OUTDOOR EDUCATION CENTER September to June, Upstate New York

The Greenkill Outdoor Education Center provides safe and educational programs for students through a holistic approach that tailors each trip to a school’s specific needs. Educational programs range from social and emotional development to recreation, to experiential environmental education. Our professional staff focuses on the needs of students and encourages learning in the natural environment.

WOMEN’S WELLNESS WEEKENDS Spring 2014 | May 16 – 18 Fall 2014 | October 17-19

Immerse yourself in nature at one or both of our women’s only retreat weekends. Activities include arts and crafts, guided hikes throughout our picturesque property, health and wellness sessions, yoga, and more.

2014 sleepaway Campopen house dates

march 23rd

april 13th april 27th

June 1st

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CROSS ISLAND YMCA - secure.ymcanyc.org Island Y Summer Camp 201… · playground, picnic area,...

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