ANA BANANA KIDS FISHING CAMP (FISHING UNDERSTANDING NURTURING)

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1 ANA BANANA KIDS FISHING CAMP (FISHING UNDERSTANDING NURTURING) 2015 REGISTRATION (June 1 thru August 28) Parent s Name: Phone: Address: City: State: Zip: (1) Child s Full Name: Age: Male Female (Check 1) T-shirt Size (circle one) Youth Medium/Youth Large/Adult Small/Adult Medium/Adult Large/Adult X-Large Week(s) attending Camp: Week (2) Child s Full Name: Age: Male Female (Check 1) T-shirt Size (circle one) Youth Medium/Youth Large/Adult Small/Adult Medium/Adult Large/Adult X-Large Week(s) attending Camp: Week (3) Child s Full Name: Age: Male Female (Check 1) T-shirt Size (circle one) Youth Medium/Youth Large/Adult Small/Adult Medium/Adult Large/Adult X-Large Week(s) attending Camp: Week FISHING FUN! FISHING FUN! FISHING FUN! FISHING FUN! FISHING FUN! June 1-5 (FULL) Week 1 June 8-12 Week 2 June Week 3 June Week 4 June 29-July 3 Week 5 July 6-10 Week 6 July Week 7 July Week 8 July Week 9 August 3-7 Week 10 August Week 11 August Week 12 August Week 13 (FULL) CAMP FEES: One Week Special: $595 per child Two Week Special: $995 per child Three Week Special: $1295 per child Four Week Special: $1595 per child Amount: $ $30 multiple child discount (ONE per family) Amount: $ $35 early registration discount (May 22 deadline) Amount: $ (other promotion/discount) Amount: $ Total Amount Due: $ Form of Payment: Check Cash Master Card Visa Discover Amex Check #: (made payable to Ana Banana Kids Fishing Camp) Credit Card #: Exp. Date: Printed Name on Card: Signature: ANA BANANA KIDS FISHING CAMP Website: Phone: Mailing Address: 6615 Dolphin Cove Drive, Apollo Beach, FL Camp Address: Little Harbor Resort (Hooks Grill), 611 Destiny Drive, Ruskin, FL (Camp Guidelines on Page 2)

2 ANA BANANA KIDS FISHING CAMP CAMP GUIDELINES Thanks for becoming a member of the Ana Banana Kids Fishing Camp Family! Summer FUN is what we re all about and we re looking forward to teaching your Camp Kid to love the art of FISHING, UNDERSTAND responsible angling, and NURTURE our natural resources. If you have any questions, please call Captain Joel Brandenburg at (813) or Fees: Please pay for camp sessions at registration. Payments for after-care are due daily. Cancellations made at least 10 working days prior to camp session will be charged a $65 processing fee, with a $75 processing fee for cancellations made 2-9 working days prior to camp session. Fees are nonrefundable otherwise. A full refund will be given if the camp session is cancelled by Ana Banana Kids Fishing Camp. Arrival and Departure: Please arrive by 8:45 a.m. on Monday for check-in. You must sign your child IN and OUT daily. Please be ready to depart at your scheduled time. Camp hours are 9 a.m. to 4 p.m. daily. Before and After-care are available from 8 a.m. to 6 p.m. at the nominal fee of $10 per hour. The Awards Banquet will be held every Friday at 2 p.m. Parents are encouraged to come to the Banquet and take photographs. Forms to be completed and returned: Hold Harmless Agreement must be returned on or before the first day of camp. Rules & Regulations Form must be returned on or before the first day of camp. *If an alternate parent/person is to pick your child up, please fill in the appropriate information on the Hold Harmless Agreement. Contacting Camp Staff: To reach Captain Joel Brandenburg from 9 a.m. to 4 p.m., please call (813) If you are unable to reach that number, please call. Dress Code: An Ana Banana Kids Fishing Camp (ABKFC) tee-shirt will be received by each camper on the first day of camp. Campers must wear the ABKFC tee shirt daily. Additional shirts are available for $8.00 each. Campers should dress casually with shorts, tee shirt, tennis shoes and socks (no sandals), hat or cap. Sunscreen is suggested, and a light jacket or poncho may be worn to protect against wind or rain. Lunch: Campers must either bring a non-perishable bag lunch daily or order lunch at Hook s Restaurant at a cost of $6 per lunch. Campers are encouraged to bring their own water bottle (refills available). Restrictions: A backpack may be brought to camp with the suggested items above. Cell phones are permitted, but must stay in the backpack while fishing. IN AN EFFORT TO IDENTIFY CAMPERS BELONGINGS, PLEASE LABEL ALL ITEMS BROUGHT TO CAMP. Ana Banana Kids Fishing Camp is not responsible for lost or stolen items. Thank you for your cooperation.

3 ANA BANANA KIDS FISHING CAMP HOLD HARMLESS AGREEMENT CAMPER S NAME: I, (Parent/Guardian Name) shall assume all risk and responsibilities associated with the above camper s visit. Ana Banana Kids Fishing Camp is not liable for accidents, theft and/or vandalism on its property or on offsite field trips. EMERGENCY CONTACT NAME: RELATION TO CAMPER: PHONE: WORK: CELL: EMERGENCY CONTACT NAME: RELATION TO CAMPER: PHONE: WORK: CELL: Emergency Medical Care for Campers In the event of a medical emergency, and I am unable to be contacted, I give permission for a health care professional to do what is necessary for the health and safety of my child. I will not hold the camp staff liable unless negligent. Insurance: YES NO If yes please provide information below: Parent/Guardian Insurance Co. Policy # Parent/Guardian Signature: Date Does the camper have any of the health problems listed below? Check ALL that apply. Epilepsy Heart Disease Seizures ADHD Other Description of above: Is the camper bringing any medication to camp? If so, please list ALL medications brought and instructions. Is your child Diabetic? Yes No (If no, please skip to the next section) If yes, does your child need to snack often throughout the day? Can he/she participate during edible activities? (some of our activities are edible and contain sugar). Can he/she administer his/her own medication? Do you give ABKFC permission to administer medication? Do you give ABKFC permission to provide sugar if necessary? Yes No. Initial Yes No. Initial Yes No. Initial Yes No. Initial Yes No. Initial

4 Is your child susceptible to any of the following? Check ALL that apply: Bees Fire Ants Ear Infections Asthma Other Please provide medications needed: Do you give ABKFC permission to administer this medication? Yes No Initial Does your child have any food allergies? (e.g., peanuts, shellfish) Yes No Initial Does your child carry an Epinephrine pen? Yes No Initial Do you give ABKFC permission to administer the pen? Yes No Initial Does your child have a communicable disease such as Pink eye, lice, flu, ringworm, peen worm, shigella, etc.? Yes No Initial Does your child have any allergies or sensitivities to medication or first aid supplies such as latex, Vinegar, soap, gauze, tape, etc.? If so, please list: Can Aspirin/Tylenol be administered with your consent via phone? Yes No Initial Can insect bite medication be administered with your consent via phone: Yes No Initial Has your child received a tetanus booster in the last 5 years? Yes No Initial *Under the Good Samaritan Act and first aid laws, we are not permitted to treat wounds with Neosporin, rubbing alcohol, peroxide or any other types of ointments. All wounds will only be treated with soapy water and/or vinegar and bandaged. I give ABKFC permission to remove splinters or hooks I give ABKFC permission to provide my child with sunscreen, (in the event it has not been provided by parent) I give ABKFC permission to perform CPR Yes No Initial Yes No Initial Yes No Initial Child Release Please list name and phone number of person(s) responsible for drop off or pick up if not the same person registering the child for camp. NAME: PHONE: RELATION TO CAMPER: NAME: PHONE: RELATION TO CAMPER: Photo Release I give Ana Banana Kids Fishing Camp, its subsidiaries, assignees and licensees, the irrevocable and absolute right and permission to copyright, use, publish, alter and distribute all photographs, videos or film in which my child may be included, taken while at ABKFC in conjunction with any publicity, promotion or advertising for such activity. I understand that these photographs, videos or film footage may be used for publicity, advertising or promotions or for any lawful purpose whatsoever without restrictions and are the sole property of Ana Banana Kids Fishing Camp. I give ABKFC permission to use photographs of my child. Parent Signature I will not hold ABKFC or staff responsible for any injuries that occur as a result of first aid procedures or procedures I have consented to. I understand the information herein and testify that the information provided is accurate and true. Parent Signature Date

5 ANA BANANA KIDS FISHING CAMP RULES & REGULATIONS 1. An official ANA BANANA KIDS FISHING CAMP Tee shirt must be work at all times. 2. Use of bad language is prohibited at Camp. 3. Campers will be assigned equipment for fishing and are NOT PERMITTED to bring their own fishing equipment to camp. 4. Campers may never go anywhere by themselves. 5. Campers must maintain respect for each other and the counselors at all times. 6. Campers are never to touch one another or their counselors for any reason. 7. The following items are permitted and should be labeled with the name of the camper: Hat, light jacket, towel, water shoes, water bottle, bathing suit and a change of clothes. 8. Campers are responsible for the items they bring to camp ABKFC is not responsible for any misplaced, lost or stolen items. Discipline Please read and sign the following, which explains the disciplinary procedures used by Camp Counselors when offenses occur: 1. First Offense: Camper will review the Rules & Regulations with a Counselor and sign the Disciplinary Book to indicate that a promise of acceptable behavior has been made. 2. Second Offense: Captain Joel will be notified of the offense and the Camper will receive a Time out. Camper will again review the Rules & Regulations with a Counselor and sign the Disciplinary Book to indicate that a promise of acceptable behavior has once again been made. 3. Third Offense: Staff will schedule a parent/staff conference. 4. Fourth Offense: Child could be suspended or expelled from the program and/or field trips. Please note that some of the above steps may be skipped if the offense warrants such action. I have read the Rules & Regulations above and agree to abide by these rules at all times. Camper s Signature: I have read the Rules & Regulations and understand my responsibilities as a Parent/Guardian. Parent/Guardian Signature Date:

6 FREQUENTLY ASKED QUESTIONS Who is the Camp Director? Captain Joel Brandenburg, Education Director What are the certifications and qualifications of the counselors: Have they had background checks and been fingerprinted? Are they local residents? Counselors are certified in CPR and First Aid. Background checks and fingerprints have been assessed for all Counselors. Counselors are family-oriented local residents. What is the ratio of students to chaperones? Ana Banana Kids Fishing Camp practices the same standards as the local school district 1 chaperone to 10 children (or less). In addition, volunteers are on hand each week to aid Counselors with campers. Is the camp program onsite or offsite? If offsite, where? The camp program is onsite, with Campers attending Orientation on Monday, and then learning fishing basics on the water and applying those fishing basics daily throughout the week. Campers receive further instruction and education from guest speakers on Tuesday, Wednesday and Thursday afternoons, and participate in a Fishing Tournament and Awards Ceremony on Friday. What are the Camp Fees? Are there any discounts? 1 week special $595 per Camper 2 week special $995 per Camper 3 week special $1295 per Camper 4 week special $1595 per Camper The more weeks your child attends, the more you save! Please ask about our multiple child discounts! Each Camper receives: * A great week of FUN (Fishing/Understanding/Nurturing)! * 5 days of fishing with a Pro Charter Captain * Visit from Mote Marine Lab Center for Shark Research * A rod & reel & tackle box & tackle from our sponsors * Ana Banana Kids Fishing Camp t-shirt and hat/cap * Certificate of Achievement at the Awards Banquet * Many prizes and gifts from our sponsors * A chance to win the First Place Tournament Trophy * Opportunity to purchase a daily hook n cook * A chance to win a two-person hog or duck hunt * A chance to win a family fishing charter * A chance to win a spear fishing or scalloping trip * A chance to win a family Tampa Bay dinner cruise

7 Is there a deposit required? A deposit is not required. However, you must pay in full for your camp at the time of registration. Your child s space will not be saved unless payment has been received. After care can be paid on a daily basis. What are the camp hours? Camp hours are 9 a.m. to 4 p.m. Monday through Thursday. Friday, Campers are required to arrive at 7:30 a.m. for participation in the Fishing Tournament, and parents are encouraged to attend the Awards Banquet from 3 to 4 p.m. Before care is available Monday Thursday from 8 to 9 a.m. free of charge. After care is offered from 4 to 6 p.m. daily at a rate of $10 per hour. What are the ages for camp and is it co-ed? Boys and Girls, ages 5 thru 15, are invited to be Campers. Campers will be divided into three groups while fishing: Ages 5-9, and However, we reserve the right to combine group ages if needed. What activities will Campers participate in? What will they learn? Do campers need to have prior knowledge or experience with fishing? Activities at Ana Banana Kids Fishing Camp include basic fishing - ethical angling practices, understanding of nature and preservation of our natural resources, knot tying, tackle, making lures, tying flies and jigs, information about marine animals and exploration of a coastal habitat. No experience is required prior to becoming a camper. Is transportation provided to and from camp? No, each child must be dropped off and picked up by their parent/guardian. What is the procedure for drop off and pick up? Each morning, a parent/guardian must bring the Camper inside and sign the log sheet with time of arrival. A child cannot be dropped off without a parent/guardian signature on the roster. Each afternoon, parent/guardian must sign the roster to pick up their child. Only adults listed on the Hold Harmless Agreement Form will be allowed to sign a Camper out. Is lunch provided? No, lunch is not provided. Campers may bring a bag lunch that does not require refrigeration, or they may purchase lunch at Hooks Restaurant. We suggest they bring an extra drink and snack for mid-afternoon. What do the campers need to wear daily? Campers should wear comfortable casual clothing. Shorts, t-shirts and sneakers are recommended. Sunscreen, a light jacket or poncho are also suggested. Campers are requested to wear their Ana Banana Kids Fishing Camp T-Shirt on Friday for the Fishing Tournament and Awards Banquet.

8 What do campers need to bring? Parents/guardians will be given a sheet for each week of camp informing them of what campers will need to bring each day of the week. Campers may bring a small backpack with their belongings. Please be sure to label all belongings with complete camper s name. Do the campers need to bring their own fishing equipment? No. Ana Banana Kids Fishing Camp provides all they need for FUN Fishing! What else should Campers not bring? Campers are not permitted to bring radios, video games or anything that would be disruptive. ABKFC is not responsible for lost or stolen items. Are parents allowed to visit staff when considering our camp program? Are appointments required? Yes, we encourage parents to visit with staff. Appointments are not required, but advance notice of your visit will help us better prepare for your arrival. Are parents allowed to participate in our camp programs? Can they join the campers when fishing? Yes, parents who want to participate will be charged an additional fee. What is the healthcare insurance policy? Is there a nurse on-site? All parents are required to complete a Hold Harmless Agreement Form which includes the health care information and emergency contact information. All Counselors are CPR and First Aid Certified. If an injury occurs an Ouch Report will be filled out and signed by the Camper and Counselor. If hospitalization is required, parent/guardian will be contacted immediately. What if I don t have health insurance? If health care is needed, the parents health care insurance policy is primary and Ana Banana Kids Fishing Camp s health insurance policy is secondary. If a child is not covered by health insurance, ABKFC s insurance is primary. What is our safety and regulations policy? What precautions do we practice to ensure safety? What is the protocol for safety when participating in water activities? Camp counselors carry a binder which contains all camper emergency information and contact phone numbers. There is at least 1 chaperone for every 10 children, all counselors are CPR and First Aid certified. All boats have personal flotation devices (PFDs) available.

9 What is the protocol if a child is missing? Headcounts are taken before and after each Camp activity. If, after all precautions have been taken, a child is missing, the proper authorities parents and Camp Director will be notified immediately. We have NEVER had a Camper go missing!!! What if a child becomes ill? If your child is ill and cannot attend, please notify staff as early in the day as possible. If your child becomes ill while at Ana Banana Kids Fishing Camp, a staff member will make the camper as comfortable as possible and contact parent/guardian for early pickup.

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