CAMP WHITTIER "Where the Adventure Begins"

Transcription

1 CAMP WHITTIER Welcome to Operation Purple Camp at Camp Whittier. Please mail all paperwork back to camp: Camp Whittier, 2400 Hwy 154, Santa Barbara, CA We can not allow your child to attend camp without all paperwork completed and signed. Your camper is confirmed to attend Operation Purple Camp at Camp Whittier July 13 th July 19th, Transportation to Camp You can bring your camper to CAMP WHITTIER on July 13th at 2:00 PM. Please adhere to the 5mph speed limit and park in designated areas only. Name of parent or authorized adult dropping off camper Return from Camp Please join your campers for a closing ceremony starting at 10:00 AM on July 19 th. Please plan on arriving at 9:30 AM so that we can start our closing ceremony on time. Pick-up your camper at CAMP WHITTIER at 10:00 AM with dismissal at 11:30 AM. Name of parent or authorized adult picking up camper Please adhere to the 5mph speed limit and park in designated areas only & follow staff safety instructions for pick up and drop off when on campgrounds. In the case of illness or injury to campers parents will be notified by telephone. If you plan on having your child dropped off on July 13 th or picked up on July 19 st by an adult (18 or older) other than you or your spouse, we will need to have that persons name listed above. Parent Signature

2 From Santa Barbara Hwy 101 to Hwy 154 This is the most direct route to Camp Whittier from Santa Barbara. Take Hwy 101 North Exit State St. / Hwy 154 (San Marcos Pass) North on Hwy 154 approx 17 miles Watch for sign that says entrance to Lake Cachuma 3/4 mile ahead. Right after that sign, at mile marker You will see a left hand turn lane and a sign for Camp Whittier, turn left. Go approx ¼ miles and turn right, take road to camp. Park in Camp Parking Lot or Oak Grove for overflow parking. Note: If you get to the entrance to Lake Cachuma you have gone too far. Directions to Camp Whittier From Santa Maria Take Hwy 101 South Turn left onto Hwy 154 (San Marcos Pass toward Cachuma Lake) Follow Hwy 154 for approx 15 miles; ¼ miles past the entrance to Lake Cachuma. Turn right at sign to Camp Whittier Go approx ¼ miles and turn right. Take road to camp. Park in Camp Parking Lot or Oak Grove for overflow parking. From Santa Barbara on Hwy 101 to Hwy 246 Take Hwy 101 North for approximately 35 miles from Santa Barbara to Hwy 246, Buellton / Solvang exit. Turn Right. Go East on Hwy 246 for approximately 10 miles to Hwy 154. Turn right on Hwy 154 for approximately 10 miles, ¼ miles past the entrance to Lake Cachuma. Turn right at sign to Camp Whittier. Go approx ¼ miles and turn right. Take road to camp. Park in Camp Parking Lot or Oak Grove for overflow parking.

3 Resident Camp (Please Type or Print) Camper s Last Name First Name Age Sex Address City Zip Mother s/guardian Name Phone Work# Mother s Address City Zip Cell Phone# Father s/guardian Name Phone Work# Father s Address City Zip Cell Phone # Please refer to the attached information sheets. You must complete the Health History & Emergency Information Sheet & the Consent to Treatment and Release Form before your child can attend camp. Registration is complete only after you have paid all camper registration balances and all of your paperwork is complete. Is there any information that you want us to know about this camper? Parent/Guardian Signature Please check your branch of service below: Please complete these forms and return them to address below We cannot allow your camper to attend OPC without all completed paperwork CAMP WHITTIER, 2400 Hwy 154, Santa Barbara, CA marycampwhittier@aol.com, Web site: campwhittier.org For questions please call (805) Camp Whittier is owned and operated by The United Boys & Girls Clubs of Santa Barbara.

4 Health History & Emergency Information (Please Type or Print) Child s Last Name First Name Age Sex of Birth Physician Phone Dentist Phone Insurance Company Policy # Parents Home Phone Work Phone Cell Phone Health Information: If your child currently has or previously has had any of the following, please check the appropriate box: Health History: Allergies: Diseases: Frequent Ear Infections Hay Fever Chicken Pox Heart Disease/Defect Poison Oak Measles Convulsions Insect Stings German Measles Diabetes Penicillin Mumps Bleeding/Clotting Disorders Other Drugs Asthma Has your child had any serious injuries, operations or illnesses during the past 3 years? Yes No If yes, please explain Disability or chronic recurring illness: Restrictions from activities: Suggestions of health related information for camp personnel: Does camper wet the bed Sleepwalk Record of Immunizations: of last tetanus shot: Medications Checklist Is camper taking medication during camp? YES NO medication dosage times to be taken Emergency Contacts: Please list the individuals to contact in case of an emergency, (in addition to the parents). Name Home Phone Work # Cell # Name Home Phone Work # Cell# Name Home Phone Work # Cell# Parent/Guardian Signature

5 CONSENT TO TREATMENT AND RELEASE (Please Type or Print) FOR Child s Full Name CONSENT TO TREATMENT This health history is correct so far as I know, and the person herein described has permission to engage in all prescribed Camp activities except as noted by the examining physician and me. I hereby give permission to the physician selected by the Camp 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 Camp Director to hospitalize, secure proper treatment for and to order injection and/or anesthesia and/or surgery for my child as named above. This authorization is given pursuant of Section 25.8 of the Civil Code of California. This authorization shall remain effective until December 31, 2008, unless sooner revoked in writing delivered to said agent. Also, for good and valuable consideration, I hereby consent to and authorize the reproduction, publication and use by the UNITED BOYS AND GIRLS CLUBS OF SANTA BARBARA, CAMP WHITTIER, and the American Camping Association, and their successors and assigns, for advertising, commercial, or any other purposes, of any photograph, picture or likeness of my child. HOLD HARMLESS CLAUSE I further agree that the UNITED BOYS AND GIRLS CLUBS OF SANTA BARBARA COUNTY and CAMP WHITTIER, its Board of Directors, Officers and Staff are hereby relieved of all liability in the event of accident or injury to the said minor. Camp activities include: Rock Climbing, Ropes Course, Hiking, Swimming, Archery, Arts & Crafts, Native American Studies, Fishing, Games, Campfires and Boating. PARENT/GUARDIAN SIGNATURE DATE PRINT PARENT/GUARDIAN NAME For questions please call (805) Camp Whittier is owned and operated by The United Boys & Girls Clubs of Santa Barbara.

6 MEDICAL AGREEMENT NON-PRESCRIPTION / PRESCRIPTION MEDICATION AGREEMENT Regulations permit child care providers to give prescription and non-prescription medication to children in care under certain conditions; prior written permission from the child's parent/guardian is required. Please fill out the MEDICAL AUTHORIZATION form completely for each prescription or non-prescription drug that you are sending with your child to Camp Whittier. NON-PRESCRIPTION MEDICATIONS: A child may receive only one dose per illness, except acetaminophen (Tylenol) and topical medications. In order to receive more than one dose, a licensed physician must pre-approve the medication and dosage for the child. These changes must be documented on the MEDICAL AUTHORIZATION form and signed by the physician All non-prescription medication must be in the original container and labeled by the parent/guardian with the child s name. DO NOT send medications with the child; all medication must be handed directly to a staff member by the parent/guardian. If child is being transported by club or organization then the medication must be given to the club staff member in charge of transportation. All medications will be kept by the Camp Medic in a locked centrally located area. Children are not permitted to keep medications of any kind with them, except inhalers and epi-pens (which must be kept with the child at all times). PRESCRIPTION MEDICATIONS: Prescription medications must be in the original container labeled by the pharmacy or physician with the child's name, dosage, and expiration date. The child may receive medication only according to the written instructions of the health practitioner or the original medication label. Manual changes made to the label s instructions and/or dosages are not acceptable. Please send/bring only the amount of medication needed while at camp. Empty containers will not be sent home. PRESCRIPTION STIMULANT MEDICATION: Camp Whittier understands that children may be on medications for ADD/ADHD, depression, or other psychological conditions. These medications allow the child to take advantage of all that a school environment has to offer. Camp is very similar in this regard. If your child in on medication like this and you are planning, or have made, a change in that medication any time up to six weeks before camp, please make Camp Whittier aware of this. Many times children benefit from continuing their medication, and perhaps even more, given that stimulants are often metabolized more quickly in warm weather. We ask that you do not bring your child to camp if he/she has any of the following: A fever of or higher within the last 24 hours Vomiting or diarrhea within the last 24 hours A common cold with discolored mucus A sore throat or persistent cough An undiagnosed rash or skin infection Pinkeye or other contagious eye infection Head lice Complaint of persistent pain Inoculation or vaccination of a live virus within 48 hours (Meningitis, Chicken Pox, Small Pox, Poliovirus vaccine) I have read and will comply with the instructions on this form. Parent Signature

7 MEDICAL AUTHORIZATION FORM I/We authorize a qualified Camp Whittier Medic to administer medications to my/our child Name of medication /medications This medication is: Non-Prescription OR Prescription This /these medication is being given for the following condition(s): I understand that I am required to send all prescription drugs in original container and that the Camp Whittier Medic will only administer the drug according to the doctor s instructions on the bottle for amounts and times of day administered. Please initial. Additional Instructions (including instructions not given on the prescription): Note any side effects of this medication: Note any reasons or conditions when this medication should be stopped or not given: I/We authorize a qualified Camp Whittier Medic to administer the above medication to my/our child. Name of Child: Signature of Parent/Guardian: : NON-PRESCRIPTION MEDICATIONS: A child may receive only one dose per illness, except acetaminophen (Tylenol) and topical medications. In order to receive more than one dose, a licensed physician must pre-approve the medication and dosage for the child. Name of Drug Dosage Signature of Physician: : Print Name of Physician: Phone Number: ( )

8 2400 Hwy. 154, Santa Barbara, CA Phone: (805) Fax: Website: What to Bring PLEASE PUT CAMPER S NAME ON ALL ITEMS WITH A PERMANENT MARKER. 2 pair of jeans or old pants 1 sleeping bag & pillow 1 comb or brush 1 water bottle with carrier 1 laundry bag or old pillow case 1 flashlight 1 pair of sturdy shoes or boots 1 pair of shoes that can get wet (old tennies are great) Shorts or cutoffs 5 t-shirts Toothpaste and toothbrush Soap and soap dish Sunscreen & insect repellant Pool / shower shoes 6 pair of underwear 2 hand towels 1 bath towel 1 washcloth 1 jacket 1 belt 1 hat with a brim 2 pair of pajamas 7 pair of socks 1 swimsuit 1 sweater Crazy pajamas Shampoo White T- shirt for tie dying Parents are advised to limit the amount of belongings sent to camp. Please limit the baggage to 2 pieces, including the bedroll. DO NOT SEND I-PODS, MP3 PLAYERS, STEREOS, DIGITAL CAMERAS, CELL PHONES OR ANYTHING OF REAL VALUE. Musical instruments may be brought and will be stored in a safe place. The camp is not responsible for loss or damage. Also, please do not send care packages with candy or junk food. The Camp Store offers sunscreen, insect repellent, snacks, smoothies and souvenirs. $5-20 will be adequate and be kept in the camp bank. Dress code for camp is as follows: shorts and pants must cover bottoms and underwear, no large tears or low hanging pants, No shirts with profanity, drugs, alcohol or other negative statements allowed and must cover entire stomach. One piece bathing suits for females and trunks for males are encouraged. Mail Campers are encouraged to write home. If you would like to write or (please put campers name in the subject box on s), the mailing address is: Camp Whittier 2400 Hwy 154 Santa Barbara, CA marycampwhittier@aol.com

9 Dear Parents & Guardians, Welcome to Camp Whittier! In an effort to make a smooth transition between home and camp, we've included these tips to help make this an awesome experience for your camper. For 1st time campers, some practice nights away from home may ease anxieties. Bringing a personal item from home, like a favorite blanket, or stuffed animal, can help them feel at home wherever they are. Receiving letters and pictures from home always helps. Homesickness is a normal reaction for anyone to have, regardless of age. Here are some things you can do before your camper leaves to help: Ways to talk about concerns: "I know you'll have a great time!" "I'm so excited for your adventure!" "Overnight camp is a good idea. Even though this is your first time away from home, I'm sure you'll do fine." I loved camp when I was a kid. Of course I missed home a little. That's normal. But I went back to camp every year I could." -No "Pick-up" deals- if your child knows you'll come to get him/her at the first sign of anxiety, he/she will be less likely to try to get through it. Please no surprise visits from family & friends. This often creates unnecessary anxiety or embarrassment for the camper. Make Goodbyes short and sweet To help familiarize your camper with the fun they will be having, here is a typical day... Breakfast at about 8am 2 programs rotations in the morning which may include: Archery, Swimming, Rock Wall, Rope making, Arts & Crafts Lunch 2 programs in the afternoon Dinner Evening programs, which may include: Campfire, Night Hikes, Campouts, Stargazing and more Let us know if we can be of any further assistance. We are so excited to have your camper come join us! The Summer Camp Staff at Camp Whittier

10 CAMP WHITTIER RELEASE AND INDEMNITY AGREEMENT THIS CAMP WHITTIER RELEASE AND INDEMNITY AGREEMENT (the Agreement ) is being executed by the undersigned Participant (the Participant ), who hereby: 1. Acknowledgment. Acknowledges that: A. The Participant intends to participate in one or more team and leadership building courses operated under the name CAMP WHITTIER and sponsored by or at a facility owned, operated, or otherwise connected with the United Boys and Girls Clubs of Santa Barbara, Inc. ( United ), and each of the separate Boys and Girls Club corporations affiliated with that entity (including but not limited to those for Camp Whittier, Carpenteria, Westside Santa Barbara, Goleta, and Lompoc) (United and all such other corporations are collectively referred to herein as the Corporations ). PLEASE INITIAL TO INDICATE THAT YOU READ AND UNDERSTOOD PARAGRAPH 1A:. B. The Camp Whittier Courses involve a number of risky events; including backpacking, hiking, rock climbing, high ropes course, initiative games, new games, team building activities, and other physical activities. The latter pose risks and dangers to participants, including but not limited to those arising from (1) the negligence of other program participants and spectators; (2) the negligence of equipment manufacturers or defects in their products; (3) the failure or negligent use of equipment; (4) slips, trips, falls, collisions, and other encounters with training equipment, trails, rocks, plant life, animal life, falling rocks, and other objects at or around the area where the Camp Whittier Courses are conducted; and (5) the negligence or inadequate training of those persons at the Camp Whittier Courses who seek to assist with medical care or other help for the Participant either before or after an injury has occurred. PLEASE INITIAL TO INDICATE THAT YOU READ AND UNDERSTOOD PARAGRAPH 1B:. C. Although the Camp Whittier Course instructors will encourage and challenge me to participate in the Camp Whittier Courses, I have no duty or obligation to participate, and I am and at all times will be solely responsible for deciding whether to participate, in any or all of the Camp Whittier Courses. PLEASE INITIAL TO INDICATE THAT YOU READ AND UNDERSTOOD PARAGRAPH 1C:. 2. Release. Releases, as a condition of my participation in any Camp Whittier Course, the Corporations, their respective officers, directors, trustees, employees, and other agents, and each instructor in the Camp Whittier Courses from any and all claims, costs, damages and expenses arising from or in any way related to my participating in any one or more of the Camp Whittier Courses, and further acknowledges and agrees that (a) this Release extends to all claims of every nature and kind whatsoever relating to the Camp Whittier Courses and the matters described in Section 1, above, whether such claims be known or unknown, suspected or unsuspected, concealed or otherwise, and (b) expressly waives all rights under California Civil Code 1542, which reads as follows: A general release does no extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor. PLEASE INITIAL TO INDICATE THAT YOU READ AND UNDERSTOOD PARAGRAPH 2:. 3. Indemnity Agrees to indemnify, defend, and hold the corporations, their respective officers, directors, trustees, employees, and other agents, and each instructor in the Camp Whittier Courses, free and harmless from any and all costs, claims, damages, and expenses arising from or in any way related to my participating in any one or more of the Camp Whittier Course. PLEASE INITIAL TO INDICATE THAT YOU READ AND UNDERSTOOD PARAGRAPH 3:.

11 4. Miscellaneous. Further understands, acknowledges, and agrees that: A. This Agreement (1) supersedes all prior and contemporaneous understandings, whether oral or written, between the Participant, on the one hand, and the Corporations and the Camp Whittier Courses instructors, on the other, and (2) may not be modified or amended, except by a written instrument executed by an authorized representative of the Corporation and the Participant. B. Prior to signing this Agreement, I have had sufficient time to read, understand, and consider this Agreement, and to ask any questions I deem appropriate concerning the Camp Whittier Courses and this Agreement, and that I have not been coerced in any way into signing this Agreement against my wishes. IN WITNESS WHEREOF, the Participant (or, if the Participant is a minor child, the parent or legal guardian of the Participant) has signed this Release on the date set forth below. SIGNATURE OF PARTICIPANT (OTHER THAN MINOR CHILD) Participant s Printed Name Participant s Signature SIGNATURE OF PARENT OR LEGAL GUARDIAN OF MINOR CHILD/PARTICIPANT The undersigned represents and warrants to the Corporations and each instructor in the Camp Whittier Courses that the undersigned is the parent or legal guardian of the Participant, and has read, understood, and hereby consents to and executes this Agreement on behalf of the Participant. Printed Name of Participant Printed Name of Parent or Legal Guardian Signature of Parent or Legal Guardian