2016 SUMMER DAY CAMP REGISTRATION YMCA OF BEAUFORT County SITE LOCATION

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1 $15 Online Registrations / family $25 In person Registration / family Weekly Fees: Please see Camp Brochure 2016 SUMMER DAY CAMP REGISTRATION YMCA OF BEAUFORT County SITE LOCATION I have attached a valid SC Certificate of Immunization for all children listed below Address City Zip Parent/Guardian s Name Cell # Employer Work # Parent/Guardian s Name Cell # Employer Work # Emergency Contact Name (May not be the same as above Parent/Guardian) Name Contact Phone #s Name Contact Phone #s Additional Authorized Pick-Up Person Name #1 Name #3 Name #2 Name #4 Child s Physician Phone Dentist Phone Health History: Note each child s Allergies (type) Emotional/behavioral, heart/lung conditions, asthma, diabetes, speech/communication, hearing, other please describe ADD / ADHD THE YMCA DOES NOT ADMINISTER MEDICATION OF ANY KIND

2 Payment Procedures ALL 2016 Summer Camp Payments will be made through a pre-authorized checking account or credit card draft. THERE ARE NO PAYMENTS MADE AT THE FRONT DESK after the initial registration (no exceptions). If you do not wish to provide us with your bank information, you may pay all camp fees at once at the front desk or online. The drafting schedule will take place the following dates: Sessions 1 and 2 are due the day you register either online or at the Y. Campers attending sessions 3,4: June 3, Draft Campers attending sessions 5,6: June 17, Draft Campers attending sessions 7,8: July 1, Draft Campers attending sessions 9,10: July 15 Draft Campers attending session 11: July 29, Draft $25 fee for all returned checking accounts, $15 fee for all returned credit cards. Credit Card Account Payment Option: Card Number: Expiration Date: American Express: Discover Mastercard: Visa: Security Number (back of card): Signature of Card Holder Checking/Savings Account Bank Draft Payment Option: Bank Name: Transit Routing Number/ABA: Checking Account Number: Or Savings Account Number: Signature of Account Holder: There is a change fee of $10 per family per session for changes made for any week of camp that you register for. If you need to cancel a camp you are registered for you must fill out a BLUE cancellation form. This must be done one week before the draft date of the camp session. There are no refunds/credits given for not attending camps that are registered for. Failure to make payments will result in removal from summer camp program. I have read, fully understand, and agree to the policies stated above. Parent s/guardian s Signature Date

3 Waivers/Permission: 1. I permit my child to participate in activities the YMCA conducts outside the YMCA facilities. 2. Photography: I permit the YMCA to use images of my child as a YMCA program participant in internal and external promotional material. This includes any printed material, broadcast and print advertising, promotional videos and the YMCA web site which are published by the YMCA. I also permit the YMCA to use images of my child in broadcast and print media news coverage of the YMCA. I understand that my child s name is not published. 3. Accident Insurance - Participants are responsible for their own accident insurance when using the YMCA and when participating in YMCA programs. 4. Medication - The YMCA does not normally administer any medication and will do so only when directed in writing by the child s medical doctor in the prescribed bottle. However, in the event of an emergency in which the parent cannot be contacted, Emergency Medical Staff and the YMCA may take appropriate action in the best interest of the child. 5. Babysitting Policy - The YMCA strives to employ the very best staff possible in all of our programs. The YMCA cannot and does not endorse or recommend its present or former staff members as babysitters to any parent or guardian of any child in any of our programs. All Y staff are forbidden to make any baby sitting arrangements with program participants. Present or former staff of the YMCA is separate and independent from any YMCA program and must be based on the independent investigation, responsibility and judgment of the parent or guardian. I agree that the YMCA shall not be responsible and will be held harmless from any claims or liability in connection with such employees acting in such a private, independent capacity. 6. I understand the YMCA is not responsible for any personal items, lost or stolen, at our programs. 7. Field Trips A parents signature on field trip forms permit the child to leave the YMCA or camp site location on authorized trips under the supervision of the YMCA staff. Parents may review a written schedule of activities to be conducted off the YMCA premises. 8. Bus Transportation- By signing this form, parents permit the child to be transported by the YMCA bus when necessary (any field trips / swim lessons / inclement weather). 9. Nature Walks By signing this form, parents permit the child to leave the YMCA building to go on nature walks within the area. The longest distance a group may go depending on age and group behavior is to the Sands Beach in Port Royal. 10. Climbing Wall & Gym Waiver- The participant assumes any and all risk of injury, illness, damage or losses arising out of his/her presence on or about the premises, or his/her intended use of the equipment of facilities, or his/her participation in the activities of the YMCA of Beaufort County, on or about the premises, and does here by himself/herself, his/hers theirs, executors, and administrators, forever waive, release, and agree to hold free from all claims for damages, the YMCA of Beaufort County and its respective officers, directors, Board of Directors, members, employees and agents. The participant, and if appropriate, his/her parent of guardian, authorizes treatment of the participant by a licensed medical doctor in the event of an emergency. I have read and agree to be bound to these terms. 11. Refunds - I understand that non-attendance does not entitle me to a refund. I understand that no refund or adjustments are granted for illness, vacation, cancellation or when YMCA programs are cancelled due to inclement weather. There is a 7 day written notice to cancel registered weeks of camp. 12. Cancellations - Non-attendance does not relieve me of the responsibility to pay for the program. I understand that I must cancel, 7 days prior to stop payment, on BLUE camp cancellation form signed by parent. There is a change fee of $10 per family per session for changes made for any week of camp that you register for. I have read, fully understand, and agree to the policies stated above. Parent s/guardian s Signature Date

4 Camp Info Page Please tear off and keep! Kick off to Camp Celebration Open House: June 4, 11am-12:30pm. Meet and greet your camp counselors and enjoy a free family cookout and outdoor pool party. At this family event, please do not leave your kids unattended. Drop Off & Pick Up Procedures: Drop-Off 7-8:20am, Pick-Up 4-5:30pm. Campers may not be dropped off at the Y earlier than 7:00AM. At that point, a Y staffer will be waiting at the car ride circle to help your camper exit the vehicle. During Pick-Up time, a staff person will be waiting to greet you at the outside circle, ask for ID, will then radio for your camper to be sent to the car line. You do not need to park, a staff person will put your camper in your car for you to allow for speed and ease. Please remain patient while we retrieve your camper from their group, we use the entire facility for programming and it may take a few minutes. If you wish to go inside to get your camper, please park in a parking space and make sure you bring in your ID. If picking your child up early, please call the Y ahead of time so we can retrieve them, as programming takes place in multiple areas in and around the Y facility. If you do not call, please be patient, as this may take several minutes. *Traditional Campers in 2nd 5th grade will walk to Port Royal Elementary School for the first eight weeks of camp for some of their activities during camp hours from 8:30am 2:30pm. Discipline: Basic rules of safety and conduct are included in our policies. Parents will be informed by phone and through a final meeting with program site director if their child continually displays inappropriate behavior. General discipline techniques involve positive reinforcement of appropriate behavior and careful explanation of behavior that is inappropriate. Failure to stop unacceptable behavior, of other children or teachers may result in suspension or expulsion from Summer Camp Program. The YMCA has a zero tolerance policy for fighting. If fighting occurs the child will be removed immediately from the summer camp program. What to Bring to Camp: Water bottle, healthy snacks, bug spray (DEET FREE), sunscreen, comfortable walking shoes, bathing suit, towel, plastic bag for wet clothes. What NOT to Bring to Camp: Money (vending machines are off limits to campers, sandals (only acceptable at pool) and electronic devices, i.e. cell phone, tablets, gaming device. As a reminder, the Y is not responsible for any lost or stolen items. Lunch: Lunch is provided for all campers. Sample of a lunch served: wheat bread with turkey and cheese, carrot sticks, apple, and skim milk. Campers can bring their own cold lunch if they choose. Parent Communication: Camp special events, newsletters, specialty camp information, etc. will all be sent out on a weekly basis.

5 Campers Name (fill out one sheet per child) Camp Session s: Session 1: May 31-June 3 Session 5: June 27-July 1 Session 9: July 25-July 29 Session 2: June 6 June 10 Session 6: July 5-July 8 Session 10: August 1 August 5 Session 3: June 13-June 17 Session 7: July 11-July 15 Session 11: August 8 August 12 Session 4: June 20 June 24 Session 8: July 18-July 22 Please circle the name of camps & session you are registering for below. Traditional Camp / CIT Camp Session 1 Session 3 Session 5 Session 7 Session 9 Session 11 Session 2 Session 4 Session 6 Session 8 Session 10 Specialty Camps (Reminder financial assistance is not available for specialty camps. If you are interested in attending specialty camps you would pay full rate). Travel Camp, Ages 7-12: Session 1 Challenge Island s Mindcraft II Camp, Ages 6-12: Session 2 Flag Football, Ages 7-12: Session 2 Tennis Camp, Ages 5-12: Session 3 Crafty Corner, Ages 5-12: Session 3 Movie Mania, Ages 5-12: Session 4 Gone Fishin, Ages 8-12: Session 4 Camp Diva, Ages 5-12: Session 5 Soccer Camp, Ages 7-12: Session 5 Travel Camp II, Ages 7-12: Session 6 Tennis Camp II, Ages 5-10: Session 7 Basketball, Ages 7-12, Session 7 Animal Grossology Camp, Ages 5-12, Session 8 Gone Fishin II, Ages 8-12: Session 8 Girls and Dolls camp, Ages 6-12: Session 9 S.T.E.A.M Camp, Ages 7-12: Session 9 Y Idol Camp, Ages 5-12: Session 10 Jurassic Brick Land, Ages 5-12: Session 10 Camp Diva, Ages 5-12: Session 11 Space Wars Camp, Ages 6-12: Session 11

6 Data Release Form Please fill in information for each child on this one form. Student (s) School: Student (s) Full Name: Student (s) date of birth: Student (s) Grade Level Entering August 2016: I give permission for the Beaufort County ( Print parent/guardian name) School District to share MAP test Data on my child(ren) (student(s) name) with the YMCA of Beaufort County for the purpose of obtaining the information and/or scores listed above. Parent/Guardian Signature Date

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