Welcome to the Kroc Center Chicago Summer Day Camp Programs!

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1 Summer 2015 Welcome to the Kroc Center Chicago Summer Day Camp Programs! If this is your first camp experience, you and your family are about to embark on an exciting and new adventure. If your family is familiar with The Salvation Army camps, you already know how much fun and rewarding a camp experience can be. Please take the time to read your Parent Handbook. The following information is designed to answer questions you may have regarding day camps. Please keep this information handy so that you may refer to it as needed throughout the summer. Periodically, additional information will be sent home with your child. Please pay close attention to this information. It is important that you are aware of any changes in time, location or daily routine. Please check with your child for any information regarding field trips, changes or upcoming events. Each week, Day Camp focuses on a specific exciting theme that is presented in a variety of ways using theme-related activities; talented entertainers, recreation, sports, art & crafts, cultural history, storytelling, group games, singing, dance, music, theatre and visual arts. Time will also be dedicated to educational activities in order to promote academic excellence in reading, science and math during the summer months. We have planned a fun carnival with great prizes and a final showcase to culminate our outstanding program. This variety in programming has been planned to maintain a high level of interest, participation and enjoyment to enrich each participant s summer! CAMP GOALS To provide an enjoyable and safe experience for each participant. To encourage self-awareness through a variety of events. To increase the knowledge and skills of each child, pertaining to the themes being explored. To enhance social, mental and physical development through outdoor adventures. Because the Salvation Army believes parents play an important role in the accomplishment of camp goals, staff openly encourages and invite comments, questions and suggestions that you may have to make the overall program experience more beneficial to the participants. A MANDATORY PARENT-ORIENTATION WILL TAKE PLACE ON JUNE 4 AT 1:00 PM AND 6:00 PM If you have any questions or concerns, please contact our Summer Day Camp Manager at Sincerely, Kroc Center Staff

2 IMPORTANT INFORMATION In order for your child to participate in summer day camp, it is required that the following forms are completed in their entirety and placed on file, at registration: General Camp Form Emergency Information Form Consent Form Medical Forms Behavior Guidelines & Agreement* *THIS FORM WILL BE GIVEN OUT AT PARENT ORIENTATION* Campers who do not have all registration forms on file will not be allowed to participate. SUMMER CAMP CONTACT NUMBER EMERGENCY PROCEDURES Staff has been trained in First Aid and CPR and will always put your child s safety first should any injury occur during camp. Be sure to include all phone numbers where you can be contacted during camp hours in case an emergency should arise. WEATHER All camps will be held rain or shine! ATTIRE The Kroc Summer Day Camp participants are required to wear the camp T-shirt every day. This policy enables the counselors and supervisors to easily identify campers in larger groups. Other children use the center during the summer and we want to be able to quickly count our children to ensure their safety at all times. Kroc City teen participants will be required to wear their lanyards every day and especially when traveling. Comfortable, slightly loose play clothing (jeans, shorts, gym shoes and camp T-shirts) are appropriate for the activity schedule. Clothing will occasionally come in contact with paint, markers, food coloring, grass, mud, etc. Please dress your child accordingly. Sandals are permitted for pool only. Campers must wear sneakers or closed toe and closed heel shoes geared for multiple activities such as running, jumping, climbing. Swimsuits must be one piece. Children will be exposed to sun and various bugs. Please provide them with sunscreen and bug spray with their name on the bottle. Please make sure to apply sunscreen on your camper prior to dropping off each day. Label all items and clothing with your child s name with a permanent marker. Do Not write your child s name on the outside of any item, including their camp bag. LUNCH & SNACK Camp Kroc (For sessions 2 & 3 ONLY) A 30-minute lunch break will be held every day of camp, followed by a brief quiet period. Campers will be provided with lunch daily. Please see the session menu for lunch options. Campers are allowed to bring in their own lunch and snack, please make sure that their name is on all their containers. A 15-minute healthy snack break will be held in the afternoon for each camper.

3 SWIMMING Each child will be tested on their swimming ability. Staff is looking for comfort level in the water; not stroke technique. More information will be provided at Parent Orientation regarding Swim Days. Swimming instruction is one of the most important aspects of the Kroc Center s Day Camp. Be assured that our staff are Red Cross trained/certified and will provide a safe environment for your children to learn and improve their swimming abilities. The swimming component is the highlight for most campers during the hot summer days. DROP OFF / PICK UP PROCEDURES Parents or authorized individuals must sign the attendance sheet for each participant at both the drop off and pick up times. It is very important that your child is placed in the care of a camp counselor and not just let off at the door at drop off time. Please do not drop off children earlier than 8:50am, unless enrolled in Before Care. Staff is not prepared to supervise your child until the designated start time. The Salvation Army Ray & Joan Kroc Center Chicago is not responsible for injuries or accidents that may occur, if you do not follow proper procedures. If someone else is authorized to pick up your child, please complete the Pick-up Authorization section of the Consent Form. If there are changes to authorized pick up designees, parents must update the consent form in person, at least one day in advance. No phone call changes permitted. LATE PICK UPS It is important that you be on time when picking up your child. The Kroc Center Chicago will charge parents $5 for the first five minutes of late time and $1 for each additional minute. A counselor will remain with your child due to a late pick up. If your child is to leave with by someone other than yourself at pick up time, please give a note a day in advance to the Day Camp Manager so that staff may ensure maximum safety. Parents must also update the consent form. The adult designee must match the persons approved on the Pick-up Authorization section of the Consent Form. The adult designee must present a picture ID. Parents are responsible for the late fee if the adult designee is late picking up your child. LOCATIONS Camp Kroc will meet inside in the Chapel. Before Care will meet in the following location: Drop off: Pick up: 9:00am 3:00 3:30pm Kids Zone Drop off: 6:00am 9:00am Kroc City will meet in the Teen Zone. Drop off: 9:00am Pick up: 2:00pm After Care will meet in the following locations: (Hours 3pm 6pm) Pick up: 5:00pm 6:00pm Parents will be notified of pick-up locations.

4 GENERAL INFORMATION PLEASE PRINT OR TYPE CAMP REGISTRATION Entire session amount is due at the time of registration. Check one camp please Camp Kroc 2015: Ages 6 12 Kroc City: Ages June 22 August 14, 2015 (1 session)* $260M/$520NM Session 1 June $130M/$260NM* Session 2 June 22 July 17 - $260M/$520NM* Afterschool: Ages 6 12 Session 3 July 20 August 14 - $260M/$520M* T-shirt Size: Only applies to Camp Kroc Youth: S M L Adult: S M L XL 2XL *Kroc Center Membership must begin at registration and continue through Day Camp Sessions. If membership lapses, family will be billed the non-member price. There is a $65.00 cancellation fee if you chose to withdrawal your child from Camp Kroc and a $75 cancellation fee if you withdraw from Kroc City.* PARTICIPANT INFORMATION Name : (First/Last) Birthdate: Age: Male/Female: Address: City: State: Zip: School (Fall 2015): Grade (Fall 2015): List any activities to be restricted: Camper lives with (Custodial Parent): Custodial Parent contact number: Does your child have permission to walk home after day camp? Walk/Public transportation Will be picked up Swimming Experience - My Child : Can swim without assistance Can Swim with assistance Does not know how to swim

5 EMERGENCY INFORMATION PLEASE PRINT OR TYPE Participant s Name: Birthdate: Mother s Name: Daytime Phone: Cell Phone: Father s Name: Daytime Phone: Cell Phone: EMERGENCY CONTACT # 1 Name: Daytime Phone: Cell Phone: Relationship: EMERGENCY CONTACT # 2 Name: Daytime Phone: Cell Phone: Relationship: EMERGENCY CONTACT # 3 Name: Daytime Phone: Cell Phone: Relationship: Preferred Physician: Phone Number: Physician s Practice: Preferred Hospital: Insurance Provider: Authorization Number: I,, parent/guardian of I recognize that there may be an occasion where the child named above or I, if I am a participant, may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of The Salvation Army Kroc Center Chicago to seek and secure any needed medical attention or treatment for the child named above or me, if I am a participant. I understand that The Salvation Army KROC Center is not responsible for the cost incurred for medical care.

6 CONSENT INFORMATION PLEASE PRINT OR TYPE FIELD TRIP PERMISSION My child,, has my permission to go on any field trips, walking or by bus sponsored by The Salvation Army, during the time they participates in a Salvation Army camp. Notification and request of participation of any trips will be sent home prior to the date the trip is scheduled. PICK-UP AUTHORIZATION I hereby grant permission for the following adult(s) to pick up my child,, from the Salvation Army camps: (We require at least (3) three authorized adults other than custodial parent/guardian.) Name Address Phone Relationship LATE PICK UP POLICY It is important that you be on time when picking up your child. The Kroc Center Chicago will bill parents $5 for the first five minutes of late time and $1 for each additional minute. A counselor will remain with your child due to a late pick up. If your child is to ride with someone other than yourself at pick up time, please send a note a day in advance with your child so that staff may ensure maximum safety. Parents are responsible for the late fee if the designated person is late in picking up your child. I understand the above policy and why there is a need for it, and I agree to abide by it.

7 PUBLICITY On occasion, The Salvation Army takes photographs or makes an audio or videotape recording of children and/or adults involved in unit activities. Such photographs or video records may be used by staff and participants to remember the activities and participants. In addition, such photographs and audio/visual recordings may be used in The Salvation Army publications or social media or advertising materials to let others know about our ministry. In addition, local news organizations may hear of our activities or events; and the Salvation Army may invite or allow them to photograph or record our events for news reporting on special interest feature. I consent to use of any such audio or visual record of the child named above or myself, if I am a participating, to be used, distributed, or displayed as agents of the Salvation Army see fit. This consent includes but is not limited to: photographs, videotape, and audio recordings. Furthermore, I give permission for the child to be interviewed by the news media or for such photographs and other audio or visual records to be used by the news media. ASSUMPTION OF RISK & LIABILITY Parent/Legal Guardian is required to sign authorization and wavier below to acknowledge understanding and agreement of content. In condition of the participation of my child in The Salvation Army s Day Camp program at the Ray and Joan Kroc Corps Community Center, I agree, on behalf of myself and my child, to make no claims or file any lawsuits against The Salvation Army or any of its agents or employees or volunteers for any loss or damage to my child s personal property or for any injury to my child. To the maximum extent permitted by the law, this liability waiver will apply regardless of whether the injury or damage was caused by the negligent act or omission of The Salvation Army or anyone acting on its behalf. I further agree to defend, indemnify and hold harmless The Salvation Army its agents, employees and volunteers against liability for any claims, lawsuits, losses, damages or expenses arising out of any personal injury or property damage caused by my child in connection with their participation in Day Camp.

8 MEDICAL INFORMATION PLEASE PRINT OR TYPE PARTICIPANT INFORMATION Name: Age: Program: Address: City: State: Zip: ILLNESS OR INURIES Check any chronic or recurring illness. Asthma Hypertension Heart Defect/Disease Carries an inhaler Y or N Epilepsy/Seizures Ear Infections Musculoskeletal Disorders Diabetes Carries insulin Y or N Bleeding/Clotting Operations, serious injuries, diseases, or restrictions on physical activity? Other, Please explain ALLERGIES Animals Insect Stings Carries an EpiPen Medication: Food Plants Hay Fever/Pollen Other: OTHER HEALTH CONDITIONS Are the participants Immunizations current? Yes No, Please explain: Signature required for those who answered no and do not believe in immunization due to personal beliefs. PARENT SIGNATURE: When was the participant s last tetanus shot: List any health conditions/concerns that staff should know about ( nosebleeds, ADHD, fainting, dietary needs): Are there any other health or behavioral concerns or needs that staff should know: MEDICAL FORMS - PAGE 1 OF 2

9 MEDICATION DISPENSING RULES When a child requires medication, the primary responsibility for administering medication rests with the parent/guardian. Medications cannot be administered at Kroc Center Chicago programs without a doctor s written order and a written request from the parent/guardian. The Kroc Center Chicago recognizes that some short- and long- term conditions can be controlled or corrected only with medication(s) prescribed at intervals which may include times during programs. In all cases, parents/guardians/prescribers should endeavor to develop a dosage schedule minimizing medication administration at Kroc Center Chicago programs. When a physician has determined that administration of prescription and non-prescription medication during Kroc Center Chicago programs is necessary, the following procedure must be followed: 1. Complete this form in its entirety including the physician s statement and parent/guardian s request & approval. 2. Medication must be brought to the program by the parent or responsible adult designee. The medication must be in its prescription bottle with the specific instructions for administration and be of current date. The orders on the prescription container must exactly coincide with the orders written by the physician. 3. This form must be completed annually or at the time that the medication and/or dosage is changed. It is the responsibility of the parent/guardian to obtain a new form from Kroc Center Chicago personnel. 4. At the time of termination of medication, a parent or adult designee is required to pick up the remaining medication. 5. All medications will be self-administered under the strict supervision of the Kroc Center Chicago program instructor. PHYSICIAN STATEMENT Physician: Phone: Practice Name & Address: Medicine Name: Dose: Time: Dispensing & Storage Instructions: Possible Side Effects/Adverse Reactions: Medicine Name: Dose: Time: Dispensing & Storage Instructions: Possible Side Effects/Adverse Reactions: Physician Signature: PARENT/GUARDIAN S REQUEST & APPROVAL I hereby request and grant permission for Kroc Center Chicago staff to dispense medication to my child,, according to the above instructions. I further waive any claims against the Kroc Center Chicago, its employees, and agents arising out of the administration of said medication and agree to hold harmless and indemnify the Kroc Center Chicago, its employees and agents, either jointly or severally, from and against any and all liability, claims demands, damages, or causes of action or injuries, costs, and expenses including attorney s fees, resulting from or arising out of the administration of medication. Address: Phone: MEDICAL FORMS - PAGE 2 OF 2

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