Wallace Academic Camp

Transcription

1 Wallace Academic Camp July 5, 2016 Dear Parents: Summer will soon be but a sweet memory and then it is back to school for your children! We would love for them to spend two weeks before the school year begins with us, getting ready for mathematics and reading and yes, still having fun and lots of Jesus! Camp will take place at Wallace Presbyterian Church, 3725 Metzerott Rd., College Park, Maryland, and is geared to children 4-12 years old. Would you like your child or children to attend our academic camp? It is very close to where you live, so lots of neighborhood kids and their friends will be joining us August 1-5 and August 6-12, 2016, from 9 a.m. 2 p.m. each day. Here is a sample of the daily or special activities scheduled: A morning math or reading class, geared to your child s level of ability Lots of educational and outdoor games in the meadow between classes Nutritious lunches and yummy snacks Specials each day after lunch will include: Playground time Swimming both Fridays at a local pool Horseshoes Arts and crafts, beading projects, etc. (and you can take them home!!) Skits for a play performed on August 12, made up by the children, the authors Water balloon toss, Capture the Flag The story of Daniel in the Bible with skits you can act out to make Daniel come alive... and so much more! Please fill out the registration and medical form ASAP, as space is limited and filling fast! It is exciting to think of a gathering of kids, ages 4-12, in one place with one purpose to discover God's wonders through academics while making new friends! You will be pleased to know that the teachers, teen volunteers, and helpers are excellent role models for your camper. They love Jesus and want to help your child! Our goal is to enrich your child academically, physically, spiritually and socially, as well as enhance his/her self-confidence, satisfaction, social skills, and moral character. The weekly registration fee is $100, but do not let the fee stop you. Call Eileen or Stan Dowd at to make other arrangements. We do, however, operate on a "first come, first served" basis, and once all spaces are filled, registration closes. Your child s name will be put on a waiting list, but experience proves that a camper rarely cancels. Don't be disappointed. Act now! We hope you choose Wallace Academic Camp as the place for your child's end of summer and get ready for school experience this August. Wallace Academic Camp is August 1-5, and August 6-12, 2016, every week day from 9:00 a.m. to 2:00 p.m. In Christ s Service, Stan and Eileen Dowd Call us at:

2 Academic Camp Registration Form Wallace Academic Camp, August 1-5, and August 6-12, 2016 For children ages 4-12 at Wallace Presbyterian Church 3725 Metzerott Road, College Park, MD This form MUST be completed by a parent before registration to be accepted Academic Camp Registrar Wallace Presbyterian Church, 3725 Metzerott Rd, College Park, MD (church phone number) Stan and Eileen Dowd (phone number) UPON OUR RECEIPT OF THIS COMPLETED REGISTRATION FORM AND $ BEFORE JULY 20, 2016 YOUR CHILD WILL BE REGISTERED FOR CAMP OR PLACED ON A WAITING LIST. Camper's Name Today s Date My child wants to be called Parent s Full Name(s) Street Address City State Zip Parent s address Home Phone ( ) Cell Phone ( ) Grade next fall Gender (M or F) Birthdate Age today How did you hear about camp? Do you attend church, and if so, what is the name? NOTE: A separate medical form is included with these registration materials. If your doctor prefers to use a medical form that provides similar instructions regarding administration of prescription medications we will accept it. It must be turned in to the Camp Director at the church the day of camp or sent to the office earlier. All medications (prescription and overthe-counter) must be turned in to the Camp Director on the first day of camp; each must be clearly labeled, and directions must appear on the container.

3 Permission to Attend / Photo Permission / Authorization / Medical Release I hereby give permission for my child to participate in Wallace Academic Camp. I understand that photos may be taken of my child at camp, which may be used by Wallace Presbyterian Church for the purpose of publicizing the camp ministry and that any such pictures would be used without the child s name. I understand that every effort will be made in case of emergency to notify me or the emergency contact. In the event that contact cannot be made and medical care becomes necessary, I hereby grant permission to the physician selected by the adult in charge of Wallace Academic Camp, to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child. Furthermore, I release the adults, leaders, and Wallace Presbyterian Church from any liability that may result from this emergency medical treatment. I understand the nature of this activity and release Wallace Presbyterian Church and the supervising adults from any liability that may result from my child s participation in this activity. Parent/Legal Guardian Signature Date CAMPER NAME: Does your child have a favorite subject in school? Yes No What is it? What one thing would you like your child to learn at camp? Does your child like to be with a group of children, or just a few kids? Does your child like to play inside or outside games? Or both! _ Can your camper swim? Yes No Do you have anything that would be helpful for the camp staff to know about your child? If so, please print it below.

4 Wallace Academic Camp Wallace Presbyterian Church August 1-5, and August 6-12, Metzerott Road - College Park, MD Or Stan and Eileen Dowd MEDICAL AND EMERGENCY INFORMATION CAMPER NAME: This information form (to be filled out by the parent) and the Physician and Order and Consent for Administration of Medication form (on the back, to be signed by your doctor) or a comparable form provided by your doctor MUST be submitted to the Camp Director the day of camp. Each and every medication must be supplied in an original pharmacy bottle or manufacturer s package and labeled with your child s name. Check any of the following health problems your child may have: Heart Condition: Kidney Condition: Seizures: Ear Infection: Fainting: Diabetes: Psychiatric or Emotional Disorders: Check allergic reactions to: Bee Stings: Hay Fever: Poison Ivy/Sumac/Oak: List any food allergies: List any medication allergies: Does your child have ANY restrictions/limitations which would not allow him/her to fully participate in all camp activities? Yes: No: If yes, please be specific: Has your child had any serious operations or illnesses? Yes / No. If Yes, explain: Are there any standard vaccinations that your child has NOT had, or from which they are exempt? Yes No If Yes, please list: In case of emergency, I will assume obligation for the necessary expenses through my personal insurance policy. It is my understanding that primary insurance coverage is provided through my family medical policy. It will be necessary to pay care-givers at the time of service pending insurance claim processing. In case of emergency, I give my permission to the physician selected by the Camp Director or Administrator to secure proper treatment for my child. Family Insurance Company: Insurance Company Address: Insurance Company Phone: Group#: ID #: Home Phone: Work Phone: Emergency Contact Phone ( ) Relationship Parent or Guardian Signature: If your child has a communicable disease, please do not bring him or her to camp.

5 Wallace Academic Camp Physician Order and Consent for Administration of Medication Required at check-in with physician s signature Camper s Name: Date of Birth: 1. List all medications with appropriate directions that your child receives on a routine/regular basis including all prescription, over-the-counter, and homeopathic medications. (These items must be SUPPLIED BY PARENT, including Epi Pens and Inhalers) Medication Dosage/Directions Please circle any over-the-counter medications listed below which you will allow the camp director to administer to your child. (These items will be PROVIDED in the Camp, along with standard first-aid supplies.) For Headache/Fever /Earache/Muscle aches Acetaminophen (Tylenol) 325 mg Two tablets every 4 hours by mouth Ibuprofen (Motrin) 200 mg One tablet every 4 hours by mouth For Coughs/ Sore Throat Throat Lozenges Cough Syrup (Robitussin) Dosage according to age/weight guidelines on package For Mild Allergic Reactions/ Rashes/ Insect Bites Diphenhydramine (Benadryl) 25 mg Tablet or liquid by mouth. One tablet or dose every 6 hours Hydrocortisone cream 1.0% For Gastrointestinal Upset Pepto-Bismol Oral dosage according to labeled guidelines Maalox Two tablet every two hours by mouth For Athlete s Foot/Jock Itch Lotrimin Cream Tinactin spray powder For Minor Wounds Neosporin ointment: Topically For Contact Dermatitis (Poison Ivy/Oak) Calamine Lotion: Topically I hereby give permission for my child to receive the named prescriptions, over-the-counter medications (or generic equivalent), and homeopathic medications checked above on this form. I understand that these medications will be administered by the Camp Director, I do not want any medication given to my child at camp. Parent / Guardian Signature Date: Home Phone: Work Phone: Cell Phone: Physician (Printed): Office Phone: Physician Signature: Date: I understand that if my child has a fever, the camp director will telephone me and may require my child to be picked up from camp.