STONYBROOK SUPER SILLY SCIENCE

Transcription

1 STONYBROOK SUPER SILLY SCIENCE Day Camp 7C Girl Scout Daisy/Brownie/Junior JUNE 22 26, 2015 CAMP STONYBROOK DAY CAMP AREA Registration Deadline: Saturday, April 25, 2015

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3 Dear Parent/Guardian: Thank you for choosing to send your Girl Scout to volunteer day camp. Through day camp, girls will have the opportunity to try new things and meet new people in a fun, safe and nurturing environment. Girls will participate in a variety of outdoor activities and Girl Scout activities led by trained volunteers. Girls will learn new skills and create new memories that will stay with them long after day camp is over. Calling all Mad Scientists! Grab your lab coats and your safety glasses and head to Camp Stonybrook's Super Silly Science week where you'll explore all matter of matter in our 314 acre outdoor laboratory. Investigate botany and biology in our babbling brook. Wonder at the physics in our natural world. Spike up your hair because Rocks Rock! We'll travel to space and the stars on rockets and nanorovers all from the comfort of our imaginations here at Planet Stonybrook. Girl Scout Juniors will get the opportunity to stay late on Thursday evening for special activities. At the end of camp each camper will receive a unit photo to commemorate their awesome time at summer camp. If you've ever wondered why or how? Then you are the very mad scientist that we are seeking! Please join us. Registrations will be accepted on a first come first serve basis starting with those registrations postmarked after the opening date of Monday, March 23, Registration ends Saturday, April 25, The only campers guaranteed a spot will be daughters of five day volunteers whose paperwork is received by Saturday, April 25, Registrations must be complete (all necessary forms and payment) to be considered. We hope you will see the value in this progressive opportunity for your Girl Scout and will help keep the history and tradition of the day camp alive by volunteering at camp with your Girl Scout. Volunteer day camp is run by a dedicated team of specially trained volunteers who work year round to make this enriching opportunity possible. Volunteer day camps are staffed completely by volunteers, so we welcome moms, dads, aunts, uncles, grandparents and other adult friends to volunteer. A Girl Scouting background is not necessary. Volunteers are asked to complete a volunteer application, background check and attend training to prepare you for your role at camp. Training is mandatory for all volunteers. Training dates to be determined. For continued progressive opportunities in Girl Scouts, we also offer many other outdoor and camp opportunities listed on our website at gswo.org. Below you will find basic information about day camp. Detailed information and instructions will be sent in a confirmation packet after you have registered. For additional questions or concerns please contact Jean Campbell, Camp Director, at or rcjc0673@gmail.com. Transportation: Due to limited parking, no campers can be dropped off at the day camp area. Transportation is available from Lebanon (Lebanon Plaza North; pick-up 8 a.m. drop-off 4:20 p.m.) and Springboro (Springboro United Methodist Church; pick-up 8 a.m. drop-off 4:25 p.m.) for a fee. There is no fee for transportation from Waynesville (school pick-up 8 8:45 a.m. drop off 4 4:30 p.m.). The drop off sites will be clearly marked and monitored by day camp staff. Detailed information on pickup locations and times will be in the confirmation packet. When you receive your confirmation packet, please pay special attention to the section concerning pickup procedures. Direct all questions/concerns to Jean Campbell at rcjc0673@gmail.com. Health: A nurse or first aider will be available at camp. Check with your physician to see if a tetanus booster or any immunizations are necessary. Special diets and medications are the responsibility of the parents/guardians. Please give any medications your daughter may need to the health supervisor or unit leader in the original container on the first day of camp. Be sure to include written instructions.

4 Food: Everyone is to bring a sack lunch and water bottle daily unless otherwise notified. Clothing: Proper dress for the weather is necessary. No halters or sandals. Wear sturdy shoes, socks, head cover and bring rain gear (no umbrellas). Camp is not cancelled because of rain. Insurance: Automatic insurance coverage occurs from Girl Scouts of the USA for all registered participants. Parents/Guardians: If you feel this camp is unsafe or a hazard to children you should contact Warren County Children's Services Department at or Warren County Combined Health District at Activity Costs: Cost includes T-shirt, patch, bandana. Girl Scout Daisies (Grades K 1) $ 70 Girl Scout Brownies (Grades 2 3) $ 70 Girl Scout Juniors (Grades 4 5) $ 70 Children Of 4 Or 5 Day Volunteers Girl Scout Daisies (Grades K 1) $ 45 Girl Scout Brownies (Grades 2 3) $ 45 Girl Scout Juniors (Grades 4 5) $ 45 Boys (Grades 1 8) $ 45 Pixies (Preschoolers K) $ 45 Bus Fee (from Lebanon or Springboro) $ 35 Additional fee for non-registered girls and adults $ 15 (All girls and adults participating in camp must register as Girl Scouts.) Make Checks Payable To: Girl Scouts of Western Ohio. Complete the registration, additional information and release forms and return with payment to: Jean Campbell, PO Box 1233, Lebanon, OH Do not send registrations to the Girl Scout Center. All registration received at the Girl Scout Center will be forwarded to the appropriate day camp on a weekly basis. Financial Assistance: Financial assistance may be available for girls who want to attend but are unable to do so because of limited family income. Applicants must pay 40% of the day camp fee. Payment must accompany registration to be considered. If the full amount requested is not awarded, payment for the remainder of the balance must be worked out with the day camp. Refund Policy: Money may be refunded for the following reasons only: 1. Moving out of town. 2. Illness or exposure to a communicable disease. 3. Required attendance at summer school. 4. Camp capacity is reached and no other camp is attended; refund will be sent within four weeks of registration date. To request a refund send a written request within ten business days from the end of camp to: Cindy Smith Girl Scouts of Western Ohio 4930 Cornell Road Cincinnati, OH CS:fs/

5 Day Camp 7C Stonybrook Super Silly Science Camper s Name: Phone: Address: City: State: Zip: School: DOB: Age: Grade in fall: Parent/Guardian Name: Phone: Parent/Guardian Troop #: Service Unit Name or #: OR Check box if not currently registered as a Girl Scout. (Please submit your $15 registration fee to be a Girl Scout with your camp fee.) Custodial Care: Mother only Father only Both Other New Girl Scout Re-registering Girl Scout Units: Volunteering: Boys/Pixies I am interested in volunteering at camp Girl Scout Daisies (Grade K 1) I would like to work with: (grade level, person) Girl Scout Brownies (Grades 2 3) Girl Scout Juniors (Grades 4 5) I would like to be in the same unit with my child Yes No (We will try to meet your requests, but placement will be made based on the needs of the camp.) Buddy s Name (ONE NAME ONLY): T-Shirt Sizes: Youth SM MED LRG Adult SM MED LRG XL XXL Girl Bus Lebanon Springboro Waynesville Financial Assistance (if needed): Please complete the section below. To be answered by parent/guardian: How would this girl benefit from day camp? $ Amount family can pay (applicants must pay some portion of the fee) + $ Financial assistance requested = $ TOTAL Parent/Guardian Signature: TOTAL FEES Day Camp Fee $ Registration Fee for non-girl Scouts (if applicable) $ Bus Fee $ TOTAL $ Date: Mail completed registration form, transportation form, health forms and late night form with fee to: Jean Campbell PO Box 1233 Lebanon, OH Deadline: Registrations will be accepted from March 23 April 25, Girls will be accepted on a first-come, first served basis based on the number of volunteers available and according to postmark. Priority will be given to girls with parents/guardians who are volunteering.

6 Additional Information, Release and Health Form Camper s Name Date of birth Age Address Parent s Name Phone Parent s Medical Information This section must be completed by all girls and adults attending in order to register for camp. Name DOB Date of last injection if this information is no longer available, write C for childhood if immunized as child. DPT: Measles/Mumps: TB: Polio: Tetanus: Hepatitis: Are medications currently being taken: No Yes, please specify: (Medication must be in original container with written instructions and given to the health supervisor at camp.) Are there any special needs or accommodations required? If yes, please explain: Are there any known behavior and/or emotional problems? If yes, please explain: Allergies and/or dietary modifications: 6

7 Is participant in good physical condition with no serious illness or operation since last health exam? Yes No If no, please specify: Physician s Name: Phone #: Insurance Information: Is the participant covered by family medical/hospital insurance? Yes No If so, indicate carrier or plan name: Group #: Name of insured: Relationship to participant: Social security number of policyholder or insurance ID number: Emergency Contact Information Emergency contact in case we can t reach parent/guardian: Name Relationship to girl Phone # Parent/Guardian Permission and Consent to Treatment (Name of participant) is in good physical health and has had a physical examination in the past 12 months. Participant has my permission to attend Girl Scout day camp and to participate in all activities except those noted. I have read the day camp flier and understand and agree to cooperate with all regulations. I further understand that the deposit is refundable only for the reasons noted on the flier. Emergency Medical Authorization: This health history is correct to the best of my knowledge, and the person herein described has permission to engage in all prescribed Girl Scout activities except as specifically noted. Authorization for Treatment: In the event reasonable attempts to contact me at the provided phone numbers have been unsuccessful, I hereby give my consent to the administration of emergency medical treatment by any licensed physician or dentist and to transfer the child to any reasonably accessible hospital facility. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery. My daughter may be registered as a Girl Scout member through September 30, Parent/Guardian Signature: Date: CS:fs/

8 Additional Information and Release Form Transportation Information Camper s Name: I understand that my daughter will only be released to the people listed below with proper ID. Parents be sure to list your name if you will be picking up your child. You may list only 4 names. Name Relationship to girl Phone # Name Relationship to girl Phone # Name Relationship to girl Phone # Name Relationship to girl Phone # 8

9 Over-the-Counter Medication Form Name: Age: For minor discomfort, the camp health supervisor(s) may treat my child with over-the-counter medication(s), according to the prescribed directions/dosage, such as acetaminophen, Pepto Bismol, throat lozenges, calamine lotion, Caladryl lotion, Benadryl and Neosporin. I give permission to the appropriate camp personnel to care for minor illness/injury using over-the-counter medications/procedures, except: Medications she may take (check all that apply): Acetaminophen (Tylenol) Pepto Bismol Throat Lozenges Calamine Lotion Caladryl Lotion Benadryl Neosporin Allergies (check all that apply): Pollen Dust Mites Insect Stings Medications: Animal Dander: Food: Other: Molds Latex The camp health supervisor(s) will contact you immediately under the following circumstances: The program assistant spends the night in the health center The program assistant must visit a medical care facility The program assistant develops any condition that poses a health or safety risk to the child or other campers Parent/Guardian Signature: Date: 9

10 10 Girl Scouts of Western Ohio 4/12 Date(s): June 22-26, 2015 Photographer/Producer: Girl Scouts of Western Ohio Assignment: Volunteer Day Camp 7C Stonybrook Super Silly Science Location: Stonybrook Day Camp Area Activity: Camp is a great way for girls to explore leadership, build skills and develop a deep appreciation for nature. RELEASE FOR MINORS For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent and agree to the following: 1. I hereby grant to Girl Scouts of Western Ohio, and others working for Girl Scouts of Western Ohio or on its behalf, and each of its respective licensees, successors and assigns (each a Releasee ), the irrevocable, royalty-free, perpetual, unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, modify, create derivative works of, reproduce or otherwise exploit my name, picture, likeness and voice (including any video footage of the same) (collectively, Media ), or to refrain from so doing, anywhere in the world, by any persons or entities deemed appropriate by Girl Scouts of Western Ohio, for any purpose (except defamatory) including, without limitation, any use for educational, advertising, non-commercial or commercial purposes in any manner or media whatsoever (whether known or hereafter devised) including, without limitation, on the internet, in print campaigns, in-store and via television. I agree that I have no interest or ownership in any of the Media. 2. I shall have no right of approval, no claim to compensation and no claim (including, without limitation, claims based upon invasion of privacy, defamation or right of publicity) arising out of any use, alteration, blurring, illusionary effect or use in any composite form of my name, picture, likeness and voice. I agree that nothing in this Release will create any obligation on Girl Scouts of Western Ohio to make any use of the Media or the rights granted in this Release. I hereby release and hold harmless Releasees from any claim for injury, compensation or negligence resulting or arising from any activities authorized by this Release and any use of the Media by Girl Scouts of Western Ohio. Name of Minor (please print): Address: City: State: Zip: Daytime Phone Number: ( ) Additional Phone (optional): ( ) Release for minors (those under the age of eighteen): I, the undersigned, being a parent or guardian of the minor, hereby consent to the foregoing conditions and warrant that I have the authority to give such consent. Name of Parent/Legal Guardian (please print): Signature of Parent/Legal Guardian (Required): Date: Parent/Legal Guardian (*will not be used for any other purposes or distributed to third parties) Region: Troop#: Service Unit:

11 11 Girl Scouts of Western Ohio Parents/Guardians of Girl Scout Juniors: LATE NIGHT PERMISSION FORM Day Camp 7C Thursday, June 25, 2015 will be the optional, Day Camp Late Night. The girls will eat dinner at camp and participate in a special program. If your daughter has special dietary needs, please plan accordingly (contact Jean for more information). Late night will go until 9 p.m. and is supervised by adult volunteers. For parents who are not able to help during the day, this is an excellent opportunity to enjoy camp. We need parents to help from 4:30 p.m. (or as soon as you can arrive) to 9 p.m. Please consider volunteering for this event. No training is necessary. I can help at late night My name: I can be reached at: No girl will be allowed to stay late without a signed permission form. You must return the late night form with the registration form even if you daughter is not staying late. Pickup will be 9 p.m. in the resident parking lot at Camp Stonybrook. Event contact and phone number will be DONNA SHELL at We will use the same pickup procedure as when we dismiss camp. Be sure you have the cards to pick up your girls. My daughter will stay late My daughter will not stay late Daughter's name: Daughter's emergency contact phone number during late night is: Camper will be picked up by parent/guardian Camper will ride home with (name): Parent/Guardian Signature: CS:fs/