Portland Parks and Recreation 265 Main Street PO Box 71 Portland, CT Kiddie Kamp Best Camp Ever! Ages 3 to 5

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1 Portland Parks and Recreation 265 Main Street PO Box 71 Portland, CT Summer Playground 2015 SummerQuest Discover the Summer Experience Completed Grade K 8 C.I.T Program & Kiddie Kamp Best Camp Ever! Ages 3 to 5 Visit Our Website Call Us at for more information FAX

2 CAMP CHOICES 2015 Day Camp Time of Day Week 1 Week 2 Week 3 Week 4 June June 29 July 2 July 6-10 July (Thurs Fri) No July 3 SummerQuest 8:30 am - 3:30 pm $54 $112 $135 $135 Base Camp SummerQuest 7:30 am - 8:30 am $6 $12 $15 $15 Early Camp SummerQuest 3:30 pm - 5:30 pm $16 $32 $40 $40 Late Camp SummerQuest 8:30 am - 12:30 pm $32 $64 $80 $80 Half-Day C.I.T. Program 8:30 am - 3:30 pm $54 $112 $135 $135 Kiddie Kamp 9:00 am to 12:30 pm $56 $70 $70 * Additional $5 off $10 off $10 off $10 off Child Discounts ** Total Day Camp Time of Day Week 5 Week 6 Week 7 Week 8 July July August 3-7 August SummerQuest 8:30 am - 3:30 pm $135 $135 $135 $135 Base Camp SummerQuest 7:30 am - 8:30 am $15 $15 $15 $15 Early Camp SummerQuest 3:30 pm - 5:30 pm $40 $40 $40 $40 Late Camp SummerQuest 8:30 am - 12:30 pm $80 $80 $80 $80 Half-Day C.I.T. Program 8:30 am - 3:30 pm $135 $135 $135 $135 Kiddie Kamp 9:00 am to 12:30 pm $70 $70 * Additional $10 off $10 off $10 off $10 off Child Discounts ** Total * - Additional Child Discount applies for each child after the first Only Applies for Base Camp Grand Total for Summer 2015 ** Please total each week and then calculate grand total for each child over the entire summer $

3 SummerQuest - Playground Program K -8 Discover the Summer Experience More Than Just A Summer Program At SummerQuest, we do more than just engage in the arts, music, theater, sports, nature and reading with our dedicated counseling staff. We build friendships and memories with our campers while fostering values of respect, understanding and honesty. Bring the Best Together We are entering our third year at the beautiful Portland High School and Middle School Complex where we expect to have another great year for Portland Summer Playground! We will continue to develop new ideas and enrichment programs as well as more swimming opportunities and new adventure trips for our Teen Camp. We still plan on having our own play and end of the year carnival as well as many different crafts. Our goal is to continue to make this the greatest summer experience Portland has ever seen! Come join us for a week or the whole summer! SummerQuest Mini-Camps Minis (Completed Grades K -2) Awesome experience for our youngest campers! Activities focus on fantastic arts and crafts, exciting music and theater, basic nature lessons and sports! Juniors (Completed Grades 3 5) Get to experience all of what camp has to offer from the most active sports and games to the most challenging arts & crafts! Don t miss out! Teens (Completed Grades 6-8) Our most independent group! Teens will get the opportunity to spend time doing what they love to do, whether it be sports, nature, arts & crafts or other! Teens will also have chances to go off campus for fun events! C.I.T. (Completed Grades 9 & 10)- For the program this year, CITs will learn valuable practical skills with handson experience and direct feedback from our directing staff. Camp Structure Specialties: Sports, Arts & Crafts, Nature & Science, and Music & Theater Where: Portland High/Middle School Times: Early Camp (7:30 8:30 am), Base Camp (8:30 am 3:30 pm), Half-Day (8:30 am to 12:30 pm), and Late Camp (3:30 pm to 5:30 pm) For each additional child - $10 discount per week only for Base Camp. Themes- Grades K - 5 Week 1 Summer Kick Off Kick off the summer with great Summer activities, sports, crafts, games & get to know your counselor! Week 2 Red, White & Blue Week - Celebrate our country with many American games and activities, culminating in the 4 th of July! Week 3 Young Picassos This is the week for creativity in all of us! Crafts will not always be traditional, because camp can get pretty wacky! Week 4 Top Chef Week Pizza English Muffins anyone? This week is all about FOOD, health and nutrition! Week 5 Olympic Week Our most popular week of the summer is back! Sochi 2014 & Rio 2016 comes to Portland! Week 6 Science Week Calling all junior scientists! This week is dedicated to science as our young scientists interact in different science projects through interactive and hands-on science activities! Week 7 Music and Theater Week Our 4th annual play is back and it is going to be bigger and better than ever! Week 8 Festivals Around the World We saved the best for last! This week is all about Festivals that are celebrated around the world as well celebrating the end of a great summer!

4 Teen Adventure Themes Completed Grades 6-8 Week 1 Summer Kick Off Kick off the summer with a trip and some great summer classic activities! Week 2 Engineering Week Lets build something, Teen Camp will be venturing into the world of Engineering! Week 3 Amazing Race Week Groups Race around the Town of Portland through a series of challenges! Week 4 Cooking Week Top Chef, crazy health foods, or the best pizza in town, campers will learn how to make some great delicacies! Week 5 Portland s Own We have Talent Week Campers design and perform their own Talent Show! Week 6 Media Frenzy Week Explore the world of radio, TV and film this week as we make our very own TV show! Week 7 Fishing Week This week we will learn the skills it takes to be a master angler! Week 8 Water Adventure Week Don t forget your bathing suit! We are all about water adventure this week! Kiddie Kamp Kiddie Kamp, or as it is more commonly known, Best Camp Ever!, is so excited that summer is just around the corner! We can t wait to see all our friends both new and old and have a blast for 5 weeks! Another Awesome Summer! Your children are about to embark on a fantastic summer journey! Kiddie Kamp is certain to bring lots of actionpacked fun into your child s life! Kiddie Kamp is a place where your child can have fun, be active, make new friends, discover new talents, while also working on school readiness skills. On behalf of the entire Kiddie Kamp staff, we would like to personally extend a warm welcome to all our campers and their families! Important Notes: Kiddie Kamp is open to kids ages 3 to 5 (and must be potty trained) No Kiddie Kamp the first Week of Summer Camp will take place summer weeks 2-6 (June 29th to July 31st) Camp is held from 9:00 am to 12:30 pm at the Portland High School Pre-school Room The week of (June 29th) will be only a four day week. No camp on Friday July 3 Campers must bring a snack and lunch everyday (no peanuts please) Kiddie Kamp is Limited to 20 campers per week Summer Themes 2015 Week 1 June No Camp this week Week 2 June 29 July 2 (no program July 3) Red, White & Blue Week Week 3 July 6 10 Young Picasso Week 4 July Young Chef Week 5 July Olympic Week Week 6 July Welcome to Broadway Week

5 Portland Parks and Recreation Mission Statement The Portland Parks and Recreation Department is committed to offering diverse leisure activities to meet the interests of our citizens. Our purpose is to provide a variety of safe, affordable programs to develop personal enrichment, promote enduring friendships make accessible recreational use of the environment, and provide fitness-related activities for all age groups. In this capacity, we hope to improve the quality of life for all our residents, physically, socially, and intellectually, thereby nurturing the health and cohesiveness of our community. We try to offer something for everyone. General Information The regular playground session will be from June 25th August 14th. Week 1 will be two days June 25 26th No Camp July 3rd You must be a Portland Resident to attend one of the SummerQuest Playground Programs. Registration Information: Registrations will be accepted starting March 16th All Registrations should be submitted before June 1 st to receive a camp shirt Registrations received after June 1 st will be charged a $25 late fee Registrations will be on a first come/first served basis Changes must be submitted to the office at least 2 weeks before the start of the SummerQuest Program Changes after the program has begun must be submitted in writing to the office at least one week before the child will be attending the program All registrations, payments and paperwork goes to the Parks and Recreation Office Not to Camp Forms can be dropped off at the Parks and Recreation Office at 265 Main Street or mailed to Portland Parks and Recreation, P.O. Box 71, Portland, CT Health Form Policy: Your child s Health Form must accompany the Summer Playground Registrations If it is not submitted before the start of the playground program, the child cannot attend Have your physician complete a copy, or you can obtain a copy from your child s school The form is good for a 3 year period. You may check to see if your child s form is on-file from last year by calling the Parks & Recreation office between 1:30 & 4:30 pm, Monday through Friday Payment Policy: Payment for weeks 1-4 must accompany registration Payment for weeks 5 8 must be submitted by July 1 st Late Payment will jeopardize your child s ability to attend the program Outstanding payments due to the Parks & Recreation or Youth Service Departments must be paid in full before a child can attend camp Refund Policy: Refunds will only be given for a canceled program or for a medical reason as demonstrated by a written note from a physician Once the program has started there will be no refund given Credits or week changes will not be given due to absences or confusion as to which weeks your child was registered for Medication: Parents must fill out the Medication Authorization form All medications must be presented in their original containers

6 For all prescription medications, the Medication Administration Form must be completed and signed by the child s physician All medications must be administered either orally, via injection, topically or via inhalant Pick-up and Drop-off: Patents & Guardians must complete a pick-up/drop off form Parents are responsible for signing their child in and out of the program All parents or designated representatives will be asked to provide identification A note must be provided and the pickup list changed if someone not on the list will pick up the child Games, Toys and Electronic Devises: Games and toys from home are not permitted. Cell phones, ipods, and other electronic devices will not be allowed at camp- exception will only be made in cases accepted by the Parks and Recreation director and/or his or her designee We are not responsible for lost, stolen or damaged items Photos and Publicity: Parks and Recreation Staff may take pictures of your child for our brochure, website, or local newspaper If you wish for your child s photo not to be used please check the appropriate section on the registration form Discipline: It is our goal to make sure that every camper is safe at all times Improper behavior will not be tolerated. Discipline will be firm but fair Disciplinary issues will be discussed with parents Any violent behavior or serious breach of rules such as physical contact or threatening of other children or staff will result in suspension from camp Scholarships: Scholarships will be awarded on a limited basis with appropriate paperwork having been submitted All scholarship requests must be in by May 1 st

7 Registration Form Select programs and weeks on the backside of cover sheet Participant s Name: Phone Number: Street Address Apt. # Town: Zip Code: Male: Female: Date of Birth School Grade entering Aug. 2015: Mother s Name Address Mom s Work Phone: Mom s Cell Phone: Father s Name Address: Dad s Work Phone: Dad s Cell Phone: If a parent is not available: Emergency Contact: Relationship: Home Phone # Work Phone: Cell Phone # Child's Physician: Phone #: * If there are any medical concerns or allergies that we should be aware of, please list below: In case of an emergency, may we transport via ambulance? Please circle: Yes No Please list anyone who does not have permission to pick up your child (If this is a biological parent, a copy of the court order must accompany this form). I give the Portland Parks and Recreation Dept. permission to use any photographs taken during the program to be used in any advertising, i.e. web site, program literature: Yes No Shirt Size (Please circle) Youth Medium Large Adult Small Medium Large My child is in good health and has my permission to participate in this program and on field trips. I understand that various activities during camp present a risk of injury. I have read the camp brochure including the registration and refund policies and hereby give my child permission to participate in all camp activities. I also agree to provide an updated health and history form with the registration. Parent or Guardian: (Print Name) (Signature) (Date)

8 PORTLAND PARKS AND RECREATION 265 Main Street, PO Box 71, Portland, CT (860) (860) FAX SUMMERQUEST PICK UP LIST Please list below the individuals that are allowed to pick up your son/daughter at camp. Please realize that we request a photo ID for anyone picking up your child so we can ensure that you child goes home with the correct person. CAMPERS NAME:. (Please print) (Please Print) (Please Sign) (Date)

9 Parent/Guardian Authorization for the Administration of Non-Prescription of Topical Medications by Youth Camp Personnel To Youth Camp Director, Nurse or Teacher: I hereby request that a staff member of the Youth Camp administer the following non-prescription topical medications to my child. I understand that I must supply the camp with the non-prescription topical medication in the original container labeled with the child s name, the name of the medication and the directions for the medication administration. This authorization is limited to the following topical medications: 1. Non-prescription medicated powders. 2. Non-prescription insect repellants. 3. Non-prescription sunscreen lotions/sprays which are free of amino benzoic acid (PABA) or its derivatives. Name of Child: Date of Birth: Address Medication: Name, method of administration, area of application: Time of administration: Medication to be administered from (date) to (date) Reason for which medication is being administered: I have administered at least one dose of the above medication to my child without adverse side effects. Name of Parent/Guardian: Date: (Print) Signature: Relationship to child: Address: work phone: home/cell phone:

10 YOUTH CAMP HEALTH EXAM/RECORD FOR CAMPERS AND STAFF Physical Exams Are Valid For 3 Years From Date of Last Examination Please Return Completed Form To Parks & Recreation Office Camper Staff Name Date of Birth Phone Guardian Address Emergency Contact Phone Date of Arrival at Camp: Departure Date TO BE COMPLETED BY THE SPECIFIED MEDICAL PRACTIONER: Date of Exam May participate in all camp activities May participate except for: Medical information pertinent to routine care and emergencies: Is this individual taking prescription medication? YES NO If yes, indicate prescription: Does the individual have allergies? YES NO Explain: Is the individual on a special diet? YES NO Explain: This camper/staff is up-to-date on all the following routine childhood immunizations currently recommended by the American Academy of Pediatrics and National Advisory Committee on Immunization Practices: Measles Mumps Rubella Chickenpox Tetanus Yes No Yes No Hepatitis B Diphtheria Pertussis Polio Comments: Print name of medical care provider: Medical care provider s address: Medical care provider s: City/Town ST Zip Code Signature of Physician, APRN or AP Date Form Signed Telephone Number