Thank you for your cooperation in ensuring a smooth transition into camp season!

Transcription

1 Dear Families, Welcome to Summer at Tower! We look forward to welcoming our campers for another fun-filled summer. Please take a few minutes to go over this packet of information and be sure to return any required forms. Below is a check-list of enclosed forms for your reference. Required Forms to Complete Health Form Certificate of Health and Immunization Record (not enclosed, please request this from your child s physician s office) Forms for Review Camp Details Drop-Off and Pick-Up Procedures Nut-Free Suggestions Optional Forms to Complete Extended Day Form Pick-Up Permission Form Counselor-in-Training (CIT) Application Thank you for your cooperation in ensuring a smooth transition into camp season!

2 CAMP DETAILS In order to make this the best summer ever, we want you to be aware of the following important camp details: If your child is registered for the Explorers program, please send your child to camp dressed in a swimsuit, regardless of the weather forecast. Please label all of your child s belongings, including their backpack, with their full name. Your child s backpack/bag should include a: change of clothes, towel, sweatshirt, and lunchbox/bag. Sneakers are the most appropriate footwear for all of our camps. They are ideal for running, climbing, playing ball, skipping, and dancing. We request that campers wear sneakers rather than flip-flops, crocs, or other footwear. Water shoes are not needed. Apply or ask your child to apply sunscreen before leaving for camp, regardless of the forecast. Swimmies are not needed. We are a peanut-free and tree nut-free camp. Tower partners with WT Café, a lunch service specializing in nutritious lunches made with fresh, wholesome ingredients. This is an optional lunch program. Visit wtcafe.com for more information. Stay connected with your for camp updates at the last minute about your child s camp. Follow Summer at Tower on Facebook, where we ll post photos of campers, their projects, and events happening throughout the summer. Please be on time for drop-off and pick-up. Thank you. We re looking forward to a great summer!

3 HEALTH FORM CAMPER Address: Date of Birth: Age as of 6/15/16: Gender (circle one): Male / Female PARENT(S)/GUARDIAN(S) Address (if different): Address (if different): EMERGENCY CONTACT(S) Please provide contact information for at least one emergency contact, who would be available to pick up a sick child during camp hours, or to contact in case of an emergency. Attach additional contacts to this form if you would like to add more than two. Address: Address:

4 PHYSICIAN Address: Phone: Date of last exam: DENTIST Address: Phone: Date of last visit: ORTHODONTIST Address: Phone: Date of last visit: INSURANCE INFORMATION Insurance Carrier: Policy or Group #: Insurance Policy Holder: CONCERNS/ALLERGIES If checking yes, please include an explanation. Attach additional pages if needed. Concerns/Allergy Asthma Penicillin Yes Explanation Other drugs Any and all medications, including Epi-Pen or inhaler Seasonal allergies Include the severity of reaction if touched or ingested: Food allergies Include the severity of reaction if touched or ingested: Insect bites and stings Other Will your child be taking any other medications at camp, including over the counter medicine? Please list those medications here. All medications must come with a completed Medication Administration Consent form.

5 MEDICATION ADMINISTRATION Please check off the following which may be given to your child if needed. Yes Yes Tylenol Antibiotic cream Advil Anti-itch cream Benadryl Sunscreen Antacid (Tums or Maaloz) HEALTH HISTORY Please complete questions and explain if yes. Attach additional pages if necessary. Has/Does the camper Yes No Explanation Been hospitalized or had surgery in the past two years? Have recurrent/chronic illness or illnesses? Had a recent injury/illness/infection? Ever had a head injury or concussion? Have diabetes? Had seizures? Had severe or frequent headaches? Wear glasses/contacts/protective eyewear? Had fainting or dizziness? Have frequent bloody noses? Have motion sickness? Have a phobia? Passed out or chest pains during exercise? Had mononucleosis during the past year? Ever had back/joint problems? Ever treated for Lyme Disease? Ever been stung by a bee? Have any skin problems? Have problems with diarrhea / constipation / stomachaches? Traveled outside the United States in the past year? Please list countries visited and dates of travel. Ever been diagnosed with ADD/ADHD? Been treated for emotional/behavioral difficulty, self-harm, or an eating disorder? Ever have need for an aid at school? Ever used an individual education plan (IEP) at school? Speak a primary language other than English?

6 OPTIONAL Summer at Tower is committed to providing a successful camp experience for all who attend. We respect that every individual who participates in our program comes with a unique personal history. Having prior knowledge of any details that may impact your child s experience is invaluable. This may include learning styles, medical conditions, behavioral issues, emotional needs or significant changes that may have impacted their lives. Please do not hesitate to use the space below on this page, attach additional information, or call us with any details.

7 AUTHORIZATION FORM LICENSING INFORMATION Summer at Tower is compliant with the Massachusetts Department of Public Health and licensed by the Marblehead Board of Health. You have the right to review background checks, health care and discipline policies and grievance procedures by contacting the director. ACCURACY OF INFORMATION This health history is correct and current to the best of my knowledge. The person herein described has permission to engage in all camp activities except as noted. If your child has any special conditions, needs or limitations you must speak with the camp director before enrolling in the camp program. Non-disclosure may result in dismissal from the program without refund. PHOTO RELEASE Summer at Tower has permission for our child s photo to appear in promotional literature, videos, session group photos, website, and social media. SICK CAMPER In the case of a child becoming ill at camp, the child will be in the care of the nurse or an administrator. The child will remain in the nurse s office. The child s parents will be notified by the nurse or administrator. If the parent is not reached, the emergency contacts will be contacted in the order submitted by the parents. If no one is reached, the child will remain in the nurse s office under the care of the nurse or administrator until a parent or contact is reached. If the child s health situation changes as time passes, the nurse or administrator will determine an appropriate course of action (i.e. returning the child to activities or seeking further medical care). AUTHORIZATION FOR TREATMENT In case of health problem or emergency, I authorize Summer at Tower to administer first aid and, where necessary, to transport my child to the nearest hospital emergency room, if needed, and to order X-rays, routine tests and treatment; and to release any records necessary for insurance purposes. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director, or his/her designee, to secure and administer treatment, including hospitalization, for the person named above. This completed form may be photocopied for trips out of camp. ACKNOWLEDGEMENT OF RISK AND WAIVER While we ask that campers refrain from bringing peanuts or tree-nuts with them to camp, we cannot guarantee that any area at camp is allergen-free. I hereby release and discharge, and agree to indemnify and hold harmless, Summer at Tower and its officers, directors, members, agents, employees, volunteers and any other persons or entities acting on its behalf, against all claims, demands, and causes of action whatsoever, either in law or equity, relating to or arising from any medical treatment, recommendation, transportation or administration, or any lack thereof. PHYSICIAN S CERTIFICATE OF HEALTH AND IMMUNIZATION RECORD The Board of Health requires that we have a copy of your most current Physician s Certificate of Health and Immunization Record. Please attach these documents to your health form and submit together. We cannot access a returning participant s record from last year. Do not wait for a scheduled doctor s appointment; you can submit an updated record at a later date. Attach the most current records that you have. Parent/Guardian Signature Date

8 DROP-OFF AND PICK-UP PROCEDURES On the first day of camp, you will receive a color-coded card with your child s name and the name of the group. Please display this card in the dashboard to facilitate easier drop-off and pick-up. If your child is going home with someone other than a parent/guardian, we must have permission in writing. MORNING PROCEDURES 8:45 9:00AM EXPLORERS The camp entrance for Explorers is the main entrance of Tower School at 75 West Shore Drive. Please pull into the driveway, form a double line and pull up as far as possible. To facilitate an efficient drop-off (thereby minimizing traffic on West Shore Drive), a counselor will open the door for your child and take him/her to his/her group. Campers should be seated behind the front passenger seat and should exit from the rear, right door. If you wish to accompany your child or communicate with your child s counselor, please park in the center lot or the adjacent overflow lot. Please do not leave your car in the carpool lanes during drop-off. ART, S.T.E.A.M., CODING, AND ADVENTURE AT TOWER The camp entrance is the Cornell Road entrance of Tower School. For security purposes, this door is only unlocked during drop-off and pick-up hours. Drop off your child on the school side of Cornell Road. Please form a single line. A counselor will open the door for your child and direct him/her to his/her group. If it is raining, campers will go directly to the Performing Arts Center after being dropped off. If you wish to accompany your child or communicate with your child s counselor, please park in the circle lot or overflow lot and walk around the building to the Cornell Road entrance. Please do not leave your car unattended or parked on Cornell Road at any time. U-turns on Cornell Road create a safety issue for children, and are not permitted. MULTIPLE CAMPERS If you have children attending different camps, please drop them off at the main entrance, 75 West Shore Drive. LATE ARRIVALS If you arrive past 9:00AM, please use the main entrance at 75 West Shore Drive. If your child is under the page of nine, we ask that you accompany your child to the main office. AFTERNOON PROCEDURES 12:45 1:00PM HALF-DAYS AND FRIDAYS; 3:45 4:00PM FULL-DAYS EXPLORERS Pick-up location is the Main Entrance Circle Loop off of West Shore Drive. Please form two lines and remain seated while counselors bring your child(ren) to your car. ART, S.T.E.A.M., CODING, AND ADVENTURE AT TOWER Pick-up location is the Cornell Road entrance off of Cornell Road.

9 MULTIPLE CAMPERS If you have children attending different camps, please pick them up at the main entrance at 75 West Shore Drive. EARLY DROP-OFF AND PICK-UP PROCEDURE All early or late drop-offs and late pick-ups are at the Main Entrance at 75 West Shore Drive. Please see the Extended Day Form if you are interested in this option. Please be advised that there is a fee for this service. Even if you have not signed up, you will be charged according to the fee schedule if you drop off your child earlier than 8:45AM or pick up later than 4:00PM.

10 PICK-UP PERMISSION FORM If your child will be picked up by anyone other than his/her parent(s) and/or guardian(s), please list those individuals below. CAMPER PARENT(S)/GUARDIAN(S) PERMISSION I give permission for the following people to pick-up my child(ren): Home/cell phone: Home/ Home/ Home/ Home/ Parent/Guardian Signature Date

11 EXTENDED DAY FORM CAMPER PARENT(S)/GUARDIAN(S) MORNING CARE 8:00 9:00AM Please select the days to enroll your child: Monday Tuesday Wednesday Thursday Friday AFTERNOON CARE 4:00 5:00PM Please select the days to enroll your child: Monday Tuesday Wednesday Thursday Note: Afternoon care is not available on Friday afternoon. All campers are dismissed at 12:45PM on Friday. SESSIONS Please select the session in which you would like to enroll your child: Session I: July 5 15, 2016 Session II: July 18 29, 2016 Session III: August 1 12, 2016 PRICING The cost for the Extended Day option is $10 per contracted hour and $20 per drop-in hour. I will be billed before camp starts for the above selected contracted hours. The Extended Day drop-off and pick-up location is inside Tower School s main entrance at 75 West Shore Drive. Parent/Guardian Signature Date

12 NUT-FREE SUGGESTIONS PEANUT/ TREE NUT SAFE POLICY All Summer at Tower camps are peanut-free and tree nut-free. No food products containing any peanuts/peanuts are allowed for the safety of all campers and staff. SUGGESTIONS Listed below are some ideas for packing a peanut/nut free snack and lunch for your child. Although certain items on this list maybe a product name, you should take responsibility and read labels when you purchase and pack snacks and lunches. All items that contain peanuts and/or tree nuts or their derivatives are not permissible for camp. In addition to those items, any products with labels stating may contain traces of peanuts or tree nuts or processed in a plant that process peanuts or tree nuts or similar statements are not considered acceptable for camp. Remember, this is just a guide as product ingredients frequently change. Please read labels at all times. Animal Crackers Applesauce Bagels (read labels) Cereals (many different types, read labels) Cheerios Cheese-Its Cheeses Crackers Doritos Fig Newtons Fruit bowls and cups Fruit Roll-Ups Fruit snacks Fruits and veggies with dip Gelatins Ginger snaps Goldfish Graham crackers Oreos Pop-Tarts Popcorn Potato chips Pretzels Pringles Puddings Raisins Rice cakes (read labels) Rice Krispie Treats Smoothies Soy crisps Sugar wafers Sunflower butter (looks like peanut butter, please label) Wheat Thins Yogurt Thank you for your consideration in keeping our classrooms and school areas peanut/nut free and safe for all.