Summer Leisure 2018 Registration March 21, Adelaide Street, South 5 p.m. 7:00 p.m.

Transcription

1 Summer Leisure 2018 Registratin March 21, Adelaide Street, Suth 5 p.m. 7:00 p.m. Cmmunity Living Lndn s Summer Leisure Prgram is a specialized day camp fr children with develpmental disabilities. Our camp is pen t children brn in 1998 thrugh 2011 wh will be attending schl in the fall f Our dedicated, highly skilled staff teams prvide a 1 t 2 camper t staff rati in accessible envirnments. CCAC nursing supprts can be arranged fr campers wh receive thse supprts during the schl year. Registratin In persn cmplete the attached package and attend ur registratin night March 21, 5 p.m. 7:00 p.m., 190 Adelaide Street, Suth After March 21st By fax Attn: Lianne Tdrvic By mail Cmmunity Living Lndn Attn. Lianne Tdrvic 190 Adelaide Street, Suth Lndn, Ontari N5Z 3L1 lianne.tdrvic@cll.n.ca Cmmunity Living Lndn is cmmitted t prviding as many children as pssible with the pprtunity t attend day camp. Based upn availability yu will receive written cnfirmatin fr ne sessin nly, within three weeks f cmpleting yur registratin. Requests fr secnd sessins will be cnsidered after June 1st and will be based upn space availability. Fr mre infrmatin cntact: Lianne Tdrvic Lianne.tdrvic@cll.n.ca ext. 399 Or visit ur webpage: Lianne Tdrvic Cmmunity Living Lndn Summer Leisure Prgram Crdinatr ext. 399 lianne.tdrvic@cll.n.ca

2 Summer Leisure Prgram 2018 Child s Name: Please clearly indicate yur first (1) and secnd (2) chice Lcatin (Ages) Sessin One July 3-July 13 Sessin Tw July 16-July 27 Sessin Three July 30-Aug 10 T Be Annunced (7-13) T Be Annunced (14-20) Typical sites include: Ashley Oaks Elementary St. Gerge s Elementary Clarke Rd Secndary Banting Secndary Sites will be cnfirmed / annunced as sn as we are able, n ur website at Fee: Sessin One July 3 - July 13 $ Sessin Tw July 16- July 27 $ Sessin Three July 30- Aug 10 $ Hurs: 8:30 a.m. 3:30 p.m. ** Please nte that camp will nt run n July 2 t recgnize Canada Day r n August 6 t recgnize the Civic Hliday **

3 **Please include a current pht f yur child with the infrmatin package** Please Print Incmplete frms will nt be accepted. Child s Name: Date f Birth: Parent/ Guardian: Other peple wh live at my huse: Address: City: Pstal Cde: Hme Phne: Cell Phne: Other: ** Please nte: Yu will receive crrespndence via ** Address: I d nt use/ have access t , please cntact me at: Emergency Cntact: Name: Relatinship: Phne Number: ** Please nte, this persn must be available fr cntact during prgram hurs ** Has yur child participated in this prgram in the past? If yes, what year? Schl: Teacher: Please describe yur child s abilities:

4 Please describe hw yur child will cmmunicate with us (i.e., verbal, pics/pecs, sign, ther): Des yur child have persnal care supprt needs? (i.e. dressing, using washrm, etc.) Please describe: Des yur child require assistance t eat? Please describe: Hw des yur child get alng with peers? What are yur child s favurite activities? Please describe what anger/ frustratin lks like fr yur child: Des yur child wander/ run away frm caretakers? Please describe:

5 Briefly describe the techniques used at hme when addressing challenging behaviurs: (i.e. time ut, redirectin, etc.) Please share any fears yur child may have: (i.e. thunder, dgs, etc.) Please share any tips/ techniques t assist yur child t calm: Please share any places/ activities t avid: Medical Infrmatin Health Card Number: Des yur child currently receive nursing supprts at schl? If yes, fr what prcedures? Des yur child take any medicatin? All medicatin t be taken at camp must: Be in a prescriptin bttle r bliss pack Be clearly labeled with child s name, name f the drug, administratin instructins and strage instructins Over the cunter medicine (i.e. Tylenl) must be prescribed r with written cnfirmatin by a

6 physician Medicatins cannt be administered if they are expired Please list ALL medicatins that yur child is currently taking. Name f Medicatin Dsage Time Given at Camp Time Given at Hme Allergies: Allergy Prtcl: Des yur child experience seizures? If yes, please describe: Seizure Prtcl:

7 Other medical infrmatin (i.e. asthma, diabetes, etc.): Other tips/ infrmatin which will be helpful in supprting yur child: ** If yu have ther infrmatin that wuld be helpful in supprting yur child, please ensure that it is attached t this package ** Check if infrmatin has been attached. Families are respnsible t infrm prgram staff f any changes t this infrmatin t ensure it is current at all times. Parent/ Guardian Signature: Date:

8 Permissin Frm Medicatins I request and give permissin fr staff frm Cmmunity Living Lndn t administer medicatin(s) t my child accrding t the prcedure utlined and fllwing the abve detailed infrmatin. Name: Signature: Relatinship: Date: Phtgraphs Phtgraphs are taken during each sessin at camp. Yur child s phtgraph may appear in publicatins prduced by Cmmunity Living Lndn. I, give permissin fr s (Guardian) (Child) phtgraph t be used in publicatins prduced by Cmmunity Living Lndn. Name: Signature: Relatinship: Date: Outings We will be ging n a variety f cmmunity based utings each sessin. These will include trips t the library, mvie theatre, bwling alley, parks, etc. I, give permissin fr (Guardian) t participate in utings while supervised by staff frm Cmmunity Living Lndn. (Child) Name: Signature: Relatinship: Date: Swimming Infrmatin Des yur child require the use f a fltatin device while in the water? What type? ** Family must prvide a life jacket if ne is required fr swimming activities ** What is yur child s swimming level? (Select ne) n-swimmer Beginner swimmer Average swimmer Strng swimmer We will be ging swimming at cmmunity pls nly. All pls will have certified lifeguards n duty. Yu will be ntified when yur child will be participating in a swimming uting. I, give permissin (Guardian) fr t participate in swimming utings while supervised by staff frm Cmmunity Living (Child) Lndn. Name: Signature: Relatinship: Date:

9 Cnsent t Share Infrmatin with the Summer Leisure Prgram The purpse f this cnsent is t assist with planning apprpriate day camp services. This may include the sharing f dcuments and necessary medical infrmatin. This may als include discussin abut yur child/r family member with the representatives f the agencies listed belw. I, give Cmmunity Living Lndn cnsent t share (Name please print) and r receive infrmatin abut, (Name please print) with the fllwing agencies: (Check all that apply) CCAC VON Salvatin Army Respite Cmmunity Living Lndn Thames Valley Children s Centre Schl (Name f schl and teacher) Other (Please specify) (Signature) (Date) (Signature) (Date) I/We als understand that this cnsent is given fr as lng as services are being prvided beginning frm date f signature (whichever ccurs first). I understand that I can revke this cnsent in writing at any time.