Celebrate Girls Hackensack Summer Program 2018 The Girl Scout Promise On my honor, I will try: To serve God and my country, To help people at all times, And to live by the Girl Scout Law. The Girl Scout Law I will do my best to be honest and fair, friendly and helpful, considerate and caring, courageous and strong, and responsible for what I say and do, and to respect myself and others, respect authority, use resources wisely, make the world a better place, and be a sister to every Girl Scout. Hackensack Middle School 360 Union Street Hackensack, New Jersey 07601 For girls entering Grades 4-7 Session 1: Monday, July 2 - Thursday, July 26, 2018 $100 Trips: All Girl Dance Party - Hamilton & Ward Steakhouse, Paterson Suez Tour/Celebrate Girl Marketplace Lake Rickabear, Kinnelon, NJ I Play America, Freehold Township, NJ Membership $40.00. For more information or to register, contact Dorothy Bing at dbing@gsnnj.org, or (973) 897-7035.
Dear Parents/Guardians, Thank you for considering Girl Scouts of Northern NJ s Celebrate Girls Hackensack Summer Program for your daughter s summer experience. We are delighted to offer many new experiences for girls entering 4th 7th grade. Girls will gain important skills in four areas that form the foundation of the Girl Scout Leadership Experience; S.T.E.M., Outdoors, Life Skills, and Entrepreneurship. All Girl Scout Summer activities are staffed by trained, skilled and capable personnel who are screened prior to placement. A first-aider is on duty at all times. The ratio of girls to staff is one staff to every 8 girls. Girls must be dressed appropriately with comfortable clothes and sneakers every day. Girls are also asked to bring a backpack to camp every day and a full water bottle. No sandals, flip flops, open-toe shoes, clogs, or platform shoes. Program T-shirts are to be worn every day. You will receive one free t-shirt with registration. Additional T-shirts may be purchased for $5/shirt from the Program Manager. Use of cell phones or electronic equipment are prohibited during camp hours. Registration for Girl Scout Program will be accepted in order of receipt of full session payment. Membership Registration does not guarantee placement; only full payment of program session guarantees placement. Rules for acceptance and participation are the same for everyone without regard to race, sex, color, national origin, age or handicap. Parents/Guardians may drop off girls at Hackensack Middle School at 11:30 a.m. to their Unit Leaders. For your child s safety, please do not leave your child unattended prior to 11:30 am. Girls must be picked up by 3:30 p.m. at Hackensack Middle School. No exceptions! A late pick up penalty will be assessed at $5.00 per 15-minute increment. Girls will only be released to adults that are designated on child release form completed with registration and health history. Lunch and snack will be provided every day. Session fees are nonrefundable. Trips - Bus leaves Hackensack Middle School promptly at 11:30 a.m. after morning attendance and breakfast, and usually return to Hackensack Middle School in time for 3:30 p.m. departure, unless noted in program calendar. Girls must be ready to board the bus at 11:30 a.m. On trip days, girls and staff must wear their program T-shirt. Staff maintains a ratio of one adult to every eight girls. Spending money is always optional for trips. Please remind your daughter to follow counselors safety instructions. Parents must make other arrangements if girls choose not to participate in trips. Girls must be a registered Girl Scout or must register to become a girl member. Membership Registration is $40.00. In order to provide the best experience for all girls, payment will be due 1 week prior to the first day of the session. Space is limited. If you have any questions regarding the program, you may contact me at ctaylor@gsnnj.org or 973-248- 8200 ext. 4103 or Pam Kanwisher, Celebrate Girls Hackensack Program Manager, pkanwisher@ gsnnj.org, or (973) 906-0075 (cell). Looking forward to a great summer! Charisse Charisse Taylor Chief Program Officer Girl Scouts of Northern NJ ctaylor@gsnnj.org (973) 906-0072 (cell)
Online Registration There are three steps required to register for Celebrate Girls Summer Program. Step 1: Is your child a registered Girl Scout? If your child is already registered, go to Step 2. Not sure or Need to Renew? Contact GSNNJ Customer Care at 973-248-8200 or customercare@ gsnnj.org New to Girl Scouts and not registered? See Brand new to Girl Scouts to complete the registration for Girl Scout membership. Step 2 Register for the Celebrate Girls Program! Go to www.gsnnj.org/ CelebrateGirls Review the Program Offerings section that best fit your girl s interests. Register online with your session choices. Click on Register Now! Create the profile for your camper, all required fields and make your selections. Complete payment with Bank Card. There will be an email confirmation and receipts sent from: GSNNJ- Celebrate Girls [noreply@ doubleknot.com] Step 3- Health History Form Health History Forms do not require a doctor s signature. The Health History form is located at the end of this brochure. Submit completed health history form by May 30, 2018 The Health History form can be mailed, faxed or dropped off. Mail to: GSNNJ ATTN: Celebrate Girls 95 Newark Pompton Turnpike Riverdale, NJ 07457 Fax to: 973-248-8050 Attn: Celebrate Girls Drop Off at: GSNNJ, Paterson Resource Center Center City Mall, 301 Main St. Paterson, NJ 07505 OR Paramus Service Center 300 Forest Ave. Paramus, NJ 07652 Brand new to Girl Scouts? Follow these directions! New Girl Scout Registration into the Celebrate Girls Summer Program Go to www.gsnnj.org and click JOIN NOW Click on GET STARTED TODAY Fill in the information and click CONTINUE Search for the Celebrate Girls Summer Program for your town: o Celebrate Girls Hackensack Summer Program Remove the zip code from the zip code search box, and click SEARCH. Select the Celebrate Girls (Town) by checking the box to the left; the selection moves to the top of the results; and click NEXT Complete the additional membership information, Click SUBMIT At the Registration Summary page, the option to ADD ANOTHER MEMBERSHIP or CHECKOUT is available. o Registering more than one person? Choose ADD ANOTHER MEMBERSHIP and complete the process o Ready to purchase membership? Click CHECKOUT The screens will guide you through the remainder of the process to complete the registration. Your registration is now complete! If you do not receive confirmation emails from us, check your spam folder. Look for an email from Member Community to set up a password for the MyGS Member Profile.
Sample schedule - Activities and times are subject to change Monday Tuesday Wednesday Thursday 11:30 am-12:00 pm Arrival/ Arrival/ Arrival/ Arrival/ 11:30 am -12:00 pm Trip 12:00-12:30 pm Lunch Lunch Trip Lunch 12:30-1:00 pm Free time, dance, songs, crafts, exercise time Free time, dance, songs, crafts, exercise time 1:00-2:00 pm Program (star lab or guest speakers) 2:00-3:30 pm Karoake Program (star lab or guest speakers) Trip Trip Trip Girl Scout Story Time Activity Arts & Crafts Arts & Crafts
Celebrate Girls Summer Program Health History Form 2018 Program Attending: Celebrate Girls Hackensack THIS HEALTH HISTORY FORM MUST BE COMPLETED BY MAY 30, 2018. The form is to be completed and signed by the camper s parent/guardian. A doctor s signature is NOT required for this health form. Girl Name: Date of Birth: Age: Address: Grade in Sept. 2018: City: State: Zip: Parent/Guardian 1 Name: Home Phone: Email (REQUIRED): Work Phone: Cell Phone: Parent/Guardian 2 Name: Home Phone: Email (REQUIRED): Work Phone: Cell Phone: Do both parents have custody? Yes No If no, who is the custodial parent/guardian? If a non-custodial parent is denied access to a child by a court order, you must provide camp with a copy of the documentation. Child Release Permit My child may be released to the following adults: Name & Phone: Relationship: Name & Phone: Relationship: My girl has permission to walk home from Girl Scout activities un-chaperoned by an adult. Yes No Emergency Contact (Will only be contacted if the parents/guardians are not available). Name: Primary Phone: Relationship to Child: Seconday Phone: Name of Family Physician: Phone: Primary Insurance Carrier: Policy or Group #: General Health Date of last health examination: Date of last tetanus shot: Provide Most Recent Dates for All That Apply: Frequent Ear Infections Heart Defect/Disease Convulsions Blood Disorders Hypertension Psychiatric Treatment Mononucleosis ADHD Autism Spectrum Disorder Seizures Sickle Cell Trait/Disease Musculoskeletal Disorder Chronic or Recurrent Illness Diabetes: 1) Glucose Testing? No Yes 2) On Insulin? No Yes 3) Pump or Injection? No Yes Asthma 1) Use of Inhaler? No Yes 2) Self Administer? No Yes 1) Most recent: 2) Medications: Allergies: Describe reaction, if known. REQUIRED: ATTACH A COPY OF ANY ALLERGY OR ASTHMA ACTION PLAN(S) SPECIFIC TO YOUR CHILD. Insect Stings: Food Allergies: Penicillin: Other Drugs: Poison Ivy: Hay Fever: Other Allergies: Prescribed Epipen? No Yes Can Self Administer Epipen? No Yes Camper Name: Date Rec d: Session(s): Medication taken routinely (prescription and OTC):
Can your child participate in all camp activities as described in the camp brochure? Yes, she is in good health and can participate without any accommodations. Yes, she can participate with reasonable accommodations in respect to health or physical special needs. Describe: No, she needs to be exempt from the following activities: Hospitalization / Operations / Injuries: Is the camper currently under the care of a physician or psychologist? No Yes, please specify: Has she started menstruation? No Yes Any additional information we should know about your child: Please feel free to attach any additional signifi cant information that will assist us in providing an enriching day camp experience for your camper. EMERGENCY MEDICAL AUTHORIZATION I give consent for my child,, to receive medical treatment according to camp protocol written by standing orders by the camp doctor, or otherwise directed in writing by the child s physician. In the event of a known severe allergy, camp staff as per physician s instructions to prevent life-threatening conditions, will administer medication. In the event of an emergency, I give my consent for the administration of emergency medical treatment and to transport the child to hospital facilities if necessary. I understand that a reasonable attempt to contact me will be made. I understand that part of the camp healthcare supervisor s role at camp is to dispense medication and that this will not occur unless she/he has written authorization and instructions from the child s doctor to dispense non-prescription and/or prescription medication (including vitamins, nutritional supplements, etc.). All medications must be in their original pharmacy containers, with an intact current prescription label. No exceptions will be made. Please send all medications, including Epi Pens and inhalers, with your child on the first day of camp. I also give permission for my child to receive the following non-prescription medications that I have checked below if the nurse deems it necessary. Dosages will be administered according to directions on the bottle unless a physician directs otherwise. Child s weight: lbs. Antacid Advil Benadryl Tylenol Cough drop Topical creams/lotions HIPAA Privacy Rule: I authorize the use of information to promote and monitor well-being while in camp, and as necessary, provision of first aid/emergency care as best as possible, according and not limited to certifications, training, and availability. This health history is complete and accurate. I know of no reason(s), other than the information indicated on this form, why my daughter should not participate in prescribed camp activities except as noted. I understand that willful omission of information that prevents GSNNJ staff from providing adequate care of my child may potentially result in dismissal of my child from camp. Read This Statement Before Signing: I give permission for my child to participate in all camp activities including visits to nearby parks and bus trips outside of the program site. I consent that my child may be photographed, videotaped, and/or recorded, and the electronic images/recordings may be made public and used for promotion of Girl Scouting free of any claims. I agree not to send my daughter to the program if she is not in physical and emotional condition to take part in program activities. I agree not to send my daughter to the program if she is not participating in the fi eld trip that day. Girls are not permitted to have in their possession or use while attending the program: alcohol, tobacco, illegal drugs, animals/pets, or weapons. Cell phone use is not permitted during the program. I understand that the program manager reserves the right to send home, without refund, any child who is unable to adjust, is repeatedly defi ant, or in the case of an illness, accident or health hazard, where it is in the best interest of the children and/ or program. We acknowledge that the child will make the Girl Scout Promise and accept the Girl Scout Law. The child has our permission to join Girl Scouts, if not already a member. Signature of parent/guardian: Date: Completed Health History Forms are due by May 30, 2018 or immediately upon registration if registering after that date. Submit the completed form via fax to 973-248-8050, scan/email to Gigi Mauder at gmauder@gsnnj.org, or by mail to Girl Scouts of Northern New Jersey, attn: Celebrate Girls Summer Program, 95 Newark Pompton Turnpike, Riverdale, NJ 07457.