SUMMER CAMP REGISTRATION APPLICATION *Please note four year olds must have attended JK in 2018/2019 to be eligible for the camp program. Camper Information: Camper Name (required) Address (required) City (required) Postal Code (required) Age at Camp (required) Grade in September (required) Date of Birth (required) Primary Contact Phone (required) Add Another Camper ---YesNo Your Name Address City Postal Code Age at Camp Grade in September Date of Birth Primary Contact Phone Add Another Camper ---YesNo Enter additional Campers information (Name, Age, Grade in September, Date of Birth, Address, City, postal code, Phone) per Child Health and Medical Information: Camper’s Doctor (required) Camper’s Dentist (required) Doctor Phone (required) Dentist Phone (required) Parent/Guardian Information: Custodial Parent #1 (required) Mobile Phone (required) E-Mail (required) Work Phone Home Custodial Parent #2 Mobile Phone E-Mail Work Phone Home Add Additional Parent/Guardian Information for Camper ---NoYes Enter Additional Parent/Guardian information (Name, Work Phone, Email, Home Phone, Mobile) per parent/guardian Emergency Contact (if parents cannot be reached): Emergency Name (required) Emergency Name (required) Emergency Contact Phone (required) Emergency Contact Phone (required) How did you hear about our camp? My Child is a Return CamperYWCA WebsiteGooglePrint AdRoadside SignsSocial MediaActivities GuideChild Care CentreSchool FlyerOther CAMP REGISTRATION Camp Registration: In order to maximize the camp experience part time is not available. Camp runs Monday-Friday (except holidays) from 9:00 a.m. - 4:00 p.m. Extended Care is available for additional costs between 7:30-9:00 a.m. and 4:00-5:00 p.m. (see below) Week 1-July2-5 Nature Camp (4-10 yrs.)- $165 Survival Camp (10-12 yrs.) - $240 Extended Care - $38 Week 2-July 8-12 Nature Camp (4-10 yrs.)- $205 Adventures on the Water (10-12 yrs.) - $245 Extended Care - $47 Week2/3-July 8-19 CIT Camp (13-14 yrs.) - $215 Two weeks of fun filled learning with the Counsellors. Followed by opportunity to volunteer at camp. Week 3–July 15-19 Nature Camp (4-10 yrs.)- $205 Camper’s Cooking (10-12 yrs.) - $229 Extended Care - $47 Week 4–July 22-26 Nature Camp (4-10 yrs.)- $205 Grossology (10-12 yrs.) - $229 Extended Care - $47 Week 5-July 29-Aug 2 Nature Camp (4-10 yrs.)- $205 Adventures in the Wild (10-12 yrs.) - $223 Extended Care - $47 Week 6–Aug 6-9Civic Holiday-Aug 6 Nature Camp (4-10 yrs.)- $165 Survival 2 (10-12 yrs.) - $240 Extended Care - $38 Week 7–Aug 12-16 Nature Camp (4-10 yrs.)- $205 Fishing (10-12 yrs.) - $240 Extended Care - $47 Week 8-Aug 19-23 Outrageous Week (6-12 yrs.)- $290 SMLXLT-Shirt Youth Size. T-shirt provided must be worn every day Extended Care - $47 First week payment: I agree to make payment WITHIN 7 BUSINESS DAYS OF SUBMITTING THIS REGISTRATION for the first week of my child’s camp by one of the following methods: call YWCA offices to provide Visa/Mastercard information (519-267-6444) or visit YWCA Cambridge at 55 Dickson Street to pay by cash, Visa/Mastercard, cheque or debit. Full Payment: I agree to make MY FULL PAYMENT WITHIN 7 BUSINESS DAYS OF SUBMITTING THIS REGISTRATION by one of the following methods: call YWCA offices to provide Visa/Mastercard information (519-267-6444) or visit YWCA Cambridge at 55 Dickson Street to pay by cash, Visa/Mastercard, cheque or debit. ** Cancellations made without one week’s notice will be charged a 50% administration fee. All other cancellations will be charged 10% of the fee. Single day refunds will not be issued. ABOUT YOUR CAMPER(S) We want your camper to enjoy their time at camp. Please provide us with the following information so that we can make her/his camp experience great. Information will remain strictly confidential. Please check ALL THAT APPLY Please check words that best describe your child (required): EnergeticAthleticMakes Friends EasilyPrefers Quiet ActivitiesEnjoys CompetitionHappyNon-SwimmerFirst Time CamperSensitiveAggressiveGets HomesickEasy GoingNervousOver ActiveBeginning SwimmerRepeat YWCA CamperCooperativeWithdrawnShyTire’s EasilyWell CoordinatedTalkativeGood Swimmer Please indicate if your camper has any of the following (required): Seizures YesNo Enter Additional Details here Vision or Hearing (required) YesNo Enter Additional Details here Mobility (required) YesNo Enter Additional Details here ADHD (required) YesNo Enter Additional Details here Asthma (required)YesNo Enter Additional Details here Diabetes (required) YesNo Enter Additional Details here Dietary (required) YesNo Enter Additional Details here Allergies (required) YesNo Enter Additional Details here Is there any other health/medical information the camp staff should know about your child? PERMISSIONS 1. Photography: I give permission for the YWCA to take photographs of my camper for the purpose of promotion and publicity of YWCA programs and services. YesNo 2. Camp Readiness: It is the intention of staff to provide a fun, safe camp experience for every child. Camp staff have been trained in a variety of behaviour management techniques to encourage positive behaviour and self-discipline. In instances where a child is causing harm to themselves or to someone else or engaging in unsafe behaviour, staff may be required to intervene or remove the child from the situation. In order to support the success and safety of all campers, it is important that campers are “Camp Ready.” The following criterion has been developed: Camper is able to take direction and instruction from a staff member Camper is comfortable in and able to interact in a group environment Camper is able to participate in the camp program Camper is able to attend school successfully Camper interacts and participates in camp in a manner that is safe for themselves and others. Camper is able to participate in the camp program Campers that are attending a program and who are not demonstrating that they are “camp ready” may be withdrawn from the camp at the discretion of the Camp Director and/or the Director of Child Care Services. I have read and agree to these terms (required). 3. Waiver of Claims: I consent to allow my child to participate in the YWCA summer day camp program. I release any legal recourse against the YWCA and all claims resulting from personal injury. In the case of emergency, I authorize the YWCA to act on my behalf and transport my child to the nearest medical facility by ambulance or taxi at my cost. I understand that summer camps are nut-aware and I will refrain from including nut products in my child’s snacks and lunches. I further understand that: Camper’s Cooking and Survival Camp involve use of fire. Adventure’s on the Water involves canoeing and rafting down the Grand River. Outrageous Outings involves taking a school bus to a different off site field trip daily that includes but is not limited to physical activity such as rock climbing, mountain biking, use of water parks, swimming pools. I have read and agree to these terms (required). 4. YWCA Day Camp Health and Emergency Procedures: If your camper becomes ill while at camp the staff will call you at the numbers listed on this Registration Form to come and pick them up. The decision to call will be based on the best interest of the camper as well as the health of the other campers. Please note that campers who have any of the following signs/symptoms will not be allowed to stay at camp: undiagnosed rash, vomiting, diarrhea or high fever. If your camper has a minor accident, the staff will administer emergency first aid and inform you of the incident upon your arrival. Should the Camp Director decide your camper would be better off at home they will contact you to come and pick up your camper before the end of the day. If your camper has an injury deemed more serious, they may be transported immediately by ambulance or taxi to the hospital at your cost. You will be called and asked to meet us there. It is YWCA policy to notify a parent by phone when a child sustains an injury to the head. I have read and agree to these terms (required). 5. Summer Safety: This is an outdoor camp and campers often experience changes in the weather over their day. Please send extra clothes for rainy, damp days as well as a jacket/sweatshirt. Dressing your camper in layers will usually optimize comfort throughout the day. Running shoes only at camp please-sandals are not safe. Please send bug spray, lip balm and sun screen; labeling clearly with the camper’s name. Please apply sunscreen before leaving your camper for the day. We will remind them to reapply after swimming and before the afternoon program under our supervision. Staff/volunteers will assist four - five year olds in their application of sunscreen. Programs are planned to allow for low energy, quiet activities in shady areas during the hottest time of the day. Campers and Counselors must wear sun hats at all times. Campers and Counselors must wear a t-shirt while swimming. I have read, understand and agree that myself and my camper will adhere to all YWCA Day Camp policies and practices as detailed in the Registration Package and in the Parent Manual.