YWCA VT Camp Hochelaga
Registration Form
Please complete a separate registration form for each child
Parent / Guardian 1 Personal Information Relationship to Camper ______
Name______PHONE (home)______
Address______(work) ______
City, State, Zip ______(cell) ______
Email ______
______
Parent / Guardian 2 Personal Information Relationship to Camper ______
Name______PHONE (home)______
Address (if different) ______(work) ______
City, State, Zip ______(cell) ______
Email ______
Emergency Contacts (In case parent / guardian cannot be reached, please fill in 2 additional contacts)
Name ______Relation to Camper ______
Day Phone ______Eve Phone ______Cell Phone ______
Name ______Relation to Camper ______
Day Phone ______Eve Phone ______Cell Phone ______
Camper Personal Information
Camper’s First Name______Last______
Nickname______DOB______School______
Grade______Camper’s Email______
Registration Date______Years at Camp ____
T-shirt Size YS____ YM____Y Lg___ AS____ AM____A Lg___XLg____ Swim Level Beg._____ Inter._____ Adv.____
Camper’s Race/Ethnicity (optional)______
Cabin Mate Request 1st choice______2nd choice______
May we publish camper’s name, address, e-mail in the SCAMP (weekly camper newspaper)? YES NO
Swim Lesson Required? YES NO
Dietary Preferences / Food Allergies? “Traditional” Vegetarian Gluten Free Lactose Impaired
Other (please explain) ______Allergies to ______
Are you referring/ were you referred by a friend? Who? ______
How did you first hear about Camp Hochelaga?______
Residential Camp1 Week Session - $700
RC 1 – June 22 – June 28
RC 2 – June 29 – July 5
LT-RC 2 – June 29 – July 5
RC 3 – July 6 - July 12
RC 4 – July 13 - July 19
RC 5 – July 20 – July 26
2 Week Session - $1250
RC 6 – July 27 - August 9
3 Week Leadership (CIT) $1800
CIT RC 5 & RC 6 – July 20 - August 9
Mini Camp Sessions - $350
MC 1– June 22 – June 25
MC 2 – June 29- July 2
MC 3 – July 27 – July 30 / Day Camp
1 Week Session - $250
DC 1 – June 23 – June 27
DC 2 – June 30 - July 4
DC 3 – July 7 - July 11
DC 4 – July 14 - July 18
DC 5 – July 21 - July 25
DC 6 – July 28 – August 1
DC 7 – August 4 – August 8
YES! I’m interested in the
DAY CAMP bus service.
Bus – Essex
Bus – Chimney Corners
Van – Shelburne Rd
So. Burlington
* “LT” - Leadership Track
“CIT” - Counselor-in-Training / Discounts
Early Registration before 2/12/14 –
$100 Residential, $50 for Day or Mini Camp (to be applied one-time regardless of the number of session attended)
Refer a New Camper
$50 for referring a new residential camper
$25 for referring a new day or new mini camper
Other Fees
· Non – refundable Registration Deposit $150 (included in session cost)
· Day Camp (Bus/Van) Service $10/day
· Transportation fee for Airport/Bus /Train $50 (each way)
· Transportation Fee before 8am & after 8pm $100 (each way)
Enclosed Payment includes the following:
Non-refundable
Registration Deposit ($150) $______
Additional Tuition Payment * $______
Store Account * $______
Transportation Fee * $______
Donation to Scholarship Fund $______
Total Enclosed $______
* = if applicable
Deposit is not needed if applying for a scholarship. / Payment Methods: Check, Visa / MasterCard
Check # ______Credit Card
Card # ______
Name on Card ______
Exp. Date ______Security Code______
Would you like us to charge the balance to same credit card
3 weeks prior to camper’s arrival at camp? YES NO
(All balances must be paid in full 3 weeks prior to your camper’s session)
Authorizations: I have read and agree to the terms and policies in the accompanying YWCA of Vermont’s Camp Hochelaga Information Bulletin.
It is my wish that my camper enjoy the experiences afforded to the girls at the camp, and I fully understand that, even after reasonable precautions have been taken, many activities such as swimming, boating, or archery, etc. may involve hazards for which the camp cannot be held responsible.
It is also understood that the YWCA of Vermont has permission to use photographs or videotapes taken of my child while at camp for promotion and various publications. Camper designed artwork may be used as well.
It is also understood that campers may be required to inventory their belongings in the presence of staff if the health or safety of the campers or staff indicates the need.
It is my desire that my camper be enrolled, as indicated on the application, subject to the conditions stated within.
In signing this application, I certify that health and accident insurance or Medicaid covers my camper and that I am obliged to provide the camp with the name of the carrier and policy number(s).
To preserve confidentiality, the YWCA of Vermont, Inc., will not release information about its members, staff, volunteers, program participants, Board of Directors, and committees to outside sources without the consent of the individual, her parent or guardian, unless the information released is in the aggregate and has no personally identifying features, or in response to a court order, or is subject to mandatory reporting under Vermont statute.
Would you be willing to let us use your name as a reference for other interested families? YES NO
Guardian Signature ______Date ______
I wish to attend Camp Hochelaga and agree to do my best to abide fully by the rules of conduct and customs of the camp.
Camper Signature ______Date ______
2014 CAMP HOCHELAGA INFORMATION BULLETIN
Camp Hochelaga is owned and operated by YWCA of Vermont, a nonprofit organization. The YWCA of VT, governed by its Board of Directors, is responsible for maintaining Hochelaga's traditions and guiding its philosophy and is represented at all times by YWCA VT Staff.
Camp Hochelaga is open to all girls and young women without regard to race, color, national origin, religious affiliation, or disability, in accordance with the Civil Rights Act of 1964 and the Americans with Disabilities Act of 1990. We will make every reasonable effort to meet the needs of all girls who wish to apply. Due to the age of Camp Hochelaga, however, much of our camp is not handicapped accessible. If your camper has a disability and you have questions or concerns, please call us at the YWCA of Vermont’s office: (802) 862-7520.
Camp Hochelaga is proud to be accredited by the American Camp Association. We voluntarily submitted to an independent appraisal completed by camp experts and have met up to 300 health, safety and quality program standards from staff qualifications and training to emergency management.
ACTIVITIES
Girls and young women benefit from exposure to a wide-range of activities and opportunities. Here is a snapshot of activities offered:
· Arts and Crafts ~ painting, beading, tie dye
· Land Sports ~ tennis, archery, soccer, team games, general sports
· Drama ~ plays, theater games, improvisation, skits
· Outdoor Education / Nature ~ plant identification, wilderness safety, nature crafts
· Small Craft Boating ~ sailing, canoeing, and kayaking
· Swimming
· Free Activities ~ variety of general camp activities offered every day
· Line Time
· Evening Program
· Banquet Preparation
· Musical
· Field Trips
· SCAMP ~ weekly camper newspaper)
· LOG ~ yearbook
· Leadership / CIT (Counselor in Training) is for girls entering 11th or 12th grade and at least 16 years old. The CIT program offers an enhanced development program that includes team building, teaches leadership skills and provides opportunities that ready girls to become counselors.
· Leadership Track (LT) is for upper mid and senior girls (entering grades 6-12) who would like the extra challenges of team building, personal development and leadership opportunities at camp. This program may include on or off site service learning activities.
Each camper will sign up for classes on Sunday after families depart. Campers select their choices for daily classes from a wide variety of offerings. Some activities have space limitations or prerequisites that must be met. Each day campers sign up for additional free and flex activities. Popular classes may be offered as free / flex activities during the week.
CABIN ASSIGNMENTS
Residential campers typically live in cabins with up to 8 girls their age/grade, in groups called “lines”.
© Lower Mids are entering grades 3-5 in the fall, or ages 8-10.
© Upper Mids are entering grades 6-8, or ages 11-13.
© Seniors are entering grades 9-12, or ages 14-17.
© Counselors-In-Training (CITs) are seniors entering grade 11 or 12 and at least 16 years old.
Girls are pre-assigned to lines and cabins according to their grade and age, at the discretion of the Camp Director. There is a section on the application to indicate a camper’s request of one or two cabin mates. When cabins are assigned, these mutual cabin requests are honored, if possible. Cabins are equipped with built in wooden bunks and shelves.
Each line has a bathhouse with toilets, sinks and showers with hot and cold running water.
SWIMMING PROGRAM
Safety in and around the waterfront is an important aspect of each camper’s Hochelaga experience. We follow the American Red Cross swimming program to develop swimming and water safety skills. We require that all campers be evaluated prior to participating in swimming and non-swimming aquatic activities, boating included.
Swim lessons are not required, but are strongly encouraged. If parents prefer, you can request your camper take a daily swim lesson as one of her activities.
HEALTH AND SAFETY
A physician must examine all campers within 12 months of their arrival at camp and complete the Health History and Examination Form provided in the confirmation packet. The camper may not be allowed to attend camp if this form is incomplete, missing or has not been signed by her custodial parent/legal guardian and a licensed physician or NP/PA.
Without exception, campers must be covered by a comprehensive Health and Accident insurance policy or be covered under a Medicaid plan.
All prescribed medications and over the counter medications (vitamins included) are to be left with the camp nurse. Medical health care staff members live at camp and counselors are trained in first aid and CPR. We have access to a nearby doctor as well as South Hero Rescue Squad, if needed.
CAMP STORE
Campers may purchase candy, camp clothing, postage, session photos, toiletries, camp memorabilia at the camp store through their store account. Special art projects or trips may have an additional fee.
· $10 per week is included in the camp tuition. Additional money may be added to their account.
Laundry service for campers spending more than one session is available at an additional expense. Please be sure that all clothing is labeled with the camper’s name.
Store balances of less than $5 will not be refunded, but will be added to the Scholarship Fund. Any store balance larger than $5 not claimed on day of departure will be automatically added to the Scholarship Fund.
REGISTRATION
Registration is on Sunday between 2-4 PM. The front gate will be closed until 2 PM. We cannot check in campers in early. Check in times help minimize time in lines.
DEPARTURE/CHECK OUT OF CAMP
Saturday is departure day for residential campers. Please do not arrive earlier than 9:30 AM. A closing ceremony will begin at 10:30 at the flagpole. A small memento will be awarded to each departing camper and we ask family and friends to stay for this special closing ceremony.
YWCA MEMBERSHIP
Camp Hochelaga is open to all girls. Upon registration, campers are members of YWCA of Vermont, where girls have the opportunity to be part of an international women’s membership movement, committed to creating opportunities for women and girls to experience growth, leadership, and power. The membership fee is included in camp tuition, and lasts for one year. Young women ages 15 and older are voting members within the YWCA of Vermont.
RULES AND POLICIES
Campers are expected to obey the rules and policies of Camp Hochelaga for the health, safety, and welfare of themselves and their fellow campers and staff.
Tobacco, alcohol, illegal drugs, and firearms are not allowed on the premises of Camp Hochelaga. Violators will be dismissed with no refund. Additionally campers may not bring live pets / animals to camp.
Campers are advised of the rules and policies of Camp Hochelaga their first day at camp.
Many activities and natural areas at camp must only be used under supervision and these activities and areas will be specified during the introduction to camp rules and policies.
· Dishonesty, theft, or borrowing of other people’s belongings without permission, are all serious offenses.
We reserve the right to inspect camper’s belongings if we suspect violation of rules or policies.
· Initiation, hazing, bullying or harassment of campers or staff is not permitted.
· Hair cutting or dyeing, piercing of any kind of any body part and tattooing are all prohibited while at camp.
· When one camper’s behavior or actions may endanger others we may ask a camper to leave and there will be no refund.
Campers are expected to follow the direction of the camp staff regarding rules and policies. We ask campers and staff to treat everyone with dignity, trust, honesty, and respect.
Confirmation
Within two weeks of receiving the completed registration form and $150 non-refundable registration fee we will mail a confirmation packet which includes the following:
· A confirmation letter
· Packing list
· Camper Health History Forms ~ must be completed and returned to our office four weeks prior to your camper’s session
· Request for Data form
· Tell Us about your Camper form
REGISTRATION FEES AND PAYMENT METHODS
The tuition balance must be paid in full 3 weeks prior to your child’s attending camp.
Payments can be made by personal check or money order made out to the YWCA of Vermont, or VISA/ Master Card. Currently our online registration is under construction.
TRANSPORTATION EXPENSES
We can provide pick up and drop-off service to either the Burlington bus station, Essex Train Station or Burlington International Airport for residential campers only. There is a fee (each way) for this service, which must be arranged in advance. We do not provide additional “in-state” transportation.