PRE-SCHOOL DAY CAMP Information Sheet

PRE-SCHOOL DAY CAMP Information Sheet

1. LOCATION:Camp Sacajawea

2. ACTIVITIES:A certified teacher (along with aides) leads outdoor games, nature crafts, music, stories and more.

3. DATES/TIMES/AGES/DESCRIPTIONS

Day Camp For Ages 4-5:This is a 3-day per week program.

*Children entering kindergarten inSeptember should register for the Junior Day Camp.

Week Day Time Fee

July 2- July 6 M/ F 9:00-11:45 $22.00 (2 day week/ holiday July 4th)

July 9- July 13 M/ W/ F 9:00-11:45 $33.00

July 16- July 20 M/ W/ F 9:00-11:45 $33.00

July 23- July 27 M/ W/ F 9:00-11:45 $33.00

July 30- Aug 3 M/ W/ F 9:00-11:45 $33.00

Aug 6- Aug 10 M/ W/ F 9:00-11:45 $33.00

Day Camp For Age 3: This is a 2-day per week program.

*Children must be 3 by the start of the chosen week.

Week Day Time Fee

July 2- July 6 Tu/ Th 9:00-11:45 $22.00

July 9- July 13 Tu/ Th 9:00-11:45 $22.00

July 16- July 20 Tu/ Th 9:00-11:45 $22.00

July 23- July 27 Tu/ Th 9:00-11:45 $22.00

July 30- Aug 3 Tu/ Th 9:00-11:45 $22.00

Aug 6- Aug 10 Tu/Th 9:00-11:45 $22.00

1. IMMUNIZATION RECORDS/HEALTH HISTORY & CONSENT TO TREAT

FORMS – A copy of your child’s immunization records along with the Health History

and Consent to Treat forms must be returned with your registration forms. No campers

will be admitted to camp without this information turned in to the Recreation Office!!

1. CHILDREN MUST BE THE APPROPRIATE AGE. Please enclose a copy

of your child’s birth certificate for verification

6. DROP-OFF/PICK-UP PROCEDURES (if applicable): They are as follows:

a)Drop off is between 8:55-9:00am. Pick up is at 11:45 AM. Camp staff is not scheduled to work after this time. Any late pick-ups will incur a charge of $1.00 per minute after 11:55.

b)Park your vehicle in the parking area in front of the Main House.

c)You must walk your child to the Pre-School building and sign them in/out every day.

d)Handicapped parents/guardians may make arrangements for your camper to be escorted from your vehicle by a counselor.

e)Please be patient, particularly on the first day, you may have to wait to find an appropriate parking space.

f)NO camper will be permitted to leave the facility unless he/she is signed out in the appropriate manner.

1. The camp staff will not change diapers.

1. The parents must furnish all transportation. Any child that is to be picked up by someone other than a custodial parent or guardian must have a note of authorization on file in the Camp Director’s office. Children will only be released to an adult approved by the custodial Parent/Guardian.

1. The camp staff will administer NO MEDICATIONS

1. FIRST AID: For your child’s well-being and safety, there will be staff members on site who are First Aid and CPR certified. The day camp is limited to first aid only and any medical situation that is beyond the scope of basic response will be referred to Sparta Ambulance and/or Newton Memorial Hospital.

1. The Club House cabin is a self-contained building, which provides bathroom facilities and their own phone. In addition, the children will be offered the opportunity to play outside in a beautiful natural environment separated from the rest of the campers in a very controlled and safe area.

1. Children should come to camp with a light snack.

1. Children must wear sneakers and socks at all times. Open shoes (flip flops, sandals) should not be worn for regular camp activities.

1. Please be aware that your child may be engaging in activities that could cause them to get messy or dirty. Please refrain from dressing them in new clothes that could be ruined by camp activities.

Your cooperation in these areas will be appreciated. We are looking forward to an exciting and enjoyable summer program for your children. If you have any further questions or need more information, please call the Sparta Recreation Department office at 973-729-2383 between the hours of 8:30am and 4:30pm.

Please review the checklist below to make sure that all of your camp paperwork is complete. Please understand that:

1. NO FORMS WILL BE ACCEPTED AT THE OFFICE UNLESS ALL INFORMATION IS COMPLETE.

1. Your child will NOT be permitted to attend camp unless all of the information is correct and on file!!!!!!

CAMP REGISTRATION CHECKLIST

_____ Registration Form

_____ Insurance Information/Health History & Consent to Treat Form

_____ Immunization Records (if not on file at Recreation Office)

_____ Photocopy of insurance card (both sides)

_____ Any custodial documentation (if applicable)

Please X the line next to the week(s) you have registered for:

Ages 4-5 camp:

wk 1. (7/2-7/6)___ wk 2. (7/9-7/13)___ wk 3. (7/16-7/20)___ wk 4. (7/23- 7/27)___ wk 5. (7/30- 8/3)___ wk 6. (8/6- 8/10)___

Age 3 camp:

wk 1a. (7/2-7/6)___ wk 2a. (7/9-7/13)___ wk 3a. (7/16-7/20)___ wk 4a. (7/23- 7/27)___ wk 5a. (7/30- 8/3)___wk 6a. (8/6- 8/10)___

PRESCHOOL CAMP REGISTRATION- SPARTA RECREATION

Name:______Birth Date: ______Gender: Male Female

Last First Middle

Home address: ______

Street address City State Zip

*Custodial parent or guardian: ______Phone: ______Phone: ______

(Home) (Cell)

Home address: ______Phone: ______

(if different from above) Street address City State Zip

Business address: ______Phone: ______

Street address City State Zip

*Second parent or guardian: ______Phone: ______Phone: ______

(Home) (Cell)

Home address: ______Phone: ______

(if different from above) Street address City State Zip

Business address: ______Phone: ______

Street address City State Zip

* If a non-custodial parent has been denied access, or granted limited access to the child by a court order, please supply documentation to this effect.*

PERSONS AUTHORIZED TO PICK UP CHILD FOR CARPOOLING PURPOSES AND/OR CONTACT IN CASE OF EMERGENCY IF NEITHER PARENT IS AVAILABLE:

1. Name: ______

Relationship: ______Phone: ______Phone: ______

(Home) (Cell)

2. Name: ______

Relationship: ______Phone: ______Phone: ______

(Home) (Cell)

3. Name: ______

Relationship: ______Phone: ______Phone: ______

(Home) (Cell)

IMPORTANT - PLEASE READ - HOLD HARMLESS FORM

I hereby give permission for myself/child to participate in the Sparta Parks and Recreation Department program noted above for the time and date indicated. I waive and release all rights and claims for damages against the Sparta Parks and Recreation Department and their employees and agents for any and all injuries which may be suffered by the herein named minor or myself while participating in the program. Inherent in outdoor activities are the risks of cuts, bruises, sprains, or concussion. I also give permission for the Sparta Parks and Recreation Department to make non-commercial use of any activity photographs of my child or myself.

SIGNATURE:______DATE:______

( parent or guardian)

INSURANCE INFORMATION-HEALTH HISTORY & CONSENT TO TREAT FORM

Insurance Information

Is the participant covered by family medical/hospital insurance? Yes No

If so, indicate carrier of plan name ______Group # ______

Photocopy of front and back of health insurance card must be attached to this form.

HEALTH HISTORY:

ALLERGIES: List all knownDescribe reaction and management of the reaction

Medication allergies (list)

______

______

Food allergies: (list)

______

______

Other allergies: (list) - include insect stings, hay fever, asthma, etc.

______

______

DISABILITIES/HANDICAPS: ______

PRESCRIPTION DRUGS IF ANY: ______

PRE-EXISTING CONDITIONS FOR WHICH CAMPER IS BEING TREATED:

______

ANYTHING ELSE A DOCTOR TREATING CAMPER SHOULD BE AWARE OF:

______

EXPLAIN ANY RESTRICTIONS TO ACTIVITY: ______

Explain any additional information about the participant’s behavior and physical, emotional, or mental health about which the camp should be aware. ______

______

CONSENT TO TREAT

This is to certify that on this date, I, the undersigned, as parent or guardian of the above-named participant, give my consent to the Township of Sparta, the personnel thereof, and the medical and other representatives thereof, to obtain medical care from any licensed physician or other qualified emergency or non-emergency medical personnel, or a hospital or medical clinic, for the above-named participant for any injury that could arise from participation in the activities of the Township of Sparta Department of Parks and Recreation Summer Camp Program, including all activities and other events, and functions directly or indirectly related thereto, whether on or off the property of the Township of Sparta. It is understood that if only one parent or guardian is signing this consent to treat, the signing parent or guardian hereby certifies that he or she is signing on behalf of and with the full consent of any other parent of guardian, and will indemnify all parties against any actions or claims brought by any non-signing parent or guardian.

Signature: ______Date: ______