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					Kayak Assoc. Girl Scout Community Camp
C/O Donna Derby
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2915 99 Avenue N.E.
Lake Stevens, WA 98258-8457




                                                                                                                                                                                                         A United Way Partner
                                                                                    Registration Form
                                                                  KAYAK ASSOC. GIRL SCOUT COMMUNITY CAMP - WESTERN WASHINGTON
                                                                               CAMP JULY 25 – JULY 31 - 2010

Kayak Assoc. Girl Scout Community Camp Forms: Registration, Health History, Share your Daughter with Us, Camper Release
Information: can be downloaded from: www.kayakgirlscout.yolasite.com
Please print & fill out top portion and return.
             CAMPER NAME __________________________________________________________________ AMOUNT ENCLOSED _______________CK#___________________

ADDRESS _________________________________________CITY____________________________STATE_______________ZIP_____________COUNTY_____________________

e-mail_____________________________________________________________________________________________
HOME PHONE# (           )_____________________ MOM'S CELL # (      )___________________________ DAD'S CELL# (     )______________________________________________
Person to notify if parents cannot be reached: ___________________________________________________Relationship Camper ___________________________________________
                          Home Phone: (      ) ___________________________________________________Work Phone: (      )____________________________________________
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1 CHOICE OF CAMP UNIT ________________________________________________                           BUDDY'S NAME _______________________________________________
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2 CHOICE OF CAMP UNIT________________________________________________
THIS IS MY ___________ YEAR AT KAYAK COMMUNITY SUMMER CAMP                          AGE_________ GRADE IN FALL __________ BIRTH DATE __________________________
HAVE YOU EVER BEEN TO ANOTHER CAMP? [] YES [] NO                      WHERE? _________________________________________________________________________________

T-SHIRT SIZE: YOUTH S M L                                ADULT S M L XL OPTIONAL SWEATSHIRT $17 YES NO SWEATSHIRT SIZE: YOUTH S M L                                                                                      ADULT S M L XL

              [ ] SCOUT                   [ ] NON-SCOUT                [ ] STAFF CHILD
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Girl Scouts of Western Washington asks that all of our campers are currently registered member of Girl Scouts during their stay at summer camp.
GIRL SCOUT MEMBERSHIP FORM
Complete ONLY if not currently a registered Girl Scout for the (2009-2010) membership year. (Oct. 1, 2009 – Sept. 30, 2010)
I give permission for my daughter,__________________________________________________to join Girl Scouting. I understand that $12 of the fee for non-scouts is the membership fee
and that membership fees are sent to the GSUSA national organization and can not be refunded or transferred.
              ( ) New Member              ( ) Re-registering Member
Address__________________________________________________________ Phone#________________e-mail_______________________________________________________
School___________________________________in City___________________Parent/Guardian Signature X___________________________________________Date____________
*********************************************************************************************************************************************************************************************************************
ALL CAMPERS: CONSENT OF PARENT OR GUARDIAN:
As parent/guardian having legal custody of the camper named, who is voluntarily enrolled as a participant in the Girl Scouts of Western Washington Community Camp program, I
understand that camping programs involve inherent risk and possible injury because of the nature of the activity, even when conducted in a safe manner. I give permission for her to attend
camp and participate in all phases of the program including off-site activities and related transportation. I understand that a statement of her good health is required before she may attend.
As the parent or legal guardian of the above child, I give permission for the above child to be photographed and/or audio/video taped during this event and for the images and /
or recordings to be published, reproduced or distributed by Girl Scouts and its affiliates in all outlets, including but not limited to television, newspapers, internet, council
publications, recruitment materials and ads without liability or limitation or claims on my or minor’s part. I have read the statements above; I understand the information and
agree to abide by the terms.

X __________________________________________________________________________________                                                                              ___________________________________________________
MUST BE SIGNED FOR CAMPER TO ATTEND: SIGNATURE OF PARENT OR LEGAL GUARDIAN                                                                                                                                                               DATE
Cut Here & Return Above Section- - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PARENTS!              * DO YOU LIKE CAMPING?                             STAFF POSITIONS MAY STILL BE AVAILABLE
           VOLUNTEER YOUR TIME FOR A WEEK AT CAMP WITH YOUR DAUGHTER & REDUCE HER COST OF CAMP. YOUR WEEK OF CAMP IS FREE!
FEES:      $155.00 FOR GIRL SCOUTS                    $167.00 FOR NON-GIRL SCOUTS                                             $100.00 FOR STAFF CAMPER * $10.00 Discount Not Applicable
                           (DISCOUNT $10.00 IF PAID IN FULL WITH INITIAL REGISTRATION AND ALL PAPERWORK IN WITHIN 30 DAYS * ENDS April 30th)
                                                                                                     **** FEE INCLUDES ***
                                            SECONDARY HEALTH & ACCIDENT INSURANCE, NOT TRANSPORTATION TO CAMP OR BACK
                            T-SHIRT INCLUDED, NOT THE OPTIONAL SWEAT SHIRT - PATCH DESIGN ON SWEATSHIRT, IF ORDERED $17 EXTRA

PLEASE ENCLOSE COMPLETED REGISTRATION FORM, PATCH ENTRY, HEALTH HISTORY, EMERGENCY CONTACTS & PARENT CAMPER RELEASE INFORMATION, WITH
COMPLETE FEE OR $50 DEPOSIT. CAN RECEIVE BY EMAIL OR DO NOT FORGET TO MAIL A STAMPED, SELF-ADDRESSED LEGAL SIZE ENVELOPE, NEEDED FOR HER
CONFIRMATION AND CAMP LIST. PLEASE MAKE CHECKS PAYABLE TO: KGSCC (KAYAK GIRL SCOUT COMMUNITY CAMP). ENROLLMENT WILL BE ON A FIRST COME,
FIRST SERVED BASIS. NO PHONE RESERVATIONS WILL BE ACCEPTED. REGISTRATION FORMS MUST BE MAILED OR DELIVERED TO REGISTRAR.

                MAIL TO REGISTRAR:                                DONNA DERBY                                                        INFO:            CONTACT DONNA (Sunshine) OR LEN DERBY (Rainbow)
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                                                                  2915 99 AVE NE                                                                      425 334-7104     FAX : 425 397-6366
                                                                  LK STEVENS, WA 98258-8457                                                           SHAWNA MACAULEY (Kermit) 360 629-0786

                                                                      DEPOSIT IS NON-REFUNDABLE AFTER MAY 25, 2010
                                                 NO REFUNDS WILL BE MADE IF A CAMPER DOES NOT SHOW UP OR LEAVES EARLY FOR ANY REASON.
                                                         WE WILL SEND HER CAMP PROJECTS, T-SHIRT, PATCH, ETC, TO HER AFTER CAMP.
CANCELLATION POLICIES:
IF SHE CANCELS PRIOR TO CAMP, REFUNDS WILL ONLY BE REFUNDED IF WE HAVE SOMEONE ON THE WAITING LIST TO TAKE HER PLACE. OR IF YOU HAVE SOMEONE
TO TAKE HER PLACE. IF CAMPER CANNOT BE PLACED IN ANY OF HER CHOICES, AND IS PLACED ON THE WAITING LIST, THE FULL AMOUNT PAID WILL BE REFUNDED.
IF FINANCIAL ASSISTANCE IS DENIED & THE GIRL CANNOT ATTEND CAMP, WRITTEN REQUEST FOR CANCELLATION MUST BE SENT TO COUNCIL AT LEAST FOUR
WEEKS PRIOR TO HER CAMP SESSION START DATE. UPON RECEIPT, REGISTRATION WILL BE CANCELLED & ALL MONEY PAID WILL BE REFUNDED. REQUESTS
RECEIVED AFTER FOUR WEEKS PRIOR TO CAMP SESSION START DATE WILL BE CANCELLED AND ALL MONEY PAID BECOMES NON-FEFUNDABLE.

ALL FINANCIAL AID RECEIPIENTS NEED TO MAIL $25 DEPOSIT WITH REGISTRATION. WE WILL REFUND AFTER WE RECEIVE F/AID MONEY FROM COUNCIL.

IF YOU HAVE QUESTIONS REGARDING COOKIE DOUGH, CONTACT BEV AT 800-541-9852 EXT. 110
           July 25 through July 31st 2010                     KAYAK ASSO. COMMUNITY CAMP                                    CAMP LYLE MCLEOD
                                                           GIRL SCOUT OF WESTERN WASHINGTON

           To win a free trip to camp, hand draw the patch below. This year’s Theme will be “Dr. Seuss”
            A patch will be chosen for this year’s camp and that person will receive a free trip to camp.




Camp Lyle McLeod was named after the first Girl Scout Leader in Kitsap County. Located 10 miles northwest of Belfair, the camp’s 60 acres
of pine, hemlock and fir woods surround Lake Bennettsen. The road into camp is a rather rough State dirt road. A 1½-mile level trail,
encircles the lake connecting some of the units. Our camp is open to Brownie, Junior, Cadette, and Senior Girl Scouts as well as non-Girl
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Scouts ( 2 – 12 Grades in the Fall ). Our camp offers a serene and secluded setting, far from busy city sounds. Everyone will have an
opportunity for swimming, canoeing, fun yaks, crafts, nature, singing, evening event, Theme Day, Scout’s Own, and much more. Most of
our camper’s meals will be cooked in the units, by the girls and their leaders. Fourth grade and above will have the opportunity to learn
Archery.
Community Camps are divided into living groups called units with the correct girl-adult ratios. Girls are placed in units depending upon
their age. Within the unit, girls are divided into patrols for planning and carrying out activities. Activities are structured to challenge the
camper based on their age level and ability, and these activities should enhance their respect for the outdoors. Each unit uses a kaper
chart for the purpose of dividing the tasks of daily living amongst the campers. All camp activities will give campers the opportunity to
make new friends and work together in harmony.
Kayak Assoc. Community Camp has been staffed entirely by volunteers for the past 26 years. The adult volunteers are trained in Girl Scout
Policies and Procedures as well as in outdoor camping skills. All campers must be able to take care of basic daily personal hygiene needs.
Our camp does not have the resources to give one on one camper, extra special attention to these basic daily personal hygiene needs.



HACIENDA              Brownies (2nd & 3rd Grades); Little to some camping experience-two story lodge with heat, electricity, kitchen, range & refrigerator
                      (18 Capacity)


LAKESIDE              Juniors (4th & 5th Grades); Little to some camping experience, open air, rustic cabins with large covered cook shelter near events
                      (18 Capacity)


HILLTOP               Juniors (4th 5th & 6th Grades); Wood floor tents, bunks, with covered cook shelter, near events (16 Capacity)


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ARK                   Juniors & Cadettes: (6 & 7 Grades); Boating unit (must be able to swim 50 yards of the swim area, tread water for three
                      minutes & pass a Tippy Canoe Test) Sleep on attached floating deck-cabin; boating back & forth to events (12 Capacity)


YURT                  Juniors & Cadettes: (6th & 7th Grades); Yurt Village and covered cook shelter (12 + Capacity)


THE NEW YOU           Cadettes (7th & 8th Grades); Positive self image, goal setting, setting a table, fashion, exercise & more having to do with growing
                      up! Basement studio room with heat, electricity, kitchen, range & refrigerator (12 Capacity)


TOTEM                 Cadettes (8th & 9th Grade); Open faced, rustic cabins with large covered cook shelter, rowing is required (18 Capacity)


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PIONEER               Seniors, Ambassadors: (9 Grade & Above); Open air, rustic “A” frame cabins, with large covered cook shelter, walking is required
                      for all events Some time planned, to work with younger campers. (18 + Capacity)

                     Age levels may change, due to registration numbers.


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SR. HELPERS Seniors (Must be sixteen years old at camp, 10 Grade & Above) that have attended Kayak Community Camp
            in the past, may send a resume and volunteer to be part of our staff and attend camp free, if positions available.
            Training is required.

				
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posted:11/19/2011
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