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					Jockey
   Hollow
        Camp
                        2
                        0
                        1
                        0
 Summer Day
Camp Program

  Girl Scouts of
  Northern New Jersey
ABOUT THE CAMP
Jockey Hollow Camp is owned and operated by
irl Scouts of Northern New Jersey (GSNNJ). The
camp’s 212 pristine acres are located in Mendham
Township, Morris County, NJ. The camp offers a
large “L”-shaped swimming pool, a Low Ropes
Challenge Course, an Equestrian Center, large
playing field and adventurous hiking trails. Six new
log cabins and activity shelters, a large troop house,
and a spacious pavilion provide protection for bad
weather days and overnight experiences. Each cabin
is equipped with a kitchen and bathrooms.

Girls entering grades 1-9 will enjoy outdoor cooking,
hiking, environmental programs, and swimming. The
Low Ropes Challenge Course, comprised of cable
wires and ropes, is designed to encourage team
collaboration and personal discovery. Pony or
horseback riding at our newly designed equestrian
center is optional for horse lovers.
The day camp program offers a diverse schedule that
gives each girl a variety of outdoor experiences in a
safe environment. She will develop her confidence,
self-reliance and leadership skills while making friends
and memories that will last a lifetime.
ACCREDITATION                                                      SUMMER 2010 SESSIONS
Celebrating our 81st year in operation this summer,
GSNNJ makes the health and safety of the girls at
Jockey Hollow our primary concern. Jockey Hollow is
                                                           Session 1 - July 5 - July 9
accredited by the American                                 Session 2 - July 12 - July 16
Camp Association (ACA).                                    Session 3 - July 19 - July 23 and
Additionally, we comply with
standards set by the New                                               July 26 - July 30 (2 weeks)
Jersey State Department                                    Session 4 - August 2 - August 6 and
of Health, American Red
Cross and Girl Scouts of                                               August 9 - August 13 (2 weeks)
the USA.                                                   Session 5 - August 16 - August 20




                                                           2
                                                 CAMP INFO NIGHT
Want to learn more about all the summer camps offered by the Girl Scouts of Northern New Jersey? Join us for one of our
Camp Info Nights as we share a general overview of our resident camp and two day camps. Drop in to meet the three Camp
Directors, ask questions, see photos, and allow us to get you and your daughter excited about camp this coming summer!
Please call (973) 248-8200 to register for the date most convenient for you. Completed Camp Registration Forms with deposit
will be accepted at any Info Night!


                                                      DATES/CHOICES:

                           Tuesday, Feb. 2, 2010       7-9 pm       Riverdale Service Center
                           Thursday, Feb. 4, 2010      7-9 pm       Paramus Service Center
                           Monday, Feb. 8, 2010        7-9 pm       Randolph Service Center



                                                    OPEN HOUSE
Opportunities are available for you and your daughter to see Jockey Hollow Day Camp, meet staff members, participate in an
activity, and get a guided tour of the camp facilities. Reservations are requested in case of cancellation due to inclement
weather. Directions to Jockey Hollow will be mailed or e-mailed when you call (973) 248-8200 to register.



                             PLACE:
                     Jockey Hollow Day Camp
                        Mendham Twp., NJ

                       DATE CHOICES:
              Sunday, April 11, 2010 1-3 pm
              Sunday, May 2, 2010    1-3 pm
              Sunday, May 23, 2010   1-3 pm




                                                                3
                                                GENERAL OVERVIEW
                                                                      FREE TO ALL CAMPERS: Every camper will receive one free
                                                                      Jockey Hollow Camp T-shirt! It should be worn every
                                                                      Monday that she attends a new session to be ready for her
                                                                      unit photo. Your daughter will receive a free Unit Photo for
                                                                      each session she attends to help her remember friends she
                                                                      made at camp!

                                                                      OVERNIGHTS: For girls entering grades 3-9, experience camp
                                                                      life after the sun goes down, while preparing dinner over an
                                                                      open fire and breakfast the next morning. Enjoy an extra free
                                                                      swim time and a campfire. Sleep in cabins or in the Large
                                                                      Pavilion. Girls must pre-register for any of the overnights.

LUNCH PROGRAM: An optional cold lunch program is                      PROGRAMS JUST FOR TEENS:
provided by Simply Gourmet, an independent company.                   Girls entering 6-9th grade may participate in General Camp or
Simply Gourmet offers “kid-friendly” nutritious, nut free meals       Teen programs. The teen programs include swimming,
delivered daily individually packaged with the camper’s name          challenge course, environmental, cookout and other general
on it. Participate by going to www.simplygourmetlunches.com.          camp activities as well as specialized activities. Pick your
Menus for both July and August will be available for ordering         program according to your interests with programs offering
by June 1, 2010.                                                      cooking in and out-of-doors, designing jewelry and fashions
                                                                      from recycled materials, joining the tribe as you hone your
CAMP UNITS & BUDDIES: Campers are assigned to camp                    survival skills, designing and constructing robots that will
units based on grade and stay with their unit for the session.        perform a function at camp, or if building is your thing, engross
Girls like to make new friends at camp, but if they need to be        yourself in engineering projects. Stay after camp for a TEENS
with a particular friend, we will try to accommodate a request        ONLY OVERNIGHT where you can relax by the pool and
to be placed with a buddy. The girls cannot be more than a            “experience the mysteries of the night.”
grade apart and must be in the same program. Only one                 TRAVEL CAMP: Join the Sisterhood of the Traveling Camps!
buddy can be requested and it must be reciprocal on the               In just one short week experience the uniqueness of all three
buddy's registration form.                                            summer camps. Begin the adventure by arriving via your own
                                                                      transportation on Sunday evening at Jockey Hollow with 1 1/2
SPECIAL NEEDS: Jockey Hollow Day Camp is open to all                  days and 2 nights of activities such as low ropes challenge
girls regardless of race, religion, ethnic background, or             course and pool swimming. Board the bus and head for Lake
socio-economic status. Girls having special health care needs         Rickabear for 1 1/2 days and 1 night of mini golf, duckpin
including physical, mental or behavioral disabilities are             bowling, and kayaking. Complete your travel to Camp Glen
welcome providing we are able to accommodate their needs.             Spey where you will experience 3 days and 3 nights of lake
A majority of the camp is handicap accessible. Feel free to           swimming, archery and hiking. Register for this program
contact Mary-Ann Lewis, Outdoor Program Director, at (973)            through the Camp Glen Spey Camp Brochure.
248-8200, ext. 38 to discuss your daughter's needs.




                                                                  4
                                                     HOW TO REGISTER
                                  Mail-in Registration begins Tuesday, February 2, 2010
                                 Walk-in Registration begins Tuesday, February 16, 2010
    Review the Program Offerings section and select the sessions and programs that best fit your daughter’s interests.
Complete the Registration Form, the Session Form and the Health History Form and mail with non-refundable deposit of $75 per
session to Girl Scouts of Northern New Jersey, 95 Newark Pompton Turnpike, Riverdale, NJ 07457. No Registration Forms will be
accepted before above date. The balance is due June 1, 2010. Registering after June 1, 2010 requires payment in FULL.

 Completed Registration, Session and Health History Forms with non-refundable deposit of $75 per session will be accepted at all
   three service centers beginning February 16, 2010. A Camp Director will be available at each of the three Service Centers on
                                Tuesday, February 16, 2010 to answer any questions or concerns.

ONLINE FORMS: As an additional service, the brochure,                     WAITING LIST: Girls are placed on a first-come, first served
the Registration and the Financial Assistance forms and the par-          basis. Girls who register for already filled sessions will be placed
ent/guardian guide can be downloaded at www.gsnnj.org for your            on a "waiting list". If a space becomes available, a girl will be
convenience. We are unable to accept e-mail registrations at              placed in the session in the order her name and deposit was
this time.                                                                received. Parents/guardians will be called about any new open-
PAYMENT SCHEDULE: Payment can be made by cash,                            ings. A return call to the office must be within 24 hours to keep
VISA/MasterCard/Discover/AMEX credit cards, or check or                   her space in the session.
money order made out to: Girl Scouts of Northern New Jersey.              HEALTH HISTORY FORMS: Completed forms are required at
All camp fee balances must be received by June 1, 2010.                   the registration. Only a parent’s signature is required.
ll camp registrations submitted after June 1, 2010 must be Paid
in Full.                                                                  CANCELLATION POLICY: Camp fees will be refunded, less the
OPTIONAL SERVICES:                                                        $75 per session non-refundable deposit, ONLY if a written
The following services are offered by Jockey Hollow for an                request is received in the Riverdale Service Center no later than
additional fee. Advance registration is required.                         June 1, 2010. (Requests received after June 1, 2010 cannot
                                                                          be refunded.) In case of an accident or illness (verification from
Extended Care: Extend the camp day for your child with our                a doctor) or death of an immediate family member, a camper will
aftercare program held on site. Activities facilitated                    be offered the next available session or a refund will be consid-
by camp staff include crafts, games and a healthy snack. The              ered on an individual basis.
program runs until 6 p.m.
Overnights: For girls entering grades 3-9, experience camp life           GSNNJ reserves the right to cancel programs that do not meet
after the sun goes down, while preparing dinner over an open              the minimum enrollment. All fees will be refunded if the camper
fire and breakfast the next morning. Enjoy an extra free swim             is not placed in another program.
time and a campfire. Sleep in cabins or in the Large Pavilion.
                                                                          CHANGES TO REGISTRATION: There will be an additional fee
Lunch Program: A “kid-friendly” nutritious, nut free lunch                of $15 for changes made after the initial registration form is
program can be ordered by Simply Gourmet, an independent                  received and processed. Please submit all changes in writing to
company.at www.simplygourmetlunches.com.                                  either toconnor@gsnnj.org or jindoe@gsnnj.org with the $15 fee.
Adding Extra Sessions: Often we hear from campers and                     If you do not receive a confirmation that the change in registra-
parents that they would like to return after a session. Pending           tion was received, please call (973) 248-8200.
availability, girls are welcome to return provided all paperwork is
                                                                          FINANCIAL ASSISTANCE: Any GSNNJ registered Girl Scout
completed. Please contact (973) 248-8200 for these dates.
                                                                          may apply for financial assistance. Each family's request and the
                                                                          availability of funds determine the amount granted. The
NON-GSNNJ MEMBER: Girls who are registered with another
                                                                          Girl/Adult Financial Assistance (GAFA) form can be found at
council are welcome to attend our council day and resident
                                                                          www.gsnnj.org. The $75 non-refundable deposit is required with
camps. An additional fee of $35 will be charged per day camp
                                                                          the camp registration in order to complete the registration
session. Current members of Girl Scouts of Northern New
                                                                          process. If your daughter is from a council other than Girl Scouts
Jersey are exempt from this fee because they participate in
                                                                          of Northern of New Jersey, contact your local council for their
GSNNJ product sales, which subsidize the camp fees. Girls who
                                                                          financial assistance procedures.
want to become a member of the world's largest all-girl member-           Deadline for applications is April 15, 2010.
ship organization are welcome to join and attend camp for an              No applications can be accepted after that date.
additional $35 fee per session. Girls may continue in Girl Scouts
year round by contacting our Membership Department.
                                                                      5
                                                   JOCKEY HOLLOW DAY CAMP PROGRAM OFFERINGS

                                                    GRADES                                                                                                                 FEE
        PROGRAM        SESSION      DATES          (ENTERING                                               DESCRIPTION                                                     PER
                                                     IN FALL)                                                                                                            SESSION


                                                                Beside daily swim lessons, hiking, singing, field games and arts & crafts, girls will participate in a
                                                                Special Interest Day (where they select their special activity), build a fire and enjoy a lunch cook-
       General Camp       1      7/5 - 7/9                      out. Girls will strengthen their self-esteem and promote teamwork when participating in the Low
          1 week          2      7/12 - 7/16          1-9       Ropes Challenge Course and Team Building Initiatives. Learn to accept others through programs             $275
         sessions         5      8/16 - 8/20                    such as the Zink the Zebra Goes to Camp program and explore the stream and forests with the
                                                                Environmental Education Specialist. Girls will be grouped in units of 16-20 girls according to grade
                                                                level. Days are busy and the time flies by!


NEW!
       Hawaiian Luau                                            Aloha! Submerge yourself in the island life at Jockey Hollow! Celebrate ten glorious days with a
                                 7/19 - 7/23and                 Hawaiian flare through activities such as making Hawaiian leis and moving like traditional hula
                          3                           1-9                                                                                                                 $530
          2-week                 7/26 - 7/30                    dancers! The session culminates with an all-camp Water Carnival filled with water games both
          session                                               poolside and in the field. Plus enjoy all the General Camp activities listed above.



         Express
NEW!                                                            Celebrate the glamorous and fabulous you! Express yourself by creating your own personal
         Yourself
                                                                fashion. Make accessories and clothing with the help of counselors and fellow campers using
                                 8/2 - 8/6 and
                          4                           1-9       recyclable materials in brand-new ways! Each unit will also design a fashion for their Unit Miss JH       $530
          2-week                 8/9 - 8/13
                                                                Piggy! Cheer her on at the all-camp grand finale as she makes her way down the runway and
          session
                                                                competes in piggy races! Plus enjoy all the General Camp activities listed above.


                          1      7/5 - 7/9
                          2      7/12 - 7/16                                                                                                                             $40 per
                          3      7/19 - 7/23 and                                                                                                                         1-week
                                 7/26 - 7/30                    Extend the camp day for your child with our aftercare program held on site. Activities facilitated       session
       Extended PM
                          4                           1-9       by camp staff include crafts, games and a healthy snack. The program runs until 6 p.m.
         Aftercare               8/2 - 8/6 and
                                                                                                                                                                         $80 per
                                 8/9 - 8/13
                                                                                                                                                                         2-week
                          5      8/16 - 8/20
                                                                                                                                                                         session


                                                                                           6
                                                    JOCKEY HOLLOW DAY CAMP PROGRAM OFFERINGS
                                                     GRADES                                                                                                                     FEE
        PROGRAM       SESSION        DATES          (ENTERING                                                 DESCRIPTION                                                       PER
                                                      IN FALL)                                                                                                                SESSION

                                                                   This basic program, under the supervision of trained professionals, introduces girls to horseman-
                          1       7/5 - 7/9                        ship in a safe, non-threatening manner. Girls interact with ponies while learning grooming, leading
         Pony Fun         2       7/12 - 7/16           1-3        and basic care of horses. Elementary riding in the ring or hand-walking on trails (weather permit-            $380
                          5       8/16 - 8/20                      ting) is included in the daily 1 ½ hrs. of equestrian time from Tuesday through Friday. Plus M-F
                                                                   enjoy the General Camp activities listed on the previous page.


                                  7/19 - 7/23 and
         Pony Fun         3
NEW!                              7/26 - 7/30
           Plus                                                    This program expands upon the one-week program providing campers with the self-confidence
                                                        1-3        and knowledge necessary for considering future equestrian endeavors. During the second week,                  $740
          2-week                                                   riders learn to steer and control their ponies on their own and experience basic sitting and posting.
                          4       8/2 - 8/6 and
         sessions
                                  8/9 -8/13


                                                                   For those who have already participated in Jockey Hollow's Pony Fun program, Pony Fast Track is
NEW!                      1       7/5 - 7/9
                                                        1-3        just for you! With more riding time, more interactive learning and mounted games and an upbeat
        Pony Fast         2       7/12 - 7/16                                                                                                                                    $380
                                                                   pace, Pony Fast Track will prepare its participants for a smooth transition into the Horsemanship
          Track           5       8/16 - 8/20
                                                                   Program.


                          1       7/5 - 7/9 and
                                  7/12 - 7/16
                                                                   Girls spend two fun-filled hours a day, Tuesday-Friday, including 30 minutes riding either large              $760
                          3       7/19 - 7/23 and       4-8        ponies or horses. Under the supervision of trained professionals, these two & three-week program          (Sessions 1 & 3)
                                  7/26 - 7/30          (2 units    for beginner and intermediate riders offer a variety of equestrian activities including grooming, tack-
       Horsemanship                                  grouped by
                                                                                                                                                                                $1,060
                                                      age level)   ing, and trail etiquette. A trail ride and a gymkhana will be offered on the last day. Plus Mon.-Fri.
                                                                                                                                                                               (Session 4)
                          4       8/2 - 8/6,                       enjoy the General Camp activities listed on the previous page.
                        (3 wk.    8/9 - 8/13, and
                       session)   8/16 - 8/20




                                                                                              7
                                                                               TEEN PROGRAMS
                       Girls entering 6-9th grade have the option of participating in General Camp or Teen programs. The teen programs include swimming,
                            challenge course, environmental, cookout and other general camp activities as well as the specialized activities listed below.

                                                       GRADES                                                                                                                FEE
        PROGRAM         SESSION         DATES         (ENTERING                                               DESCRIPTION                                                    PER
                                                        IN FALL)                                                                                                           SESSION

                                                                   Are you inquisitive and like to design and build things? This program is for geared for you! Work
NEW!                                                               alongside female engineers from the Society of Women Engineers as you make apple crisp in a
        Gear It Up!         1       7/5 - 7/9            6-9       solar oven, build bridges and water filtration systems, disassemble clocks and partake in other          $325
                                                                   activities that relate to things you do in everyday life. Get geared up as teams battle in the Jockey
                                                                   Hollow Engineering Jeopardy Game.

                                                                   Tribe On! Back by popular demand, spend the week learning how to live off the land by building a
                                                                   debris hut, constructing a nature still for water, becoming confident with a compass and map, and
         Survivor           2       7/12 - 7/16          6-9       assembling a personal survivor kit to keep. Sleep over Wednesday night to become a night                 $325
                                                                   prowler. The week culminates with a Survivor Challenge! All the fun without being eliminated at
                                                                   Tribal Council!

                                                                   Travel around the world as you create recipes from other countries. Girls will create French pastry,
NEW!                        3       7/19 - 7/23 and                Italian specialties and oriental delicacies. Prepare and sample additional recipes from at least 5
       World Cuisine      2 week                         6-9                                                                                                                $600
                          session
                                    7/26 - 7/30                    other cuisines including: Mexican, Caribbean, German, African, Indian, and more. Go home at the
                                                                   end of the session with a great cookbook!

NEW!                        4                                      For the fashion divas who like to be Green! All the specialty projects will utilize recycling as the     $600
        Recycled                    8/2 - 8/6 and
                          2 week                         6-9       unifying theme. Use everything from bottle caps to paper and old clothing as you create wearable
       Wearable Art                 8/9 - 8/13
                          session                                  art such as jewelry, clothing and a handbag.

NEW!                                                               Wish you could build a robot to fetch your water bottle or roast a marshmallow at camp? Join the         $325
         Campin'
                            5       8/16 - 8/20          6-9       teen robotics challenge unit. Build and take home a robot. Then with your team, design, build and
         Robotics
                                                                   program a Lego Mindstorm robot to meet the Jockey Hollow challenge!

                                                                   Join the Sisterhood of the Traveling Camps. In just one short week experience the uniqueness of          $450
                                                                   all three summer camps. Begin the adventure by arriving at Jockey Hollow via your own trans-
                                                                   portation on Sunday evening. Spend 1 1/2 days and 2 nights participating in activities such as low
                            2       7/11 - 7/16
       Travel Camp                                       6-8       ropes challenge course and pool swimming. Board the bus and head for Lake Rickabear for 1 1/2
                            3       7/18 - 7/23
                                                                   days and 1 night of mini golf, duckpin bowling, and kayaking. Complete your travel to Camp Glen
                                                                   Spey where you will experience 3 days and nights of lake swimming, archery and hiking. Register
                                                                   for this program through the Camp Glen Spey Camp Brochure.

                                                                                             8
                                                                                  TEEN PROGRAMS

                                                  GRADES                                                                                                                         FEE
        PROGRAM        SESSION         DATES     (ENTERING                                                      DESCRIPTION                                                      PER
                                                   IN FALL)                                                                                                                    SESSION

                                                                     Girls entering ninth-tenth grade (and 14 yrs. old as of 7/5/10) can register for this two-week leader-
                                                                     ship training program. During the first week, develop skills needed to work with younger girls and
       Program Aide                                     9
                                 7/5 - 7/9 and                       understand their needs at camp and throughout the Girl Scout year. Next, use these newly
         Training        1                       (must be 14 yrs.                                                                                                               $300
                                 7/12 - 7/16                         acquired skills under the guidance of camp counselors in the units and the specialist staff during
          (PAIDE)                                old as of 7/5/10)
                                                                     the second week. Upon completion of the program, girls are encouraged to volunteer for one or
                                                                     more weeks during the remainder of camp.

                                                                     Girls who have completed the PAIDE training will continue to build their camp counselor skills
NEW!                                                                 during this two-week session. The first week will focus on camp counselor training including
        Counselor                                      10
                                                                     conflict resolution, risk management, and unit planning. Girls will be certified in American Red
       Aide Training             7/5 - 7/9 and   (pre-requisite-
                          1                      completion of       Cross First Aid and CPR. During the second week, the girls will be assigned to a unit and work             $300
         (CAIDE)                 7/12 - 7/16         PAIDE           alongside the unit staff. Upon completion of the program, girls are encouraged to volunteer for one
                                                    Training)
                                                                     or more weeks during the remainder of camp. Only girls who complete this training and are 16
                                                                     yrs. old by the start of the following summer may be considered for hire as a Junior Counselor.

                                                                            OVERNIGHT PROGRAMS
                                                                     Experience camp life after the sun goes down while preparing dinner over an open fire and break-
        Overnight         2      7/14                                fast the next morning. Enjoy an extra free swim time and a campfire sing-along! Sleep in cabins
                                                      3-9                                                                                                                        $25
        Adventure         4      8/11                                or in the Large Pavilion and listen to the hoot of an owl as it lulls you to sleep. Girls MUST PRE-
                                                                     REGISTER for Overnight Adventure. A maximum of 100 girls will be allowed for each overnight.

                                                                     Extend your stay with a late night luau! Enjoy an extra free swim time, and a savory Hawaiian din-
NEW!     Overnight                                                   ner prepared over a roaring fire. Sing songs around the campfire late into a perfect summer night!
                          3      7/28                 3-9                                                                                                                        $25
           Luau                                                      Sleep in cabins or in the Large Pavilion. Breakfast is included. Girls MUST PRE-REGISTER for
                                                                     the overnight. A maximum of 100 girls will be allowed.

                                                                     The fun begins when the buses leave. Enjoy an afternoon swim and a delicious campfire dinner.
                                                                     Prepare to explore the mysteries of the night by hiking a trail with the moon and stars as your
NEW! Overnight Teen
                          4      8/4                  6-9            guide. Listen to the thrilling tales of a storyteller around the warm fire. Sleep in cabins and enjoy a     $30
      Night Owls
                                                                     continental breakfast. Teens MUST PRE-REGISTER for the overnight. A maximum of 75 girls will
                                                                     be accepted.


                                                                                                9
                                                    TRANSPORTATION 
                                                                    
The day camp fee includes bus transportation to and from camp.  Campers arrive at camp at about 8:50 a.m. and leave camp by bus at 
about 3:40 p.m.  Select a bus stop and write the bus stop number on the application.  Bus times may vary due to traffic, weather 
conditions or number of campers per stop. 
 
Buses cannot wait beyond the scheduled times.  Arrive at the bus stop 10 minutes prior to pick‐up and drop‐off times.  An adult must 
stay with the camper until the bus arrives. For the safety of our campers an authorized adult must present a photo ID when picking up 
each day. 
 
Campers transported to camp by a parent/guardian should arrive between 8:30 and 8:45 a.m. and should be picked up at 3:35 p.m.  For 
those campers being transported by parent/guardian, use #9A as bus stop on application form. 
         

STOP #9A – Campers transported to camp by a parent/guardian. 
 

                                                     BUS ROUTES SCHEDULE  
                                                            2010 
                                                                    
                      STOP #          TOWN                               PLACE                   TIMES AM       TIMES PM 
                        1A      Oakland              ShopRite, 14 Post Rd.                          7:45           4:50
            BUS         1B      Wayne                Kohl’s Shopping Center, Rt. 23                 8:05           4:35
            #1          1C      Towaco               Train Station                                  8:20           4:20
                        1D      Boonton              Municipal Building                             8:30           4:05
                                                                    
                        2A      Florham Park         Dress Barn Shopping Ctr‐ Columbia Tpk          8:15           4:15
            BUS         2B      Madison              Train Station side of Kings Road               8:25            ‐‐‐‐
            #2                                       Town Hall side of Kings Road                    ‐‐‐‐          4:00 
                        2C      Harding              6th Day Adventist Church                       8:40           3:45
                                                                    
                        3A      Parsippany           St. Peter’s Church                             7:45           4:30
            BUS         3B      Denville             St. Mary’s Church                              7:55           4:20
            #3          3C      Rockaway             D. O’Brien School                              8:10           4:10
                        3D      Dover                St. John’s Episcopal Church                    8:20           4:00
                                                                    
            BUS         4A      Byram                ShopRite, Rt. 206                              7:55           4:30
            #4          4B      Landing              Nixon School                                   8:10           4:15
                        4C      Brookside            Community Club                                 8:35           3:50
                                                                    
                        5A      Budd Lake            Tinc Road School                               7:45           4:30
                        5B      Flanders             Mt. View School                                8:00           4:20
            BUS         5C      Washington Twp       West Morris Central High School                8:10           4:10
            #5                  (Morris County) 
                        5D      Chester              Municipal Parking Lot, Collis Lane             8:20           3:55
                        5E      Mendham              Mendham High School                            8:30           3:45
                                                                    
            BUS         6A      Chatham              Lafayette School                               8:10           4:20
            #6          6B      Stirling             Central School                                 8:25           4:05
                                                                    
                        7A      Whippany             Pine Plaza                                     7:45           4:40
                        7B      Parsippany           St. Christopher’s Church                       7:55           4:30
            BUS         7C      Morris Plains        Simons Park                                    8:10            ‐‐‐‐
            #7                                       Friendly’s Restaurant                           ‐‐‐‐          4:15 
                        7D      Morristown           St. Margaret’s Church                          8:20           4:05
                        7E      Morristown           Thomas Jefferson School                        8:30           3:55
                                                                    
                        8A      Hackettstown         Target, Rt. 46 W                               7:45           4:45
            BUS         8B      Landing              Pathmark Shopping Ctr.                         8:05           4:25
            #8          8C      Succasunna           Horseshoe Lk.‐ Imagination Park Lot            8:20           4:15
                        8D      Randolph             Randolph High School                           8:40           3:55
 
 

        Please note: Schedule subject to change due to the number of campers per stop.  
                                                                                                                        Office Use Only:

                                    GSNNJ 2010 CAMP REGISTRATION FORM                            □ R □ NR
                                                                                                 □ HFOS □ HF Copies
              Camp Attending:                □ Glen Spey □                 Jockey Hollow □ Lake Rickabear
                               (Must complete a separate registration form for each camp attending)
  Registration begins February 2, 2010. Complete this form in its entirety and mail with payment to: Girl Scouts of Northern New Jersey, 95 Newark
  Pompton Turnpike, Riverdale, NJ 07457. Cash, checks made payable to Girl Scouts of Northern New Jersey, or credit cards are accepted. FAXES will
  NOT be accepted.
  CAMPER INFORMATION: Please print all information in black or blue ink.
  Name: __________________________________________________________________________ Age: ____________
                First Name                              MI                                  Last Name

  Mailing Address: ________________________________________City: ______________________________
  State: ______ Zip Code: ________ Home Phone: ______________
  Date of Birth: ____/____/____Grade Completed June 2010: ______ School in June 2010: ___________________

  Active Girl Scout Member:           □ Yes □ No             Troop #: ___________ Council Name: ______________________
  Will you be on vacation or out of the area during your daughter’s stay at camp? □ Yes □ No
  Buddy request: ________________________ (only one request, not more than one grade apart and must be reciprocal on buddy’s registration)
  PARENT/GUARDIAN INFORMATION-FILL OUT THIS SECTION COMPLETELY Camper may be released to:
           □ Both parents               □ Mother only            □ Father only           □ Other _________________________
  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.
  Parent /Guardian Name: _____________________________________ Relationship: ________________________
  Address if different from camper: ________________________________________________________________
  Home Phone: ______________________ Cell Phone: ____________________ Business Phone: ___________________
  Email Address: __________________________________________________________________________________
  Parent /Guardian Name: _____________________________________ Relationship: ________________________
  Address if different from camper: _____________________________________________________________
  Home Phone: ______________________ Cell Phone: ____________________ Business Phone: ___________________
  Email Address: __________________________________________________________________________________
  MUST PROVIDE LOCAL EMERGENCY CONTACT INFORMATION: (other than parent/guardian). Please notify
  individual of their role. Parents/Guardians will always be the first contact.
  Name: ____________________________________________________ Relationship:________________________
  Home Phone: ______________________ Cell Phone: ____________________ Business Phone:____________________

The following information provides GSUSA and Girl Scouts of Northern New Jersey with essential statistical data on the racial & ethnic
population groups that are served. It helps to further our goal to serve all girls.

            □Am. Indian/Alaskan Native □Asian □Black/African American □Hawaiian/Pacific Islander □White □Latina/ Hispanic

  READ THIS S T A T E M E N T B E F OR E SIGNING:
  I give permission for my camper to participate in all camp activities including selected overnights and bus trips outside of camp. I consent that
  my camper 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 camper to camp if she is not in physical and emotional condition to take
  part in camp activities. Campers are not permitted to have in their possession or use while attending camp: alcohol, tobacco, illegal drugs, MP3
  players, personal sports equipment, animals/pets, or weapons. Cell phone use is not permitted during camp. I understand that the camp
  director reserves the right to send home, without refund, any camper who is unable to adjust to camp living, is repeatedly defiant, or in the
  case of an illness, accident or health hazard, where it is in the best interest of the camper or campers. We acknowledge that the camper will
  make the Girl Scout Promise and accept the Girl Scout Law. The camper has our permission to join Girl Scouts, if not all ready a member.

  Parent/ Guardian Signature: _________________________________________________________________________ Date:_____________________
  Print Name: _________________________________________________________________________________Relationship:___________________

               Please attach Session Form to Registration Form before sending in for processing.
                                         2010 Jockey Hollow Day Camp Session Form
                                                                                                    Non          Overnight
Session
          Camp
          Code
                             Lake Rickabear Summer Camp 2010 Session Form
                           Program     Entering Grades Dates Fee GSNNJ Entering
                                                                                                                                  PM Care
                                                                                                                                   4-6 pm
                                                                                                                                            Totals
                                                                                                  member         Grades 3-9
   01      460          General Camp 1              1 through 9          7/5-7/9     □ $275        □ $35             N/A            □ $40

   01      461             Pony Fun                   1, 2, 3            7/5-7/9     □ $380        □ $35             N/A            □ $40

   01      462          Pony Fast Track               1, 2, 3            7/5-7/9     □ $380        □ $35             N/A            □ $40
                                                                       7/5-7/9 &
   01      463           Horsemanship               4, 5, 6, 7, 8                    □ $760        □ $35        □ $25 (7/14)        □ $80
                                                                       7/12-7/16
   01      464            Gear It Up!                6, 7, 8, 9          7/5-7/9     □ $325        □ $35             N/A            □ $40
                                                                       7/5-7/9 &
   01      465      Program Aide Training                9                           □ $300        □ $35        □ $25 (7/14)        □ $80
                                                                       7/12-7/16
                                                                       7/5-7/9 &
   01      466     Counselor Aide Training               10                          □ $300        □ $35             N/A            □ $80
                                                                       7/12-7/16
   02      467          General Camp 2              1 through 9        7/12-7/16     □ $275        □ $35        □ $25 (7/14)        □ $40
   02      468             Pony Fun                   1, 2, 3          7/12-7/16     □ $380        □ $35        □ $25 (7/14)        □ $40

   02      469          Pony Fast Track               1, 2, 3          7/12-7/16     □ $380        □ $35        □ $25 (7/14)        □ $40

   02      470              Survivor                 6, 7, 8, 9        7/12-7/16     □ $325        □ $35       Included (7/14)      □ $40
                                                                      7/19-7/23 &
   03      471           Hawaiian Luau              1 through 9                      □ $530        □ $35        □ $25 (7/28)        □ $80
                                                                       7/26-7/30
                                                                      7/19-7/23 &
   03      472           Pony Fun Plus                1, 2, 3                        □ $740        □ $35        □ $25 (7/28)        □ $80
                                                                       7/26-7/30
                                                                      7/19-7/23 &
   03      473           Horsemanship               4, 5, 6, 7, 8                    □ $760        □ $35        □ $25 (7/28)        □ $80
                                                                       7/26-7/30
                                                                      7/19-7/23 &
   03      474           World Cuisine               6, 7, 8, 9                      □ $600        □ $35        □ $25 (7/28)        □ $80
                                                                       7/26-7/30

                                                                                                              □ $30 (8/4) Grade
                                                                        8/2-8/6 &
   04      475          Express Yourself            1 through 9                      □ $530        □ $35        6-9 Only    □       □ $80
                                                                        8/9-8/13
                                                                                                                 $25 (8/11)

                                                                        8/2-8/6 &
   04      476           Pony Fun Plus                1, 2, 3                        □ $740        □ $35        □ $25 (8/11)        □ $80
                                                                        8/9-8/13

                                                                        8/2-8/6,                              □ $30 (8/4) Grade
   04      477           Horsemanship               4, 5, 6, 7, 8      8/9-8/13 &    □ $1060       □ $35      6-8 Only □ $25       □ $120
                                                                       8/16-8/20                              (8/11) Grade 4-8

                                                                        8/2-8/6 &                               □ $30 (8/4)
   04      478      Recycled Wearable Art            6, 7, 8, 9                      □ $600        □ $35                            □ $80
                                                                        8/9-8/13                                □ $25 (8/11)
   05      479          General Camp 5              1 through 9        8/16-8/20     □ $275        □ $35             N/A            □ $40

   05      480             Pony Fun                   1, 2, 3          8/16-8/20     □ $380        □ $35             N/A            □ $40

   05      481          Pony Fast Track               1, 2, 3          8/16-8/20     □ $380        □ $35             N/A            □ $40

   05      482          Campin' Robotics             6, 7, 8, 9        8/16-8/20     □ $325        □ $35             N/A            □ $40

* Registering after June 1, 2010 requires payment in FULL.                                                Total Camp Fees:
                     Non refundable deposit: $75.00 per session  x   _________   sessions (enclosed)=  (minus) (‐)
              Tax Deductible Contribution ‐  Your gift, in any amount helps a girl in financial need benefit from a week at camp. (+)
                                          Balance Due by June 1, 2010
          Method:              Check           Cash           Visa         Mastercard         AMEX         Discover     
                           Make checks payable to: Girl Scouts of Northern New Jersey
Card # ________________________________________________               Exp Date _______   V-Code ________
Signature ___________________________                        Print Name______________________________  
   Check here to authorize the automatic payment of your balance in full on or after the week of June 1, 2010.
       I understand that I authorize Girl Scouts of Northern NJ to charge my credit card on or after the week of  June 1, 2010 
       for the balance on this registration.  Initial here to authorize automatic payment ______  Date: _______
                    Bus Stop Selection ‐ MUST  be completed in order for registration to be processed.
                   Please use Stop #9A for campers transported to/from camp by a parent/guardian.
                 AM Bus # _______        Stop # _______ Location ______________
                 PM Bus # _______        Stop # _______ Location ______________ □ PM Care
                                                                                                                          Camper/ Staff Name: ____________________________________________________
                Girl Scouts of Northern New Jersey, 95 Newark Pompton Turnpike, Riverdale, NJ 07457-1426
                            Phone (973) 248-8200     Fax: (973) 248-8050  http://www.gsnnj.org

            DAY CAMP HEALTH HISTORY                         JOCKEY HOLLOW                   LAKE RICKABEAR
           This health history is to be completed and signed by the parent/guardian of girls or by adult staff.
  Please DO NOT fax. Originals only. Please submit this Health Form with the completed camp registration form..

Girl’s/Staff name                                                                      Date of Birth                Age

               # & Street:
Address:                                                                               Grade in Sept.
               City:                               State:          Zip:


Mother/Guardian:                                                                       Home phone: (            )

Address (if different than child):                                                     Work phone: (            )

Business name & address:                                                               Cell phone: (        )

Father/Guardian:                                                                       Home phone: (            )

Address (if different than child):                                                     Work phone: (            )

Business name & address:                                                               Cell phone: (        )

Emergency Contact (name, other than Parent/Guardian):                                  Relationship to child:

Primary phone: (        )                                     Cell phone: (   )

Name of Family physician:                                                              Phone: (         )

Primary insurance carrier:                                                             Policy or group #:

                                     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 health care 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




                                                                                                                          Session(s): __________________________________
  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.
     All medications will be collected by the camp nurse on the first day. (Exceptions are Epi Pens & Inhalers)

  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___________

  Signature of parent/guardian:                                                          Date:
Part I: GENERAL HEALTH (check those that apply and give appropriate dates)
    Ear Infection                    Bleeding/Clotting Disorders                  Sickle Cell Trait/Disease
    Hypertension                      Asthma                                      Seizures
    Heart Defect/Disease              Musculoskeletal Disorder                    Diabetes
    Other chronic or recurring illnesses and injuries (specify)

                                                  CONTINUED ON BACK
 Date of last health examination:
 Were any complicating medical problems noted in last health examination?       No       Yes
 Is the participant currently under the care of a physician or psychologist?   No        Yes (Please specify)


 Since last health exam has participant had: (√ all that apply)
    Serious injury requiring medical attention?                 An illness lasting more than five days?
    Any prescribed medication?                                  A surgical operation or fracture?
    Treatment in a hospital or emergency room?                  Any restrictions concerning physical activities?
 Please explain any "yes" answers to the above questions (use additional paper as necessary). Include dates:

                                                                                                            _______

Part II: DISEASE AND IMMUNIZATION                                     Immunization Dates are required.
HISTORY                                                                “Up to date” is NOT acceptable
                                                      Vaccine:                Dates:
     Which of the following has the participant                               Mo/Yr Mo/Yr Mo/Yr        Mo/Yr    Mo/Yr
             had? Please list dates.                 DTP                       ____ ____ ____          ____     ____
      Measles              ______________            TD (tenanus/diphtheria) ____ ____ ____            ____     ____
      Chicken Pox          ______________          n Varicella (chicken pox)   ____ ____ ____          ____     ____
      German Measles ______________                  Polio                     ____ ____ ____          ____     ____
      Mumps                ______________            MMR                       ____ ____ ____          ____     ____
      Hepatitis A          ______________            Haemophilus Influenza B ____ ____ ____            ____     ____
      Hepatitis B          ______________            Hepatitis B               ____ ____ ____          ____     ____
      Hepatitis C          ______________            TB Mantoux Test: Date of test_________ Result:      Pos.     Neg
                                                     H1N1: Date received ________
                                                     Influenza: Date received ________

 Allergies:                         Describe reaction, emergency allergy action plan, and doctor’s documentation
 Specific Food:
 _________________________          ________________________________________________________________________________
 _________________________          ________________________________________________________________________________
 Specific Medication:
 _________________________          ________________________________________________________________________________
 _________________________          ________________________________________________________________________________
 Other Allergies:
 _________________________          ________________________________________________________________________________

 Health Needs:
    Wears contact lenses/ corrective glasses
    Wears orthodontic appliance &/or orthopedic device
  Wears an insulin pump
    Wears medical ID for
    Has started menstruating - if not, does she know what to expect?      Yes     No
 Seizures - What type?                                           Help by
  Other:
 Health Exemptions:
 Are there any camp activities the child should be exempted from for health reasons? (Please explain)
 ________________________________________________________________________________________________
 ________________________________________________________________________________________________
 Please feel free to attach additional significant information that will assist us in providing an enriching day camp
 experience for your camper.
 Part III: HIPPA 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/I should not participate in prescribed camp activities except as noted.

 Signature of parent/guardian:                                                                 Date:

 Signature of Staff Member (18+):                                                    _______Date:

				
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