Summer 2010 Printable Registration Packet - REGISTRATION PACKET

Document Sample
Summer 2010 Printable Registration Packet - REGISTRATION PACKET Powered By Docstoc
					                 REGISTRATION PACKET CHECKLIST
    *All documents listed below must be returned for your child to begin*
_____ Weeks of Camp Form (all weeks checked off that child will be attending)
      Additonal Copy for parent given.

         NOTE* There will be a $ 10.00 fee for withdrawal or change in weeks after enrollment is complete,
         for each week affected.

_____ Field Trip form (DEPOSIT paid.)
      Additional copy for parent given.


_____ Completed Agreement Form

_____ Completed Emergency Contact Form (including insurance information)

_____ Completed Child Health Assessment Form (due 15 business days after enrollment)
      If your child already has an updated Health Assessment, please write “on file” so we know it is up to
      date.

_____ There is a $ 15 weekly deposit due at registration for each week enrolled to hold a place for your
        Child. This deposit is non-refundable and non-transferable.
      .

_____ Aquatics Program Permission Slip form.

______ Sunscreen and Photograph permission slip.



                             PARENTS KEEP THE FOLLOWING:
    1.   Copy of “Weeks of Camp” checklist.
    2.   Copy of “Field Trip form” – List of ‘Fun-Filled Trips!
    3.   Camp Orientation Letter
    4.   PARENT HANDBOOK
    5.   Updated information Sheet
    6.   Personal Belongings reminder.
    7.   Fee Sheet
Dear Families,

       We are excited about your interest in our summer day camp program. Our day camp is a
place where your child will have the opportunity to make new friends, participate in various games
and team-building activities, learn about character development, and swim each day. Ultimately,
they enjoy a fun-filled summer full of new experiences.
       Camp this year will be held at the Rose E. Schneider Family YMCA located at 2001Ehrman
Road in Cranberry Township. Children should be dropped off and picked up at the YMCA. Our
drop-off and pick-up area is behind the YMCA, through the doors located next to our picnic table
area.
       While we do plan to have a fun summer, you can feel confident that we will provide a safe
environment for your child as well.
       We are open daily from 7:00am-6:00pm to accommodate our families’ busy work schedules.
Below are our weekly fees for Summer Y Camp.
           • Full time:                            $117. 00 per child plus field trips
           • Sibling Discount (full time only): $102.00 per child plus field trips
           • Part time:                            $ 97.00 per child plus field trips

                                        Registration for Day Camp

                                    * April 6th -9th, 2010
                                    6:30 a.m. – 6:00 p.m. at the Member Service Desk.

                                    *April 13th – 17th , 2010
                                    BY APPOINTMENT ONLY.

                       Please Contact Tim Palisin @ (724) 452-9122.

We look forward to assisting you in your summer child care needs, and creating a fun- filled summer for your child to enjoy!

Sincerely,

Timothy Palisin
Childcare Coordinator
Rose E. Schneider Family YMCA
2001 Ehrman Road
Cranberry Township, PA 16066
Phone: (724) 452-9122
Fax: (724) 452-8561
tpalisin@rsymca.org
                 Information & Policies


                      DAY CAMP WEEKLY FEES:
            Full Time:                                    $117 per child

            Sibling Discount (full time only):            $102per child

            Part Time:                                    $97 per child




             DEPOSIT                            SUBSIDEIZED CARE
A $15 deposit is required for each         Provided for the YMCA Day Camp
week of camp you wish to reserve for       Program through CCIS.
your child. This deposit is applied to
                                           For more information on how to re-
the weekly fee and is due at the time
                                           ceive assistance, call 724-285-9431.
of registration.



    HEATH ASSESSMENTS                                  T-SHIRTS
Each child registered for camp will        Every child participating in camp will
need to provide a current physical by      receive a complimentary T-shirt cour-
their doctor by their first day of camp.   tesy of the YMCA. (One t-shirt per
                                           child, per summer.)
     Fun-Filled Field Trips
 While we have a blast at camp each day, we are looking to explore many op-
 portunities that are offered here in Western Pennsylvania. We will be taking
 weekly field trips to offer many different experiences to those who attend
 summer camp this year. Below is a list of our planned field trips:
 •   Succop Conservancy
 •   Skate Castle
 •   Family Bowl- Away and Laser Tag
 •   Pittsburgh Zoo & PPG Aquarium
 •   Gemini Theater Production Show @ Armco Park!
 •   Fun Fore All
 •   Clearview Movie Theater
 •   Carnegie Science Center/Sports works
 •   Zelienople Park and Pool

Field trips are an additional cost for each child. They will be set up in a weekly
draft the same as your childcare payment. If a child does not attend a field trip,
it is the responsibility of the family to find alternative care for that day.
                                       Rose E. Schneider Family YMCA
                                     Summer Day Camp 2010 Field Trips
                                          Prices include transportation
                                     Payments Will Draft Week of Field Trip
                                                  (No pre-pay)

I give my child, _____________________ permission to attend the field trips as checked below. I
am aware that my child must be enrolled in the corresponding week of day camp to attend the field trip.
I am also aware that there will be no childcare available on the day of field trips if my child chooses to
not attend the field trip. Depart/Return times are subject to change.

Parent Signature_______________________                    Print Name:_____________________________

Wednesday, June 16th   Will attend Will NOT attend       Wednesday, July 28th      Will attend Will NOT attend
LaserTag/Family BowlAway                                   Gemini Theater Production
Depart: 11:00 a.m.                                          @ Armco/Swimming
Return: 4:00 p.m.                                          Depart: 9:30 a.m.
Cost: $ 8.00                                               Return: 3:00 p.m.
…………………………………………………………………………………………………………                   Cost $6.00………………………………………………………………………………………………
Wednesday, June 23rd       Will attend Will NOT attend   Wednesday,,August 4th    Will attend Will NOT attend
Carnegie Science Center                                    Zelienople Pool
 And Sportsworks                                           Depart: 11:00 a.m
Depart: 11:00 a.m.                                         Return: 4:00 p.m.
Return: 3:45 p.m.                                          Cost: $ 5.00
Cost: $11.00
……………………………………………………………………………………………………………………………………         …………………………………………………………………………………………………………….………………………….
Wednesday, June 30th       Will attend Will NOT attend   Wednesday, August 11th Will attend   Will NOT attend
Zelienople Pool                                            Pittsburgh Zoo and Aquarium
Depart: 11:00 a.m.                                         Depart: 11:00 a.m.
Return: 4:00 p.m.                                          Return 4:00 p.m.
Cost $ 5.00                                                Cost: $ 9.00
…………………………………………………………………………………………………………………………………….        ………………………………………………………………………………………………………………………………………..
Wednesday, July 7    th
                           Will attend Will NOT attend   Wednesday, August 18th   Will attend Will NOT attend
Succopp Conservancy                                        Skate Castle
Depart: 9:00 a.m.                                          Depart: 11:00 a.m.
Return: 4:00 p.m.                                          Return: 4:00 p.m.
Cost $ 5.00                                                Cost: $ 9.00


…………………………………………………………………………………………………………………………………….        …………………………………………………………………………………………………………………………………………
Wednesday, July 14    th
                           Will attend Will NOT attend   Wednesday, August 25th   Will attend Will NOT attend
Zelienople Pool                                            Fun Fore All
Depart: 11:00 a.m.                                         Depart: 11:30 a.m.
Return: 4:00 p.m.                                          Return: 4:00 p.m.
Cost: $ 5.00                                               Cost: $ 20.00
…………………………………………………………………………………………………………………………………….
Wednesday, July 21st       Will attend Will NOT attend       Overnight Camping Trip @ Armco Park.
Clearview Movie Theater                                         Limited to 15-25 Grades 4-6 ONLY.
Depart: 11:00 a.m.                                            *Depart Thursday, August 15th: 11:00 a.m.
Return: 4:00 p.m.                                             *Return Friday,   August 16th: 1:00 p.m.
Cost: $ 8.00                                                  Cost: $25.00      Will attend     Will NOT attend
                               ROSE E. SCHNEIDER YMCA SUMMER CAMP

 Parent’s Name: ________________________ Child’s Name:__________________________
 Phone Number:_________________________ Grade Entering:________________________
 E-mail Address:________________________ T-Shirt Size:__________________________

PLEASE COMPLETE ONE FORM FOR EACH CHILD. Check appropriate box for ALL weeks listed below. Part-time is
considered three (3) days or less. If you have two children attending, choose “full-time” for one child and “sibling” for the
second child (only the second child receives the discounted rate). If your child will not be attending a particular week,
please choose “not attending.”

June 14-18         Full-Time Sibling Part-Time Not attending   July 26-30     Full-Time Sibling Part-Time Not attending
June 21-25         Full-Time Sibling Part-Time Not attending   August 02-06   Full-Time Sibling Part-Time Not attending
June 28-July 2     Full-Time Sibling Part-Time Not attending   August 09-13   Full-Time Sibling Part-Time Not attending
July 05-09         Full-Time Sibling Part-Time Not attending   August 16-20   Full-Time Sibling Part-Time Not attending
July 12-16         Full-Time Sibling Part-Time Not attending   August 23-27   Full-Time Sibling Part-Time Not attending
July 19-23         Full-Time Sibling Part-Time Not attending   TOTAL DEPOSIT PAID $_____________

                                                   Important Reminders
   •   $15.00 deposit fee for each week enrolled due at registration (each deposit will be deducted from corresponding
       weekly fee). Deposits are non-refundable and non-transferable.
   •   $10.00 fee for withdrawal and/or change in scheduled weeks after enrollment is complete, for each week affected.
   •   $20.00 NSF/Late Fee for all returned bank/credit draft payments.
   •   Please keep your billing information current to avoid additional late fees. An expiration date change on debit/credit
       cards will cause payment to be declined.
   •   Automatic draft payments occur on Wednesday of each week at 12:00 a.m.

                                       Checking/Savings Account information
Account Type     □ Checking      □ Savings

Name on Account _____________________________________________________________________________
Routing Number (first set of numbers) ______________________ Account Number ________________________
Authorized Signature ____________________________________ Date __________________________________

                                       Debit/Credit Card Account information
Credit Card Type     □ Visa     □ MasterCard     □ American Express

Cardholder Name ______________________________________________________________________
Account Number _________________________________________ Expiration Date _______________
Authorized Signature ________________________
  Melissa Brandt

                             Per Week        The Monday of the Week of Care


Day Camp/Child Care

AM & PM Snack
Activities
Swimming




 $3.00                       Per 5 Minutes


Field Trips (including transportation)

Various Parties/Activities
                                                                                                                                                              CHILD HEALTH REPORT
                                                                                                                                                             (55 PA CODE §§3270.131, 3280.131 AND 3290.131)

                                                                                                 CHILD’S NAME: (LAST)                                       (FIRST)                        PARENT/GUARDIAN:
  Parent/Provider fill in this part.




                                                                                                 DATE OF BIRTH:                                             HOME PHONE:                    ADDRESS:


                                                                                                 CHILD CARE FACILITY NAME:


                                                                                                 FACILITY PHONE:                                            COUNTY:                        WORK PHONE:


                                                                                                 † I authorize the child care staff and my child’s health professional to communicate directly if needed to clarify information on this form about my child.

                                                                                                 PARENT’S SIGNATURE:


                                                                                                                                                                      DO NOT OMIT ANY INFORMATION
                                                                                                                  This form may be updated by a health professional. Initial and date any new data. The child care facility needs a copy of the form.

                                                                                                 HEALTH HISTORY AND MEDICAL INFORMATION PERTINENT TO ROUTINE CHILD CARE AND DIAGNOSIS/TREATMENT IN EMERGENCY (DESCRIBE, IF ANY):
                                                                                                 † NONE


                                                                                                 DESCRIBE ALL MEDICATION AND ANY SPECIAL DIET THE CHILD RECEIVES AND THE REASON FOR MEDICATION AND SPECIAL DIET. ALL MEDICATIONS A
                                                                                                 CHILD RECEIVES SHOULD BE DOCUMENTED IN THE EVENT THE CHILD REQUIRES EMERGENCY MEDICAL CARE. ATTACH ADDITIONAL SHEETS IF NECESSARY.
                                                                                                 † NONE



                                                                                                 CHILD’S ALLERGIES (DESCRIBE, IF ANY):
                                                                                                 † NONE


                                                                                                 LIST ANY HEALTH PROBLEMS OR SPECIAL NEEDS AND RECOMMENDED TREATMENT/SERVICES. ATTACH ADDITIONAL SHEETS IF NECESSARY TO
                                                                                                 DESCRIBE THE PLAN FOR CARE THAT SHOULD BE FOLLOWED FOR THE CHILD, INCLUDING INDICATION OF SPECIAL TRAINING REQUIRED FOR STAFF,
                                                                                                 EQUIPMENT AND PROVISION FOR EMERGENCIES.
                                                                                                 † NONE


                                                                                                 IN YOUR ASSESSMENT, IS THE CHILD ABLE TO PARTICIPATE IN CHILD CARE AND DOES THE CHILD APPEAR TO BE FREE FROM CONTAGIOUS OR
                                                                                                 COMMUNICABLE DISEASES?
                                                                                                 † YES † NO      IF NO, PLEASE EXPLAIN YOUR ANSWER:

                                                                                                 HAS THE CHILD RECEIVED ALL AGE APPROPRIATE                    NOTE BELOW IF THE RESULTS OF VISION, HEARING OR LEAD SCREENINGS WERE ABNORMAL. IF
                                                                                                 SCREENINGS LISTED IN THE ROUTINE PREVENTIVE                   THE SCREENING WAS ABNORMAL, PROVIDE THE DATE THE SCREENING WAS COMPLETED AND
                                                                                                 HEALTH CARE SERVICES CURRENTLY RECOMMENDED                    INFORMATION ABOUT REFERRALS, IMPLICATIONS OR ACTIONS RECOMMENDED FOR THE CHILD
Parents may write immunization dates; health professional should verify and complete all data.




                                                                                                 BY THE AMERICAN ACADEMY OF PEDIATRICS? (SEE                   CARE FACILITY.
                                                                                                 SCHEDULE AT WWW.AAP.ORG)
                                                                                                                                                               VISION (subjective until age 3)
                                                                                                 †     YES   †   NO
                                                                                                                                                               HEARING (subjective until age 4)

                                                                                                                                                               LEAD

                                                                                                                 RECORD DATES OF IMMUNIZATIONS BELOW OR ATTACH A PHOTOCOPY OF THE CHILD’S IMMUNIZATION RECORD

                                                                                                 IMMUNIZATIONS                                      DATE          DATE         DATE          DATE          DATE                               COMMENTS

                                                                                                 HEP-B

                                                                                                 ROTAVIRUS

                                                                                                 DTAP/DTP/TD

                                                                                                 HIB

                                                                                                 PNEUMOCOCCAL

                                                                                                 POLIO

                                                                                                 INFLUENZA

                                                                                                 MMR

                                                                                                 VARICELLA

                                                                                                 HEP-A

                                                                                                 MENINGOCOCCAL

                                                                                                 OTHER
                                                                                                 MEDICAL CARE PROVIDER:                                                                                 SIGNATURE OF PHYSICIAN, CRNP OR PHYSICIAN’S ASSISTANT


                                                                                                 ADDRESS:
                                                                                                                                                                                                        TITLE:

                                                                                                                                                               PHONE:                                   LICENSE NUMBER:                                DATE FORM SIGNED:



                                                                                                                                                                                                                                                                     CD 51 09/08
I _______________________________
parent/guardian of
___________________________________;
give my permission to release my child from
the YMCA Day Camp Program to the
YMCA Pool – Aquatics Free Swim Time.
YMCA Day Camp Counselors will still be
in ratio and helping with the overall
supervision of the children.



Dated: _______________



Thank you~
Dear Families:

        Our first day of summer camp (Monday, June 14th, 2010) is just around
the corner!
        We will have our Summer Day Camp Orientation on Thursday May 27th
2010 from 6:30pm-7:30pm. The orientation will be held at the Rose E.
Schneider Family YMCA in the Community Meeting Room. At this orientation
families will have the chance to meet counselors and directors that will be
working with their children on a daily basis. This time will also be a chance for us
to explain our daily routines and the things that you should remember to pack
daily for your child. At the orientation, we will address any paperwork that still
needs to be completed. We will review the Summer Day Camp Handbook as well
as discuss the weekly field trips.
        We hope that you will be able to join us on May 27th as we prepare for our
fun summer to begin!



Sincerely,

Tim Palisin- Child Care Coordinator
Rose E. Schneider Family YMCA
(724)452-9122
tpalisin@rsymca.org
         A Reminder about Personal Belongings

     Required daily items are:
       • SNEAKERS
       • SWIMSUIT AND TOWEL
       • SUNSCREEN
       • LUNCH/DRINK
       • WATERBOTTLE
       • Extra set of clothing for emergency purposes
       • Long sleeve shirt and pants for environmental
         excursions
       • Rain gear for rainy days

     Please clearly identify all personal belongings with your
     child’s name.


Children should have his/her own carrying bag clearly
identified with their name for personal belongings.



For the welfare of your child, please be sure he/she is dressed
according to the weather and always dressed for active play!

Note: We ask that the children do not bring toys or games
from home. If your child does bring games or toys from home
to camp, the YMCA will not be held responsible for lost or
stolen items. The YMCA staff will take games and toys from
home if they cause a problem and hold them until the end of
the day.
                                                                                             SUMMER YCAMP
School will be out soon and we’ve got an “APP” for
that! So “close” that facebook; “relax” that twitter; “delete”
that text; and upload the experience, fun and interaction that our
YCamps have to offer. Watch for details of additional camps being
offered and available to our Summer Day Camp participants . Reg-
istration, pricing and day/time information will be forthcoming
for the Sports, Dance, Music and Art camps. It’s going to be an-
other Energizing Summer at the YMCA!




  Tim Palisin:724-452-9122                                        Dance Camp
                                                   ●Our new Dance Camp will get our toes
                                                   tappin’ and hands clappin’ as we discover
  Child Care Coordinator                                 basic elements of movement.
                                                                                Sports Camp
                                                                   Our Sports Camp gives the children a
  tpalisin@rsymca.org                                            fantastic opportunity to participate in and
                                                                   learn more about such sports as Deck
                                                                    Hockey, Soccer, baseball and more!!

                                                      Art Camp
                                                                                        Music Camp
   We Build Strong Kids, Strong Fami-       ●Our new Art Camp is designed
                                              to show the campers the
                                                                            ●Our new Music Camp works on the
                                                                              elements of rhythm, tempo, and

  lies and Strong Communities.                fundamentals of art using
                                               several mediums such as
                                                                           composition through the use of games,
                                                                          instruments, and, of course, many kinds
                                                 drawing or painting.
                                                                                         of songs

				
DOCUMENT INFO