Ultimate Potential
FITNESS
Training for Fitness, Function & Sport
LLC
April 1, 2005
Dear Parent/Guardian, Ultimate Potential Fitness and St. Louis County Parks and Recreation are excited to bring you Dance and Cheer Camp 2005. Dance and Cheer Camp is sure to fill your child's summer days with fun as they learn new dance routines, cheers, and technique all week. This camp is perfect for kids who like to groove! Every day your camper will learn a new dance or cheer. An all-camp performance will be held at 2:30 daily for parents, friends, and other campers to show-off our new skills. Instructors from local high school dance teams and cheerleading squads will teach your child fun and age-appropriate routines. All campers will receive a water bottle and Tshirt. Parents are required to fill-out and return the following forms by the first day of camp: Participant Information, Medical Release Form, Authorized Pick-Up Release, and Fair Play Policy. Please note that your child will not be able to attend camp if these forms are not on file by the first day of camp. The Consent to Administer Medication form should only be filled out if your child will be taking medication. The following packet contains information regarding camp policies and procedures. If you require additional clarification on any aspect of the camp, please feel free to call me, Sarah Fuehne, at 314-517-1284. For bonus pack information, please contact Tonya O'Connell at 636-391-0922. It is the utmost goal of Ultimate Potential Fitness and St. Louis County Parks to promote a safe and positive atmosphere for your child to develop new skills during Dance and Cheer camp. We look forward to seeing you this summer! Sincerely,
Sarah T. Fuehne Dance and Cheer Camp Director Owner of Ultimate Potential Fitness, LLC
PO Box 28552 St. Louis, MO 63146-1052 Tel 314-432-5382 Fax 314-432-5382 Web www.ultimatepotentialfitness.com Email sarah@ultimatepotentialfitness.com
Ultimate Potential
FITNESS
Training for Fitness, Function & Sport
LLC
Dance and Cheer Camp Information Rules and Procedures
Campers must follow St. Louis County Parks and Recreation Fair Play and Behavior Policy. Please share this with your child. FORMS: All campers will have a completed Participant Information/Medical Release Form (pink) and Walk/Ride/Pick Up for (yellow) on file the first day of the program. Campers are not allowed to have any kind of medication during camp hours. If your child needs medication, you must follow the medication policies and procedures. Appropriate dress is required for all camp activities. 1) Wear old clothes that do not restrict movement. This is an OUTDOOR camp program, and campers will participate in dancing, cheering, jumping and playing. Your child may need a hat. PLEASE DRESS FOR THE WEATHER. 2) Tennis shoes must be worn at all times. NO SANDALS! Camp activities are conducted in various parts of the park, wooded areas, parking lots and playground. While we make every effort to remove hazardous items from the areas, we cannot pick up everything. If proper footwear is not worn, we will call a parent and the child will not be allowed to participate in certain activities. If this continues, the parent will need to bring proper footwear back to camp or the child will be sent home. 3) We do not provide sun screen/lotion. We recommend you put sunscreen on your child before coming to camp and send along extra sunscreen for your child to apply on a regular basis. LUNCH: Please send a non-perishable lunch with a drink to camp every day. Refrigeration is not available. Please mark the lunch box/bag with the child's name. Lunch is not provided. WATER: The weather during camp is usually hot. Drinking fountains are available, but are not always cold. We suggest you send extra bottles of water to camp with your child. Please clearly label bottles. HINT: freezing a bottle of water with a squirt top allows cold water to drink as ice melts throughout the day. SHOW: At 2:30 p.m. every camp day, there will be an all camp "show" to perform the routines that your children learned that day. Parents, friends, and siblings are welcome to attend to cheer on your dancer. It is recommended you bring a chair or blanket for seating as we will be outside. GUESTS: The program is limited to registered participants only. No visitors are guests are permitted. LOST AND FOUND: Ultimate Potential Fitness and St. Louis County are not responsible for any personal lost or stolen items. Please label all items (lunch, swim gear, water bottle, etc). Do not allow your child to bring expensive items (computer/video games, cameras, cellular phones, etc) to camp. If your child rides a bike, please provide a bicycle lock. Items found will be displayed at check-out table to be claimed at the end of each day.
PO Box 28552 St. Louis, MO 63146-1052 Tel 314-432-5382 Fax 314-432-5382 Web www.ultimatepotentialfitness.com Email sarah@ultimatepotentialfitness.com
Ultimate Potential
FITNESS
Training for Fitness, Function & Sport
LLC
Dance and Cheer Camp Information Rules and Procedures
DROP-OFF/PICK-UP: Parents should be punctual in dropping off and picking up campers. Staff supervision begins at 9:00 a.m. and ends at 3:00 p.m. unless camper is enrolled in Bonus pack. Do not drop off your child earlier than 9 a.m. unless he/she is enrolled in AM bonus pack. Please notify the Dance and Cheer Camp Director in writing if your child will be dropped off later or picked up earlier than these times. Queeny Park drop-off/pick-up is at Picnic Site 1. Love Park drop-off/pick-up is at Mary's shelter. Bonus Pack drop-off/pick-up is behind the Greensfelder recreation complex at Queeny Park and Mary's Shelter at Love Park. 1) PLEASE NOTE: Parents must walk their child to the designated day camp and day camp bonus pack drop-off location and sign their child in each morning and go to the same location each afternoon to sign out their child. Sorry for any inconvenience, but this is for the camper's safety. 2) All campers must have an up-to-date Authorized Walk/Ride/Pick-Up Release Form on file the first day of camp. Children with out a Release Form will not be allowed to walk or ride bicycles to/from camp at any time. Children will not be released to anyone who is not on the authorized Walk/Ride/Pick up Release Form. Please keep this up to date. If changes need to be made to this form, you must do so in person. 3) While we realize traffic is a problem, it is essential children are picked up on time from camp. A $5 late fee will be assessed for any child not picked up by 3:15 p.m. An additional $5 fee will apply for each additional 15 minute increment thereof after 3:30 p.m. If enrolling in Bonus Pack, please see the separate sheet for drop-off/pick-up location. Park your car in the parking lot and walk to the area behind the recreation complex to drop off and pick up your child. Do not forget to sign in and out. Remember, anyone else picking up a camper MUST be listed on the Authorized Walk/Ride/Pick-Up Release. PAYMENT: Camp cost is $125. Payment can be made by check made out to Ultimate Potential Fitness. Credit card payment can be made online through our secure PayPal account at ultimatepotentialfitness.com. Please complete all necessary camp forms and return them with payment to the Queeny Park office or Ultimate Potential Fitness no later than registration deadline. DANCE AND CHEER CAMP Queeny Park Session 1 Love Park Session Queeny Park Session 2 Queeny Park Session 3 Queeny Park 550 Weidman Road Ballwin, MO 63011 Attn: Dance and Cheer Camp Fax: 636-527-2259 June 13-June 17 June 27-July 1 July 11-July 15 August 1-August 5 Registration Deadline: June 10 Registration Deadline: June 24 Registration Deadline: July 8 Registration Deadline: July 29
Ultimate Potential Fitness, LLC PO Box 28552 St. Louis, MO 63146 Attn: Dance and Cheer Camp Fax: 314-432-5382
PO Box 28552 St. Louis, MO 63146-1052 Tel 314-432-5382 Fax 314-432-5382 Web www.ultimatepotentialfitness.com Email sarah@ultimatepotentialfitness.com
Camp Drop-off/Pick-up Locations
Queeny Park
550 Weidman Road Ballwin, MO 63011
Love Park
2239 Mason Lane Manchester, MO
X
Ultimate Potential
FITNESS
Training for Fitness, Function & Sport
LLC
Dance and Cheer Camp Bonus Pack Information
1) Bonus Pack must be prepaid with camp registration fees. For AM Bonus pack, supervision begins at 7:30 a.m. and for PM Bonus Pack supervision ends at 6:00 p.m. For AM bonus pack the cost for the week is $15. For PM bonus Pack the cost for the week is $25. 2) Drop-off and pick-up for Bonus Pack will be behind the Greensfelder Recreation complex at Queeny Park and Mary's Shelter at Love Park. 3) The same check-in and check-out procedures used for day camp will be used for the Bonus Pack. Remember to sign your child in and out each day. 4) Only persons on the authorized pick-up release will be allowed to pick-up your child and they must sign the child out. Please keep this form up to date. 5) In case of inclement weather, there will be signs on the doors to the complex at the normal pick-up site indicating the location of the bonus pack activities. This is where you will pick-up your child that day. 6) Remember there is no daily registration for the Bonus Pack. 7) A $5 late fee will be assessed for any child not picked up by 6:15 p.m. An additional $5 fee will apply for each additional 15 minute increment thereof after 6:30 p.m. to be paid at time of pick-up. 8) For AM Bonus Pack, staff supervision begins at 7:30 a.m. Do not drop your child off before that time. For PM bonus pack, you may wish to send along a snack for your child to eat during this time.
PO Box 28552 St. Louis, MO 63146-1052 Tel 314-432-5382 Fax 314-432-5382 Web www.ultimatepotentialfitness.com Email sarah@ultimatepotentialfitness.com
ST. LOUIS COUNTY PARKS AND RECREATION FAIR PLAY AND BEHAVIOR POLICY (Return this signed form by 1st day of camp) Our goal is to provide for personal growth in a safe environment. Please assist us in maintaining a safe and enjoyable environment by following the Fair Play Policy. Individuals using the St. Louis County facilities are expected to: 1. Wear appropriate attire in recreation facilities, this includes a shirt and shoes in the recreation complex. 2. Refrain from using profane language. 3. Refrain from placing themselves and/or others at risk (i.e. hitting, fighting, biting, kicking, spitting, etc.) 4. Respect one another and one another’s belongings. 5. Not participate in any unlawful activities (i.e. illegal drugs, weapons, vandalism, stealing, etc.) 6. When participating in recreation programs, remain with the instructors, following directions to the best of their ability and refrain from disrupting class. Persons endangering the safety of themselves or others will be removed from the park facility or recreation program. Other infarctions of the rules will be handled as deemed necessary by the recreation staff. BEHAVIOR POLICY Children who misbehave or break camp rules will be given a series of check marks leading up to a “strike”. We reserve the right to bypass one or more steps in this process if a situation warrants it. Modifications to these rules may be made in order to accommodate individual needs 1st Offense: Child will be given a five-minute time out. 2nd Offense: Child will be given a ten-minute time out. 3rd Offense: A “strike” will be given. Not cooperating while disciplined will result in additional time added to a time out. 1st Strike: Conference with Camp Director, Recreation Supervisor, child and parents nd 2 Strike: Conference with Camp Director, Recreation Supervisor, Complex Manager, child and parents, suspension from camp for 3 days. 3rd Strike: Dismissed from camp with NO REFUND.
Parent/Legal Guardian Date Camper Date
DANCE AND CHEER CAMP PARTICIPANT INFORMATION FORM
Please check the session for which you are registering.
_____ QUEENY SESSION 1
______ LOVE PARK ______ QUEENY SESSION 2 ______ QUEENY SESSION 3
Participant Name
June 13-June 17 June 27-July 1 July 11-July 15 August 1-August 5
Registration Deadline: June 10 Registration Deadline: June 24 Registration Deadline: July 8 Registration Deadline: July 29
Bonus Pack Enrollment (please check if applicable)
_____ AM Bonus Pack 7:30 AM-9:00 AM add $15
______ PM Bonus Pack 3:00 PM-6:00 PM add $25
Street Address City State Zip Code
Birth Date
Age
Sex
T-Shirt Size (circle)
S M L XL
Mother’s Name Home Phone
Mother’s Employer
Work Phone
Father’s Name
Home Phone
Father’s Employer
Work Phone
EMERGENCY CONTACTS
Emergency Contact #1 To be used in the event we cannot reach someone at the numbers listed above Phone Relationship
Emergency Contact #2
Phone
Relationship
Doctor
Phone
In case of emergency, which hospital do you prefer?
MEDICAL/HEALTH INFORMATION
Please complete the following items to provide pertinent health/medical information on the Allergies (medication, food, insect stings, bites, etc)
Medications taken on a regular basis (please complete the Consent to Administer Medication Form)
Past Pertinent Medical History
Accommodations, assistance, or modifications necessary for desired participant
Treatment Authorization: The above information is correct to the best of my knowledge. St. Louis County Parks and Recreation is hereby authorized to provide basic first aid and/or seek advanced emergency medical attention for the participant from designated Emergency Medical Service providers for illness and/or injury occurring during Ultimate Potential Fitness and St. Louis County Parks and Recreation programs.
Parent/Legal Guardian Signature Date
Dance and Cheer Camp Release Forms
AUTHORIZED WALK, RIDE, PICK-UP RELEASE Please fill-out the following and return with camp packet
My child has permission to (please check appropriate selection): ________________Walk to Camp ________________Ride Bike to Camp
Please list four people you authorize to pick up your child from Dance and Cheer Camp. Please remember to include all carpool drivers, neighbors, co-workers and relatives. Also please include names of parents, non-custodial parents/or spouses. Camper’s Full Name:________________________________________________
1.
Phone
2
Phone
3.
Phone
4.
Phone
PHOTOGRAPHIC RELEASE Please fill-out the following and return with camp packet
I hereby do_____ do not_____ consent and authorize Ultimate Potential Fitness and St. Louis County Parks and Recreation to reproduce photographs or video taken of my child participating in camp activities for advertising and publicity purposes of every description.
Parent/Guardian Signature
Date
Ultimate Potential
FITNESS
Training for Fitness, Function & Sport
LLC
St. Louis Parks and Recreation Department Medication Policy and Procedures
Campers are not allowed to have medications of any kind in their possession during the day camp hours. We urge parents to check with their child's physician to see if alternate medications can be dispensed at home. Our preference is that our staff shall not be responsible for assuring that campers take their medication(s). However, if a camper does require medication during camp hours then all medications will be given in accordance with the following policies: 1) The Parks and Recreation department must have a release form signed by the parent on file for each medication the camper is to receive before camp begins. The release form is attached. 2) Parents must provide a letter from the prescribing physician stating the diagnosis and confirming the need for medication during camp hours. Included in this letter must be the physician's prescription for all medication the camper will be taking at camp. Any changes in medication, dosage, or time administered must be documented in writing by the prescribing physician. 3) These required documents (including the release form) must be brought or mailed to Queeny Park or Ultimate Potential Fitness before the first day of each camp session. 4) All medication must be in the original prescription bottle from the pharmacy when given to the Camp Director on Monday morning(s). We recommend bringing a week's worth of medication on Monday. 5) Parents are responsible for making sure their child has enough medication at camp. 6) The camper, accompanied by a counselor/volunteer, is responsible for coming to the Camp Director to receive medication at the scheduled time. 7) Staff will be responsible for documenting all actions pertaining to medication at camp. 8) If there is any unused medication at the end of the camp week, the prescription bottle and a copy of the medication log will be given to the adult responsible for the camper. Said adult must sign the original medication log which will be retained for our files. Should you have any questions or concerns, please call us at 636-391-0922 (Tonya at Queeny Park) or 314-517-1284 (Sarah at Ultimate Potential Fitness).
PO Box 28552 St. Louis, MO 63146-1052 Tel 314-432-5382 Fax 314-432-5382 Web www.ultimatepotentialfitness.com Email sarah@ultimatepotentialfitness.com
Ultimate Potential
FITNESS
Training for Fitness, Function & Sport
LLC
St. Louis Parks and Recreation Department Consent to Adminster Medication
My name is _______________________________________ and I am the parent/legal guardian of _______________________________________, who is a participant in the Dance and Cheer Program at Queeny Park/Love Park run by Ultimate Potential Fitness, LLC. This programs runs from ____________________to _______________________. My child has a medical need that requires that he/she take the following medication: _____________________________________________________________________. However, during the time the program is being conducted, I am not available to administer the medication to my child. Therefore I am, by this document, requesting the personnel of Ultimate Potential Fitness administer the medication to my child. I will deliver the medication to the appropriate personnel prior to the time my child needs it. I understand that the persons who will be administering the medication are not trained in administering the medication I am asking them to administer to my child. I promise not to make any claim against Ultimate Potential Fitness, St. Louis County or any of its employees or volunteers for any acts of negligence which may arise out of the administration of the above described medication to my child. _______________________________________________ ______________________
Name of Parent/Guardian Date
Approximate times to administer medication: ______________________________________________________________________ Date through which the consent is valid: ______________________________________ Please return this form and the other required documents to the Parks and Recreation Department or Ultimate Potential Fitness by the registration deadline or bring to check-in on the first day of camp. Thank you. DANCE AND CHEER CAMP Queeny Park Session 1 Love Park Session Queeny Park Session 2 Queeny Park Session 3 June 13-June 17 June 27-July 1 July 11-July 15 August 1-August 5 Registration Deadline: June 10 Registration Deadline: June 24 Registration Deadline: July 8 Registration Deadline: July 29
Queeny Park 550 Weidman Road Ballwin, MO 63011 Attn: Dance and Cheer Camp
Ultimate Potential Fitness, LLC PO Box 28552 St. Louis, MO 63146 Attn: Dance and Cheer Camp
PO Box 28552 St. Louis, MO 63146-1052 Tel 314-432-5382 Fax 314-432-5382 Web www.ultimatepotentialfitness.com Email sarah@ultimatepotentialfitness.com