ENDLESS SUMMER FUN AND ADVENTURE
REGISTER ONLINE:
www.stamfordymca.org
STAMFORD FAMILY YMCA 2015 SUMMER CAMPS
MAKING FRIENDS...
Dear Families, For the last 102 years we have been creating memories that are sure to last a lifetime. Summer camp is the perfect place to explore the great outdoors, learn new skills, foster independence, and meet new friends! Whether this is your first summer with us or your seventh, each summer guarantees you fun, laughter, and new adventures. Your child will enjoy a diverse daily schedule filled with fun adventures tailored to each camp group. Our goal is to provide the children with a safe, stimulating and nurturing environment where they feel encouraged to learn, grow and thrive throughout the summer. We are thrilled to announce weekly field trips that highlight the weekly themes. Also, this summer the Y is bringing back our hugely successful Camp Mini and Camp WOW theatre production and is expanding our summer reading program. The following pages detail all of the opportunities for your child to learn, grow, and make memories that will last a lifetime this summer in one of our camps. We look forward to seeing you! Kind regards,
Tif f any Wilso n Tiffany Wilson Camp Director Stamford Family YMCA
EXPLORE NATURE.
LEARN TO SWIM.
MAKING MEMORIES!
The Stamford Family YMCA is the perfect place for your children to spend their summer away from school. They’ll be active and enjoying sports, arts, science, nature, swim lessons, field trips, theatre, and fun camp adventures. At the Stamford Y, children pursue their potential and explore new interests in a safe, nurturing environment. All children are encouraged to participate in our many camp activities through our “challenge by choice” philosophy. Your children will make lasting friendships and have fun discovering who they are and what they can do.
ABOUT OUR CAMPS Day camp like many other programs at the Stamford Family YMCA is about learning skills, developing character and making friends. But few environments are as special as camp, where kids become a community as they learn both how to be more independent and how to contribute to a group as they engage in physical, social, and educational activities. The day camp experience is built on the Y’s values of caring, honesty, respect and responsibility. STAFF The Stamford Family Y carefully selects and screens caring role models who demonstrate a passion for developing confidence and good character in our youth. The Y maintains a commitment to a recruiting process that includes comprehensive training and background checks. All of our staff are CPR/First Aid/AED certified. Approximately 80% of the staff return each year providing familiarity and continuity. Y counselors are dedicated to making sure camp is an amazing experience for every camper.
BE ACTIVE.
FINANCIAL ASSISTANCE The Stamford Family Y offers financial assistance for families who qualify. Financial assistance is given on a first come, first served basis and is determined by need. Applications for assistance are available at the Front Desk or online at www.stamfordymca.org.
HOW TO REGISTER Camp registration begins February 2015. All registration requires a non-refundable $250 deposit and the balance for all sessions is due in full by June 19, 2015. Enroll in person at the Stamford Family YMCA for the session(s) of your choice or log on and register online at www.stamfordymca.org.
BUILD CONFIDENCE.
CAMP MINI: PRE-KINDERGARTEN - KINDERGARTEN
WHAT IS CAMP MINI? For our youngest campers, Camp Mini provides enriched learning experiences in a safe and fun environment with qualified counselors. Children will enjoy activities like arts and crafts, swim lessons, nature, athletics, field trips, outdoor adventures and more, all incorporated into weekly themes. Campers must be three years old and toilet trained before attending.
CAMP MINI: PRE-KINDERGARTEN - KINDERGARTEN CAMP MINI | PROGRAM DETAILS R Grades: For children who have completed one year of Pre-K or are currently in Kindergarten R Summer Camp Dates: June 22 – August 14 R Staff to Camper Ratio: 1:6 R Transportation: Provided to and from field trips by school bus R Drop off and pick up: Monday through Friday at the Stamford Family YMCA R Hours: Monday – Friday from 9:00am – 4:00pm R Extended care hours available: Monday – Friday from 7:30am – 6:00pm R Lunch and afternoon snack provided daily R Breakfast provided to those campers enrolled in early care R Extra snack provided to those campers enrolled in after care R Weekly field trips highlighting each theme week R Swim lessons R Weekly visits to Cove Island Beach R ABC reading corner R Adventure to the Bronx Zoo R Austin Daily Hip Hop Workshop R Campers receive 1 Camp t-shirt
SAMPLE CAMPER DAY
Morning 9:20 - 10:10 10:15 - 11:05 11:10 - 12:00 12:05 - 12:55 Afternoon 1:00 - 1:50 1:55 - 2:45 2:45 - 3:00 3:00 - 3:50 3:50 - 4:00
Arts & crafts Swimming Theatre LUNCH Play Area ABC Corner SNACK Fields & Sports Prep to go home
CAMP MINI | DATES & RATES A non-refundable deposit of $250 per child is due upon registration. No credits or refunds will be given for any reason. THE BALANCE FOR ALL SESSIONS IS DUE IN FULL BY JUNE 19, 2015 Parent orientation & new camper orientation is Thursday, June 4, 2015, from 6 – 7 pm. SESSION Dates Member Non-Member
FULL SEASON June 22 - Aug 14 $1,650 $1,925
SESSION ONE June 22 - July 3 $412.50 $481.25
SESSION TWO July 6 - 17 $412.50 $481.25
SESSION THREE July 20 - 31 $412.50 $481.25
SESSION FOUR August 3 - 14 $412.50 $481.25
CAMP WOW: FIRST GRADE - FIFTH GRADE
WHAT IS CAMP WOW? The Stamford Family Y offers campers our rich heritage of summer fun and new innovative opportunities to enjoy, learn, and create lifelong friendships through weekly field trips, “theme” weeks, beach days, and safe, fun and instructional activities. Throughout the summer, campers will enjoy swim lessons, athletics, nature studies, archery, dance and more.
CAMP WOW: FIRST GRADE- FIFTH GRADE CAMP WOW | PROGRAM DETAILS R Grades: For students currently in grades 1 through 5 R Summer camp dates: June 22 – August 14 R Staff to camper ratio: 1:8 R Transportation: Provided to and from field trips by school bus R Drop off and pick up: Monday through Friday at the Stamford Family Y R Hours: Monday – Friday from 9:00am – 4:00pm R Extended care hours available: Monday – Friday from 7:30am – 6:00pm R Lunch and afternoon snack provided daily R Breakfast provided to those campers enrolled in early care R Extra snack provided to those campers enrolled in after care R Weekly field trips highlighting each theme week R Campers participate in annual theatre production R Swim lessons R Weekly visits to Cove Island Beach R Reading lounge activities R Journey to Dinosaur Place R Lake Quassy Amusement Park R Campers receive 1 Camp t-shirt
SAMPLE CAMPER DAY
Morning 9:20 - 10:10 10:15 - 11:05 11:10 - 12:00 12:05 - 12:55 Afternoon 1:00 - 1:50 1:55 - 2:45 2:45 - 3:00 3:00 - 3:50 3:50 - 4:00
Basketball Theatre Swimming LUNCH Nature/science Reading lounge SNACK Play area Prep to go home
CAMP MINI | DATES & RATES A non-refundable deposit of $250 per child is due upon registration. No credits or refunds will be given for any reason. THE BALANCE FOR ALL SESSIONS IS DUE IN FULL BY JUNE 19, 2015 Parent orientation & new camper orientation is Thursday, June 4, 2015, from 6 – 7 pm. SESSION Dates Member Non-Member
FULL SEASON June 22 - Aug 14 $1,650 $1,925
SESSION ONE June 22 - July 3 $412.50 $481.25
SESSION TWO July 6 - 17 $412.50 $481.25
SESSION THREE July 20 - 31 $412.50 $481.25
SESSION FOUR August 3 - 14 $412.50 $481.25
TEEN ADVENTURE: SIXTH GRADE - EIGHTH GRADE
WHAT IS TEEN ADVENTURE CAMP? Is your teen looking for a summer filled with new experiences? Teen Adventure Camp is ideal for the teen who is up for a challenge and wants to explore. The Stamford Y’s camp for teens will let you discover the great outdoors in the company of exceptional leaders. Activities may include canoeing, rock climbing, swimming, fishing, white water rafting, paint balling, skeet shooting and more.
TEEN ADVENTURE: SIXTH GRADE - EIGHTH GRADE TEEN ADVENTURE CAMP | PROGRAM DETAILS R Grades: For students who are currently in grades 6-8 R Summer camp dates: June 22 – August 14 R Staff to camper ratio: 1:10 R Transportation: Provided to and from field trips R Drop off and pick up: Monday - Friday at the Stamford Family YMCA R Hours: Monday – Friday from 9:00am – 4:00pm R Extended care hours available: Monday – Friday from 7:30am – 6:00pm R Lunch and afternoon snack provided daily R Breakfast provided to those campers enrolled in early care R Extra snack provided to those campers enrolled in after care R Teens attend Moose River Outpost in Maine for one week during session 4 R Weekly field trips highlighting each theme week R Swim lessons R Tennis lessons R Ropes course training R Weekly adventures R Campers receive 1 Camp t-shirt
TEEN ADVENTURE CAMP | DATES & RATES A non-refundable deposit of $250 per child is due upon registration. No credits or refunds will be given for any reason. THE BALANCE FOR ALL SESSIONS IS DUE IN FULL BY JUNE 19, 2015 Parent orientation & new camper orientation is Friday, June 5, 2015, from 6 – 7 pm. SESSION Dates Member Non-Member
FULL SEASON June 22 - Aug 14 $1,732.50 $2,021.50
SESSION ONE June 22 - July 3 $412.50 $481.25
SESSION TWO July 6 - 17 $412.50 $481.25
SESSION THREE July 20 - 31 $412.50 $481.25
SESSION FOUR August 3 - 14 $495.00 $577.50
C.I.T. PROGRAM: AGES FIFTEEN - SIXTEEN
WHAT IS THE COUNSELOR IN TRAINING PROGRAM? The Counselor-in-Training Program at the Stamford Family Y is designed to offer qualified young people an opportunity to prepare for positions as camp counselors or recreation leaders. Emphasis is placed upon developing leadership skills, sensitivity to children, and program skills.
C.I.T. PROGRAM: AGES FIFTEEN - SIXTEEN COUNSELOR IN TRAINING | PROGRAM DETAILS Participation in the CIT program is by selection. Those interested in the program must complete an application process, which includes an application, references, and an interview. This program gives participants the opportunity to place the needs of others ahead of their own, share what they have learned and be a role model for younger campers. CITs will be assigned to a specific age group and work with the senior and junior counselor for the summer, attend field trips and staff meetings and be an active participant in Summer Camp WOW. CIT’s in the Summer Camp WOW program are leaders in training and receive weekly evaluations from the Camp Director.
CHALLENGES OF THE CIT PROGRAM The CIT program is challenging for young people on many levels. First, it takes a large amount of energy to complete all of the daily tasks and responsibilities of a CIT and maintain a positive attitude. Second, it is a transition time. Participants are no longer campers and must be willing to be a role model, placing the campers’ needs in front of their own. CIT program participants often times become future staff members.
POTENTIAL QUESTIONS TO ASK YOURSELF R Do I have a sincere desire to work with children? R Would I like the opportunity to develop and improve my leadership ability? R Do I enjoy learning in a hands-on environment? R Am I ready to be committed; is a summer position right for me? R Am I ready to be a role model for younger children? R Can I handle the responsibility of being a camp counselor? R Am I ready to put the camper’s needs in front of my own? R Am I able to work well with others in a variety of situations? R If the applicant answered yes to the questions above, then the CIT program may be an opportunity to gain valuable experience in a fun-filled environment.
ELIGIBILITY & REQUIREMENTS
1) Applicants must be fifteen or sixteen, previous work experience with children or strong desire to work with kids. 2) CIT applicants prepare an application with references 3) Interview with Camp Director and Program Director 4) Notification of successful candidates
RATES
$100.00 per session (members) $150.00 (non-members) $400.00 for full session (members) $600.00 (non-members)
Today’s Date:
Please print information on form.
CAMP REGISTRATION FORM Child’s Information: Last Name:
First Name:
Nickname:
Gender:
Address:
City:
MI : Female
Birth Date:
Age:
State:
Primary Phone #: School Attending:
Male
Zip:
Stamford YMCA Member: School Phone #:
Yes
No
Grade Completed:
Parent(s)/Guardian(s) Information: Parent/Guardian: Address: Home Phone: Place of Employment:
Birth Date:
City: Work Phone:
Relationship: State: Cell Phone: Business Address:
Zip:
Primary E-Mail: Parent/Guardian: Address: Home Phone: Place of Employment:
Birth Date:
City: Work Phone:
Relationship: State: Cell Phone: Business Address:
Zip:
Primary E-Mail: Person or agency having legal custody: Address if different from above: Emergency Contact Information: (Must list 2; local and other than Parent(s)/Guardian(s) listed above) First Emergency Contact: Home Phone: Cell Phone: Address: Second Emergency Contact: Home Phone: Cell Phone: Address:
Relationship: Work Phone: Alternate Phone:
Company Name: City:
Zip:
Relationship: Company Name:
Work Phone: Alternate Phone:
Person(s) authorized to PICK-UP your child: Person(s) authorized to PICK-UP your child: Person(s) NOT authorized to PICK-UP your child: Person(s) NOT authorized to PICK-UP your child:
State:
City:
State:
Zip: Relationship: Relationship: Relationship: Relationship:
Please note: Appropriate paperwork, such as custody papers, must be attached if the custodial parent requests not to release the child to someone else.
Summer Camp Registration Checklist:
q Physical examination or a Youth Camp Exam Record Form completed by campers physician
q Completed and signed camp registration form
q Administration of Medication Form or Self Administration Form
q Signed payment plan form (if applicable) q $250 non-refundable deposit made upon registration
(must be signed by parent and physician) or you will not be able to leave medicine in YMCA
*All Summer Camp fees must be paid by June 19, 2015 or your child may not start camp. If your child receives Connecticut Care for Kids, half your total camp fees must be paid by 6/19/2015.
Medical Information: Allergies or intolerance to food, medication, or any other substance: If an allergic reaction occurs, please list steps to relieve reaction: Chronic physical problems, pertinent developmental information, any special accommodations needed:
For special accommodations, or to share important information about your camper, please schedule a meeting with the Camp Director Does your child take medications or vitamins on doctor’s orders? Please specify: Registrants must submit a physical examination or a Youth Camp Exam Record Form completed by campers physician by June 19, 2015 Child’s Physician and Office Name:
Physician’s Phone:
Emergency Medical Authorization: I give the Stamford Family YMCA permission for my child to be given cardiopulmonary resuscitation (CPR) and first aid treatment by a certified staff member of the Stamford Family YMCA. I also give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I authorize the Stamford Family YMCA to obtain immediate medical care and give consent to the hospitalization and performance of necessary diagnostic tests upon, the use of surgery on, and/or the administration of drugs to his/her child or ward if an emergency occurs when he/she cannot be located immediately. It is also understood that this agreement may only cover those situations which are true emergencies and only when he/she cannot be reached. I understand that the provider will take every effort to contact me and/or my designated emergency contacts. I/we will be responsible for payment of medical expenses. Medical treatment costs are covered by: Medical Insurance Provider:
Policy #:
I understand and agree to the Emergency Medical Authorization as outlined above. Parent/Guardian Signature:
Date:
Parental Agreements: I GIVE PERMISSION FOR MY CHILD, ___________________________________________, TO ATTEND THE STAMFORD FAMILY YMCA’S SUMMER CAMP AND TO PARTICIPATE IN ALL ACTIVITIES AND FIELD TRIPS AND PROGRAM TRIPS ORGANIZED BY THE STAMFORD FAMILY YMCA CAMP PROGAM. I AUTHORIZE THE STAMFORD FAMILY YMCA TO USE PHOTOGRAPHS AND VIDEOTAPES OF MY CHILD (REN) FOR THE PURPOSE OF TELLING THE PROGRAM STORY AND PROMOTING THE MESSAGE OF THE PROGRAM IN STAMFORD YMCA MARKETING AND PUBLICITY. IF YOU DO NOT WISH TO HAVE YOUR CHILD’S PHOTO INCLUDED, PLEASE INITIAL HERE ___________ AND PROVIDE US WITH A PHOTO SO THAT WE MAY CULL ANY PHOTOS WHICH MAY CONTAIN YOUR CHILD’S IMAGE. I UNDERSTAND THAT THE PROGRAM IS NOT RESPONSIBLE FOR THE PERSONAL PROPERTY OF THE PARTICIPANT(S). Cancellation Policy: If fees have been paid and cancellation is made two weeks before the start of camp session, the balance
will be returned less the deposit. If fees have been paid out but cancellation is made less than two weeks before the start of the camp session no refund will be issued. Swimming Assessment:
Non-Swimmer (unable to swim/no swim instruction)
Beginner (some limited swim instruction)
Intermediate (average swimming ability)
Advanced (skilled swimmer)
All information on this form is true and complete to the best of my knowledge. I understand and agree to the Emergency Medical Authorization and the Parental Agreements, and cancelation policy outlined above. Parent/Guardian Signature:
STOP! GO!
Date:
If you are completing an online registration, please sign the participant waiver form, submit required additional forms & STOP HERE. If you are completing an in-person, mailed, e-mailed, or faxed registration, please CONTINUTE TO THE NEXT PAGE, as well as submit additional required forms.
CAMP SELECTION & FEES Please fill out one form for each camper
Camper Name:
Date:
STAMFORD FAMILY YMCA SUMMER CAMPS REGISTRATION FORM
FULL SEASON
SESSION 1
SESSION 2
Please check all that apply
June 22 - Aug 14
June 22 - July 3
July 6 - July 17
SESSION 3
SESSION 4
July 20 - July 31
Aug 3 - Aug 14
CAMP MINI (Completed Pre-K - Kindergarten) Member
q $1,650.00
q
$412.50
q
$412.50
q
$412.50
q
$412.50
Non-Member
q
$1,925.00
q
$481.25
q
$481.25
q
$481.25
q
$481.25
Member
q
$1,650.00
q
$412.50
q
$412.50
q
$412.50
q
$412.50
Non-Member
q
$1,925.00
q
$481.25
q
$481.25
q
$481.25
q
$481.25
Member
q
$1,732.50
q
$412.50
q
$412.50
q
$412.50
q
$495.00
Non-Member
q
$2,021.50
q
$481.25
q
$481.25
q
$481.25
q
$577.50
Member
q
$400.00
q
$100.00
q
$100.00
q
$100.00
q
$100.00
Non-Member
q
$600.00
q
$150.00
q
$150.00
q
$150.00
q
$150.00
CAMP WOW (Completed First - Fifth Grade)
TEEN ADVENTURE CAMP (Completed Sixth - Eigth Grade)
C.I.T. PROGRAM (Ages 15 - 16)
EXTENDED CARE HOURS OPTIONS EXTENDED CARE OPTIONS
FULL SEASON
SESSION 1
SESSION 2
June 22 - August 14
June 22 - July 3
July 6 - July 17
SESSION 3
SESSION 4
July 20 - July 31
Aug 3 - Aug 14
Before Care 7:30AM - 9:00AM
q $200.00
q $50.00
q
$50.00
q $50.00
q
$50.00
After Care 4:00PM - 6:00PM
q $200.00
q $50.00
q $50.00
q $50.00
q
$50.00
Before/After Care 7:30AM - 9:00AM/4:00PM - 6:00PM
q $300.00
q $75.00
q $75.00
q $75.00
q
$75.00
TOTAL CAMP FEE: EXTENDED HOURS FEE: ADDITIONAL CAMP SHIRT(S):
CAMP T-SHIRT INFORMATION Size: q Youth XS q Youth S q Youth M
q Youth L
q Adult S
q Adult XL
q Adult M
q Adult L
Camp Shirts are required on every field trip and beach day!
GRAND TOTAL:
Each camper receives 1 camp shirt with registration
TOTAL FEES PAID AT THIS TIME:
Additional camp shirts are $10 each. Would you like to order camp shirts? q Yes q No
REMAINING BALANCE DUE:
How Many? q 1 q 2 q 3 q 4
CAMP PAYMENT OPTIONS YMCA Financial Assistance participants must be authorized BEFORE REGISTERING. For more information call 203-357-7000 x117 or email tiffany@stamfordymca.org BEFORE registering. CAMP FEES: Camp fees must be paid in full prior to June 19, 2015. Participant must be the active member to receive member rates (M) or non-member (NM) rates will apply. CANCELLATIONS: If fees have been paid and cancellation is made two weeks before the start of camp session, the balance will be returned less the deposit. If fees have been paid out but cancellation is made less than two weeks before the start of the camp session no refund will be issued. ADDS: Additional camp sessions can be added after initial registration by submitting a new camper registration form. However, we cannot guarantee availability.
PAYMENT OPTIONS: A $250.00 non-refundable deposit fee per camper is due upon registration. Camp fees may be paid in full upon registration or remaining balance will be automatically drafted per fee schedule below. For drafted balances YOU MUST: 1.) Pay the $250.00 non-refundable deposit fee; 2.) List the dates and amounts you want your remaining camp balance drafted; 3.) Provide an approved debit or credit card for scheduled balance payments; 4.) Recieve signed approval from ONLY the Camp Director or Senior Program Director. Connecticut Care for Kids: If you receive Connecticut Care for Kids you MUST pay half of your total camp balance prior to June 19, 2015. $ _______________________ Total Camp Fees $__________________________ Total Fees Paid At This Time $______________________ Balance Due Payment Method I have enclosed a check for $_______________________ Check# ________________________________________________________ OR Credit/Debit (check one)
VISA
MC
AMEX
DISC
Name on Card: _____________________________________________________________________________________________________Card# ___________________________________________________________________________________ Exp. __________________ VCODE____________ Signature ________________________________________________________________________________________________________ Date ________________________________________ Fee Schedule: By providing my signature below, I authorize the Stamford Family YMCA to charge my credit card on the following dates: Payment 1: $_____________________________ on _________________________________
Payment 5: $_____________________________ on _________________________________
Payment 2: $_____________________________ on _________________________________
Payment 6: $_____________________________ on _________________________________
Payment 3: $_____________________________ on _________________________________
Payment 7: $_____________________________ on _________________________________
Payment 4: $_____________________________ on _________________________________
Payment 8: $_____________________________ on _________________________________
Total balance remaining balance of $_____________________________ paid in full on _____________________________________________ I/We understand and agree to the above payment terms. I/We understand that completion of all required summer camp forms is a required condition of participation in summer camp programs. 1ST PARENT/LEGAL GUARDIAN Print Name: ___________________________________________________ Signature: ____________________________________________________ Date: ________________________
CAMP DIRETOR APPROVAL Print Name: ___________________________________________________ Signature: ____________________________________________________ Date: ________________________
FOR OFFICE USE ONLY:
Accepted By: Group Placement: Comments:
Date:
Processed By:
Date:
SM
STAMFORD FAMILY YMCA 10 Bell Street Stamford, CT 06901 www.stamfordymca.org | 203-357-7000
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