Greenbelt Recreation Summer Camps 2021

Greenbelt Recreation

SUMMER CAMPS 2

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• Kinder Camp • Camp Pine Tree • YOGO • Creative Kids Camp • Camp Encore • Summer Classes: Ceramics & More

Registration Begins at 10am!

Greenbelt Residents: April 19, Non-Residents: May 3 Registration packets accepted by email!

GREENBELT RECREATION 301-397-2200

www.greenbeltmd.gov/recreation

TABLE OF CONTENTS Summer Camps

Kinder Camp (ages 31/2-5)................................... 5 Camp Pine Tree.5 (ages 6-11)............................ 6 YOGO-Youth on the Go.5 (ages 12-14)............... 7 Creative Kids Camp (ages 6-12)...................... 8-9 Camp Encore (ages 13-17).......................... 10-11

COVID Protocols................................................. 12 Summer Classes Ceramics and More............. 13 Registration Information

Practicing the 3 R’s.......................................... 14 Inclusion......................................................... 14 Send a Kid to Camp Fund................................ 14 Registration Checklist..................................... 15 Camp Registration Procedures........................16 Registration Form...................................... 17-18 Payment Form........................................... 19-20 COVID Waiver................................................. 21 Participant Profile........................................... 22 Medication Form............................................ 23

CAMP MISSION STATEMENT

To provide the ideal atmosphere and a unique opportunity for campers to have fun and learn through a variety of enriching programs that will develop the social skills, fitness, independence, self-worth, and confidence of each camper, all while fostering lasting friendships.

www.greenbeltmd.gov/recreation 3

SUMMER FUN IN GREENBELT We’re excited to welcome back our camp families onsite this summer! We will be

offering our traditional camp programs on weekday mornings, and implementing safety protocols to ensure a safe space for participants and staff. We will offer camps for youth, ages 31/2 – 17 years. Many camp activities will take place outdoors, following CDC guidance on face coverings and social distancing. We will also offer a camp option for families seeking to participate at home. Our Camp Guide includes details for each camp offered this summer.

In addition to our morning camp programs, Greenbelt Recreation will be offering a variety of recreation classes for youth on weekday afternoons. Please see page 13 to preview a few of our visual arts classes. Our Summer 2021 Activity Guide will be available online on Friday, May 7. Please visit the Greenbelt Virtual Recreation Center at www.greenbeltmd.gov/recreation to access the Summer 2021 Activity Guide and learn more about the classes offered this summer. Classes will be offered for dance, arts, and sports enthusiasts. Class registration will begin on May 17 for Greenbelt residents and May 24 for non-residents.

Please look over the Camp Guide, as well as the Summer 2021 Activity Guide, and considering joining us this summer. We can’t wait to welcome you to our camps and classes! Please call 301-397-2200 or 301-397-2208 for more information.

CAMP VISION STATEMENT

To be a leader in the field of camp programming that consistently provides premier spring and summer camp options to a diverse community, emphasizing that learning is synonymous with fun.

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KINDER CAMP Ages 3½-5 Our youngest campers are invited to join us back at camp this summer. While the camp is only half day, your campers will enjoy days filled with fun unique themed activities that include: music, arts, crafts, games, yoga, physical activities, and additional opportunities for learning, and much more. The majority of camp activities will be outdoors, weather permitting.

We can’t wait for another great summer!

LOCATION: Greenbelt Community Center, 15 Crescent Road, Nursery School Rooms

SESSION: 326202-1 326202-2 326202-3 326202-4

TIME: 8:30am11:30am

FEES: R: $148 NR: $170

DATES: June 21- July 2 July 6- July 16* July 19- July 30 August 2- August 13

*This session is prorated 10% to account for the camp closure on July 5th (in observance of July 4th).

All campers MUST be completely potty-trained by the start of camp session.

www.greenbeltmd.gov/recreation 5

CAMP PINE TREE 5 AGES 6-11

All the familiar activities, traditions, and faces of Camp Pine Tree return this summer . . . modified for safety, but maximized for fun! Each camp day will be action-packed with campers experiencing a variety of sports, group games, crafts, and nature explorations throughout each session. The majority of camp activities will be outdoors, weather permitting. While we will only be together for a half day, our goal with Camp Pine Tree .5 is to provide so much activity that our campers will nap the second half of their day.

We can’t wait to reconnect with our campers and create another memorable summer!

LOCATION: TIME: FEE:

Youth Center - 99 Centerway 8:30am – 11:30am R: $148, NR: $170

Session 336503-1 336503-2 336503-3 336503-4 336503-5

Dates June 21 – July 2 July 6 – July 16* July 19 – July 30 August 2 – August 13 August 16 – August 27

*This session is prorated 10% to account for the camp closure on July 5th (in observance of July 4).

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CAMP YOGO 5 AGES 12-15

Camp YOGO is back—prepared to help campers engage and interact through traditional camp games and activities that will keep both the body and mind active.

“Try everything once” is the perfect motto for a group that gives campers the opportunity to expand their comfort zones while building lifelong summer memories. One day campers might complete team building exercises, compete in a traditional YOGO sport, and create a beautiful friendship bracelet, while the next day they help pass on YOGO folklore—beware of the amongalong—learn during a nature hike, and complete “the Great Escape.” Each day is packed with plenty of opportunities to explore, engage, and enjoy. Sounds like summer!

LOCATION: TBD TIME: 8:30am – 11:30am FEE: R: $74, NR: $85 Session Dates 336505-1b June 28 – July 2 336505-2 July 6 – July 9* 336505-2b July 12 – July 16 336505-3 July 19 – July 23 336505-3b July 26 – July 30 336505-4 August 2 – August 6 336505-4b August 9 – August 13 336505-5a August 16 – August 20 *This session is prorated 10% to account for the camp closure on July 5th (in observance of July 4).

www.greenbeltmd.gov/recreation 7

CREATIVE KIDS CAMP AGES 6-11

BLAST OFF for FUN! Join Spark Swenson, space ranger, and his scientist

friend Doctor Darla, as they journey to the moons of Jupiter on an interplanetary goodwill mission!

Campers will enjoy activities in music, art, movement, puppetry, theater and circus. Our camp show will be a musical retro sci-fi adventure movie, Message To Tomorrow, featuring a new destination each camp session.

Choose from two camp options, Camp At Home or Camp At The Community Center. Our at-home and at-the-center content will overlap substantially, with some activities tailored for their respective settings.

CREATIVE KIDS CAMP AT HOME Campers will receive activity videos and project downloads each weekday morning, which they can enjoy on their own schedule. After lunch, campers can join their camp group for an afternoon Zoom session of guided activities and sharing time.

SCHEDULE Activity Videos and Project Downloads: E-mailed at 8:15am Afternoon Zoom Sessions: 30 minute session between 1:00pm and 3:00pm; time depends on age group SESSION 336206-1 336206-2 336206-3 336206-4

DATES

June 21 - July 2

July 6 - July 16* July 19 - July 30 August 2 - August 13

FEES: R: $78 NR: $90 *This session is prorated 10% to account for the camp closure Monday, July 5th in observance of July 4th.

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CREATIVE KIDS CAMP AT THE COMMUNITY CENTER Campers will convene at the community center each weekday morning, head home for lunch, and rejoin their camp group for an afternoon Zoom session of guided activities and sharing time.

Weather permitting, we will begin each camp day outdoors and hold our first activity periods outside. We will move indoors later in the morning, as the temperature rises.

The time for our transition to indoors will vary with the weather.

Note: Although we will prioritize outdoor time, parents should be aware that campers will be inside for at least a portion of the camp morning, and potentially all of it, depending on the weather. If you are not comfortable with your child participating in indoor group activities, please enroll in the Camp At Home option instead.

BONUS: Families enrolled in Camp At The Community Center will also receive the Camp At Home daily downloads. That way, if your campers have to miss a morning of attending in person, they can still participate in camp!

IMPORTANT NOTE: In the event of a communicable disease outbreak or severe weather, Camp-At-The-Center may be suspended or cancelled, and all campers will be moved to Camp-At-Home.

SCHEDULE Morning Session at the Community Center: 8:30am – 11:30am Afternoon Zoom Sessions: 30 minute session between 1:00pm and 3:00 pm; time depends on age group SESSION DATES

*This session is prorated 10% to 336202-1 June 21 - July 2

account for the Monday, July 5th 336202-2 July 6 - July 16* camp closure in observance of July 4.

336202-3 July 19 - July 30 336202-4 August 2 - August 13 FEES: R: $198 NR: $228 Ceramics fans: see page 13 for information about summer youth clay classes!

www.greenbeltmd.gov/recreation 9

CAMP ENCORE AGES 13-17

Join Director Kate Magill Robinson, and the Encore Artistic Team, as we spend Camp Encore 2021 exploring two of Shakespeare’s most beloved comedies! Campers will meet on-line to rehearse and record the camp shows over Zoom, with the option of attending camp in person three afternoons per week.

For filming their scenes, campers who live locally will be provided costumes and props. The completed video productions will be shared with friends and family after the end of the camp session.

The optional in-person meetings will focus on fun theatre-related activities (stage combat is BACK!) and improvisation. Weather permitting, in-person sessions will take place outdoors.

SESSION 1: MUCH ADO ABOUT NOTHING

There are few couples in literature who are more beloved than Beatrice and Benedick from Shakespeare’s Much Ado About Nothing. On their thorny path to the altar, this power couple runs into detours involving an evil villain, hapless lovers, wacky servants, and a blundering town constable. When gossip and slander stain the reputation of young Hero, it takes the whole town banding together to bring the truth to light. It’s a classical comedy, so everything ends well!

SESSION 2: TWELFTH NIGHT

In Shakespeare’s Twelfth Night, Viola of Messina is cast upon the shore of Illyria, believing she is the sole survivor of a shipwreck. For her safety, she disguises herself as a young man and finds a job working for the Duke Orsino, carrying epistles of love to the duchess Olivia. Viola’s disguise boomerangs when she falls in love with Orsino – and Olivia falls in loves with the young man Viola is pretending to be. More mix-ups occur when Viola’s twin brother, Sebastian, turns up.

Mistaken identities abound, but all will be happily resolved in the end!

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SCHEDULE Monday and Wednesday Zoom from home

10:30am-3:30pm

Tuesday and Thursday* 1:30pm-3:30pm In person at the Community Center

Friday

10:00am-12:15pm Zoom from home In person at the Community Center 1:30pm-3:30pm *No morning camp on Tuesday and Thursday.

SESSION DATES 346202-1: June 21 - July 9 346202-2: July 19 - August 6 Session 1 is prorated to account for the Monday, July 5th holiday camp closure.

FEES R: $343 NR: $388 (includes $45 refundable Tech Bag* deposit)

*A Tech Bag containing costumes and props will be loaned to campers for filming their scenes at home. The deposit will be refunded after the Tech Bag is returned with contents intact.

NOTES During Zoom Days, campers will need: • Access to a device (laptop or tablet) and WiFi. • A relatively quiet space where they can both move freely and speak up. (Campers cannot record scenes for the show in a car or a noisy setting.)

Campers will record most scenes for our shows at home over Zoom, but depending on the level of on-site participation, some dances and combat scenes may be recorded in person.

Campers who do not wish to attend the in-person sessions will be provided alternative athome projects.

Zoom sessions may be substituted for in-person sessions if the weather precludes meeting outdoors.

IMPORTANT NOTE: In the event of a communicable disease outbreak or severe weather, all in-person meetings may be suspended or cancelled, and camp will proceed via Zoom.

www.greenbeltmd.gov/recreation 11

CAMP COVID PROTOCOLS

These protocols reflect public health orders in effect on the publication date of this camp guide, April 8, 2021. We will notify you if protocols change prior to the start of camp, so that you can make informed decisions about your child’s participation.

For All Camps: • Daily pre-camp symptom screening and temperature checks will be conducted.

• All campers and staffers must wear masks that cover the nose and mouth. In addition to the mask your camper wears to camp, please send an extra mask with your camper each day.

• Physical distancing of at least six feet will be maintained, indoors and outdoors.

• Camper groups will be limited in size to ten persons, including campers and staffers.

• Camper groups will be podded, so that groups don’t intermix.

• Indoor air quality will be enhanced through a combination of HEPA air cleaners and increased fresh air intake, via HVAC systems or open windows.

• Indoors, each camp group will use only one classroom each day, rather than rotating between rooms. The rooms will be sanitized each day.

• For art projects and other activities involving supplies, campers will be provided individual kits.

• Camp counselors will be assigned to one camp group throughout the session.

• We’ll plan to take a mid-morning, super-distanced snack break outdoors to change masks.

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SUMMER CLASSES...

CERAMICS AND MORE! In addition to our camp offerings, Greenbelt Recreation is excited to offer youth classes for arts, dance and sports enthusiasts! Sample listings are provided below that may hold special appeal for our Clay at the End of the Day alumnae. The full array of youth and adult classes will be detailed in our Summer 2021 Activity Guide. Please visit the Greenbelt Virtual Recreation Center to access the Activity Guide starting on May 7. Registration for summer classes will begin on May 17 for Greenbelt residents and May 24 for non-residents.

CERAMIC HAND-BUILDING

Ages 6-adult YOUTH POTTER’S WHEEL

Splish, splash - let’s dive into creative clay fun! The joys of summer will inspire both sculptural and functional ceramic creations. We may make wonderful ceramic bowls to eat ice cream sundaes in or create sculptural ice cream itself. We may create creatures who live in the oceans, bay and lakes or paint koi, blue herons and sea scenes on our own ceramic platters. This class is appropriate for ALL ages and is suitable for both beginning and returning students. Students will receive clay, ceramic tools, ceramic underglazes and a wareboard on loan. Students will provide a water container, a sponge, a ruler, plastic utensils, and a sock filled with cornstarch. The instructor will provide more information at the start of class.

333208-1 Tuesdays, 1:00pm-2:00pm, live on Zoom 7 weeks: 6/22 - 8/3 333208-2 Tuesdays, 4:00pm-5:00pm, live on Zoom 7 weeks: 6/22 - 8/3 333208-3 Thursdays, 4:00pm-5:00pm, live on Zoom 7 weeks: 6/24 - 8/5 R: $65, NR: $70 Instructor: Judy Goldberg-Strassler

Wedging, centering, throwing, trimming, glazing, and alternative surface decorations! Learn to create on the potter’s wheel and fall in love for life! Students who have mastered basic pots may learn to make handles and lids. Enrollment limited to 4 students per section.

Masks and social distancing required. Clay purchased separately ($23); select the optional fee in Rec Link or list on your form when registering. Section 4 (ages 1012) meets on site daily for two weeks. Section 2 (ages 13-15) meets on site weekly for eight weeks.

343251-4 Ages 10-12 M-F, 3:30pm-5:15pm, CC-305 2 weeks: 8/16 - 8/27 Prerequisite: must have completed at least one prior ceramics class with Greenbelt Recreation in the past two years. COVID-19 waiver required.

R: $135, NR: $140 Clay: $23 343251-2 Ages 13-15 Wednesdays, 3:30pm-5:15pm, CC-305 8 weeks: 6/23 - 8/11 Prerequisite: must have completed at least one prior wheel class in the past two years. COVID-19 waiver required.

R: $110, NR: $115 Clay: $23 Instructor: Gina Denn

www.greenbeltmd.gov/recreation 13

PRACTICING THE 3 Rs

Greenbelt Recreation is committed to ensuring a safe, nurturing, and fun environment for all its campers. Behavior policies are enforced in a fair and consistent manner. To this end, all campers are expected to:

• Take responsibility for their own behavior • Be courteous • Be respectful of others and their property • Cooperate with others • Speak appropriately • Seek alternatives to verbal and physical conflicts • Exhibit self-control

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At Greenbelt camps we practice the 3 Rs: Respectful, Responsible and Ready.

Campers should be respectful of others and the equipment, responsible for their actions and their belongings, and ready to participate and listen to instructors. The 3 Rs is an easy way for campers to remember the Recreation Department’s expectations. Individuals may lose the opportunity to participate in programs and services if these expectations are not met.

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Save Forms

Print Forms

Camp Registration Form is complete Camp Selection and Payment Form is complete Proof of Residency is included (Greenbelt Residents only) COVID-19 Waiver is complete Participant Profile is complete Medication Administration Authorization Form(s) is complete (separate form for each medication) for any/all medication administered at camp. Each form must be signed by your physician.

Register via email and include all the documents listed above in your email attachment.

Camp Pine Tree and YOGO registrations are emailed to: cpracht@greenbeltmd.gov Kinder Camp, Creative Kids Camp, and Camp Encore are emailed to rcampbell@greenbeltmd.gov Call 301-397-2200 or 301-397-2208 for more information on our camp programs.

Thank you for joining us this summer!

www.greenbeltmd.gov/recreation 15

DAY CAMP REGISTRATION PROCEDURES

CAMPER REGISTRATION FORMS ARE AVAILABLE starting on page 15 of this brochure. Registration forms must be complete to process your registration and reserve your spot in camp. A COVID-19 Waiver is required for camp participation. Please sign the Waiver and submit it with the completed registration forms.

COMPLETED REGISTRATION FORMS should be submitted via email. All camp contact information is provided below. Forms will be accepted from Greenbelt residents* for Summer Camps beginning on Monday, April 19 at 10:00am and from non-residents beginning on Monday, May 3 at 10:00am. Registrations received before the start date/time will not be accepted. Please submit proof of Greenbelt residency to receive the resident rate. If registration via email is not possible, please contact the staff member designated below.

Camper registration forms will be accepted on an ongoing basis until all slots are filled. At that point, interested persons’ names will be placed on a waiting list. Those persons will be contacted in the order in which names were taken if/when a slot becomes available.

Camp Pine Tree I & II and Youth on the GO: please direct completed forms to: cpracht@greenbeltmd.gov or call 301-397-2200.

Creative Kids Camp, Camp Encore, and Kinder Camp: please direct completed registration forms to: rcampbell@greenbeltmd.gov or call 301-397-2208. * GREENBELT RESIDENCY: In order to qualify to receive the resident rates as listed in this brochure, you MUST provide CURRENT proof of Greenbelt residency in the form of a driver’s license, MVA change of address form with a driver’s license, or a lease. If you are unable to provide one of these documents at the time of registration, you will be charged the non-resident rate.

FINANCIAL ASSISTANCE PROGRAM: Financial assistance is available to qualified Greenbelt residents. An application and supporting documentation is required. For more information, contact Becky Sutfin: prior to registration: rsutfin@greenbeltmd.gov.

A DEPOSIT of $50 per child/per camp session is required at the time of registration for ALL CAMP sessions. *DEPOSITS ARE NON-REFUNDABLE AND NON-TRANSFERABLE* CAMP PAYMENTS are DUE ten days prior to the session start date.

MEDICATIONS: If your child requires ANY medication including over the counter medications during the camp day, a Medication Form (see page 23 of this brochure) must be completed and signed by your Physician. Please call the 301-397-2200 or 301-397-2208 to obtain the medication form or visit our website at www.greenbelt. gov/recreation.

CAUTION: REGISTRATION FORMS MUST BE COMPLETED IN FULL in order to be processed.

Your registration email must include: • completed registration forms • COVID-19 Waiver • Proof of residency (Greenbelt residents only).

SUMMER CAMP REGISTRATION START DATES/TIMES: GREENBELT RESIDENTS: Monday, April 19 at 10:00am NON-RESIDENTS: Monday, May 3 at 10:00am 16 GREENBELT RECREATION CAMP PROGRAMS 2021

2021 Greenbelt Day Camp Registration Form This form must be completed in full for each participant to be registered.

1. PARTICIPANT INFORMATION Participant Name: Age:

Preferred Name: DOB:

Gender

Street Address:

T-shirt size City/State/Zip:

Parent/Guardian Name:

Phone Numbers:

Parent/Guardian Name:

Phone Numbers:

Parent/Guardian Emails: Emergency Contact Name:

Phone Numbers:

Emergency Contact Name:

Phone Numbers:

School attended this year:

2. HEALTH INFORMATION Primary Care/Clinic Name:

Phone Number:

Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware?

Yes

No

Yes

No

If YES, please explain: Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child’s camp experience is positive?

If YES, please explain: Participant requires medication during camp?

Yes No *If yes, signed medication authorization form required prior to the first day of camp!

Immunization Information: (Please Note) 

Is this participant exempt from immunization for religious or medical reasons?

Yes No If yes, the Maryland Department of Health Immunization Certificate must be completed and attached to this form. Program Staff can provide you with this form.



A participant who does NOT reside within the United States, a United States territory or the District of Columbia must provide proof of immunization (MDH896).

Participant requires emergency medication at camp?

Yes No * If yes, signed medication authorization form required prior to the first day of camp!

If yes, Please explain. (i.e. inhaler, epi-pen, etc.):

Please attach any additional information if needed.

Participant requires or would benefit from inclusion support at camp?

Yes

No *If yes, please explain:

Please provide any additional information you would like to share:

IMPORTANT REMINDER: Campers may not be admitted to camp until all required forms are signed and submitted. No exceptions.

Our camps are licensed by the Maryland State Department of Health and are legally required to comply with safety standards for the benefit of all children in our camp programs.

A Medication Authorization Form is required in advance for any medication (including non-prescription) distributed at the program. A Medication Authorization Form for Epi Pens, Inhalers and Insulin Pumps is required in advance for any medical device/procedure used at the program. A separate form is required for each medication.

FORM CONTINUES ON BACK

www.greenbeltmd.gov/recreation 17

3. PARTICIPANT RELEASE (OTHER THAN PARENT OR GUARDIAN ON PREVIOUS PAGE) Name

Greenbelt Recreation Day Camp is authorized to release my Child,

Phone Number

Relationship

1.

Participant’s Name: to the following individuals who may pick up my child from the Day Camp. I understand that each authorized person must be at least sixteen (16) years old, and my child will not be permitted to leave the camp with anyone not listed at the right. All authorized individuals will be required to show identification and sign the child out each day. My child may be released to the following people:*

2.

3.

4.

Departure Procedure: Please notify your child's camp when one of the above people will be picking up your child. *If you wish for your child to sign himself/herself out, please complete the camp sign-in/sign-out release permission form and return it to the camp office.

4. LATE PICK UP POLICY A late fee will be assessed for participants who are not picked up by the program’s scheduled closing time. Greenbelt Recreation’s Policy is $1 per minute in 5 minute increments.

We understand that emergencies do arise and request that parents call the camp’s office if they are delayed. However, late charges may still be assessed. Payment is due by 4:30pm the next business day. Thank you for your cooperation in ensuring your participant is picked up from the program on time.

5. ACTIVITY/PROGRAM FIELD TRIP LIABILITY RELEASE/AUTHORIZATION I hereby give permission for the applicant to participate in all program activities, including field trips in approved vehicles and agree to release the City of Greenbelt and Greenbelt Recreation, its officers, employees, and agents, from all liability arising from any harm or injury incurred by the participation of my child in the summer day camp program.

6. PHOTOGRAPHY/VIDEO RELEASE I agree that photographs and video footage may be taken of participants during program activities for use in City of Greenbelt publications, cablecasts, and social media, as well as for the production of camp show keepsake videos, which may be ordered through the Recreation Department business offices.

7. MEDICAL CARE/HOSPITAL TREATMENT RELEASE By way of copy of this form, I authorize the staff of The City of Greenbelt and Greenbelt Recreation to obtain medical/hospital treatment for the above participant in the event of an emergency.

I hereby represent and warrant that if the participant is a minor, I am his/her parent or guardian and am authorized to provide the releases, authorizations, and permissions as stated below.

X SIGNATURE OF PARENT/GUARDIAN (Typed signature is Acceptable)

Print name of parent/guardian

18 GREENBELT RECREATION CAMP PROGRAMS 2021

Date

GREENBELT RECREATION 25 Crescent Road, Greenbelt, MD 20770 Business Office: (301)397-2200 Fax: (301)397-2203 .

Camper’s Name: ______________________________________________ Parent/Guardian’s Name: _______________________________________ Please take a moment to fill out the front and back of this form to assure that your child is registered in the proper camp and session. Refer to the Camp Brochure for the correct registration number and session.

Please total your fees at the bottom of the table and choose your payment option. A $50 deposit for each session of camp is due at the time of registration. Each session’s payment is due in full ten days prior to the start of each session.

SESSIONS Summer Summer Summer Summer Summer

Session Session Session Session Session

1 2 3 4 5

SESSION DATES

PAYMENT DUE DATES

June 21-July 2 July 6-July 16 July 19-July 30 August 2-August 13 August 16-August 27

Friday, Friday, Friday, Friday, Friday,

June 11, 2021/4:30pm June 25, 2021/4:30pm July 9, 2021/4:30pm July 23, 2021/4:30pm August 6, 2021/4:30pm

CAMP NAME

SESSION

Example: Camp Pine Tree .5

Example: 336503-1

COMPLETE FINANCIAL INFORMATION ON THE BACK OF THIS PAGE!

www.greenbeltmd.gov/recreation 19

FINANCIAL INFORMATION PLEASE NOTE: A $50.00 Non-Refundable, Non-Transferable deposit, per child, per session is required at the time of registration. Registrations will not be processed until all paperwork is complete and the appropriate payments have been submitted.

PAYMENTS DUE

TOTAL X $50

Number of Camp Sessions Kids to Camp Fund (optional donation) Total Due at Registration:

CREDIT CARD INFORMATION: If you prefer, you may phone this information in, however a signature is required.

Name on Card: ______________________________________________ Billing Address:______________________________________________ Type of Card: _______________________________________________ Card Number: _______________________________________________ CVV#: ____________________________________________________ Expiration Date: _____________________________________________ Signature: __________________________________________________ (Typed signature is acceptable)

YES! I would like to have my credit card charged for the remaining balance due for each session, on the due date. Initials: _____

FOR ADMINISTRATIVE USE ONLY: Registration Received by:_________

VERIFY:

Date Received: _________________

License

Amount Received: ______________

Lease

CASH

CREDIT

CHECK

20 GREENBELT RECREATION CAMP PROGRAMS 2021

MVA Change of Address Card

Assumption of Risk and Waiver of Liability Relating to Coronavirus/COVID-19 City of Greenbelt Program Registration and Facility Reservations Coronavirus disease 2019 (COVID-19), has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious as is believed to spread mainly from personto-person contact.

The City of Greenbelt has created new protocols and put in place preventative measures to reduce the spread of COVID-19; however, the City cannot guarantee that you will not become infected with COVID-19. Further, attending any program may increase your risk of contracting COVID-19, and may increase the risk of transmitting COVID-19 to others.

•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• By signing this agreement I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I, my minor child, or members of my group or organization, may be exposed to or infected by COVID-19 by participating in an event, program, activity, reservation or rental taking place at a City of Greenbelt recreation facility or park, and that such exposure or infection may result in personal injury, illness, permanent disability, or death. I understand that the risk of becoming exposed to or infected by COVID-19 at a City of Greenbelt recreation facility or park may result from the actions, omissions, or negligence of myself and others, including, but not limited to, City employees, volunteers, and other participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself, my child, or members of my group or organization, including, but not limited to, personal injury, disability, or death, illness, damage, loss, claim, liability, or expense, of any kind, that they or I may experience or incur in connection with participation in any event, program, activity, reservation or rental taking place at a City Recreation and Parks facility. I hereby release, covenant not to sue, discharge, and hold harmless the City of Greenbelt, its employees, agents, and representatives, of and from any claims related to COVID-19, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I further agree to indemnify and hold harmless the City of Greenbelt and its employees, agents, and representatives from any claim that may arise from or in connection with my or members of my group or organization’s participation in any program taking place at a City of Greenbelt Recreation and Parks facility, including claims related to COVID-19.

I understand and agree that this release includes any claims based on the actions, omissions, or negligence of the City, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any City of Greenbelt Recreation and Parks program.

I agree to comply with any participation guidelines, such as the use of face coverings and physical distancing, to enhance the health and safety of all participants.

Adult Participant or Guardian Signature (Typed signature is Acceptable)

Organization Name (if applicable)

Printed Name

Date

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PARTICIPANT PROFILE FOR TEACHERS, MANAGERS AND STAFF Profiles are reviewed by staff and help them to better serve your child. Please take the time to complete.

Child’s Name: Child’s Preferred Name: Parent/Guardian: Camp:

Date: Age:

Child’s likes and dislikes: My child enjoys these physical activities: My child has difficulty with these activities: Things my child may need help with: Fears and concerns of the participant: Current medications: Any change in daily medication of the last six months: Specific behavioral concerns: Triggers of the specific behavioral concerns: What behavioral techniques have been successful that can be maintained during programs?

Are any special accommodations needed to give your child a positive learning experience during the program?

Is there any other additional information that would help to ensure that your child is successful during the program?

If there is any confidential information you don’t want to include on this form but feel it is important to share with us, please contact Rebekah Sutfin, Therapeutic Recreation Supervisor (Senior & Inclusion Programs) at 240-542-2056.

Greenbelt Recreation - Maintaining a Safe, Fun, and Enriching Environment.

22 GREENBELT RECREATION CAMP PROGRAMS 2021

Maryland Department of Health Center for Healthy Homes and Community Services (CHHCS) (410) 767-8417 Toll Free1-877-4MD-DHMH ext. 8417

MEDICATION ADMINISTRATION AUTHORIZATION FORM For Youth Camps in Maryland

This form must be completed fully in order for youth camp operators and staff members to administer the required medication or for the camper to self-administer medication. A new medication administration form must be completed at the beginning of each camp season, for each medication, and each time there is a change in dosage or time of administration of a medication.

Prescription medication must be in a container labeled by the pharmacist or prescriber.

Nonprescription medication must be in the original container with the instructions for use. Nonprescription medication includes vitamins, homeopathic, and herbal medicines.

An authorized individual must bring the medication to the camp and give the medication to an adult staff member.

I. PRESCRIBER’S AUTHORIZATION

2. DATE OF BIRTH ___/___/______

1. CHILD’S NAME

3. CONDITION FOR WHICH MEDICATION IS BEING ADMINISTERED: 5. MEDICATION NAME

6. DOSE

8. TIME/FREQUENCY OF ADMINISTRATION

4. EMERGENCY MEDICATION [ ] YES -If yes, see Section III below. [ ] NO 7. ROUTE 9. IF PRN, FREQUENCY

10. IF PRN, FOR WHAT SYMPTOMS 11. KNOWN SIDE EFFECTS SPECIFIC TO CHILD 12. MEDICATION SHALL BE ADMINISTERED during the year in which this form is dated in 14b below unless more restrictive dates are specified in 12a and 12b. This authorization is NOT TO EXCEED 1 YEAR. 13. PRESCRIBER’S NAME/TITLE

12a. FROM

Month Day Year

___/___/______

12b. TO

___/___/______

Month Day Year

This space may be used for the Prescriber’s Address Stamp

TELEPHONE

FAX

ADDRESS CITY

STATE

14a. PRESCRIBER’S SIGNATURE (Parent/guardian cannot sign here) (ORIGINAL SIGNATURE OR SIGNATURE STAMP ONLY)

ZIPCODE 14b. DATE

II. PARENT/GUARDIAN AUTHORIZATION

I request the authorized youth camp operator, staff member or volunteer to supervise the camper in self-administration as prescribed by the above authorized prescriber. I certify that I have legal authority to consent to medical treatment for the child named above, including the administration of medication at the facility. I understand that at the end of the authorized period, an authorized individual, as listed in 15c below, which may include the child, must pick up the medication, otherwise it will be discarded. I authorize camp personnel and the authorized prescriber indicated on this form to communicate in compliance with HIPAA. 15a. PARENT/GUARDIAN SIGNATURE

15b. DATE

15d. HOME PHONE #

15e. CELL PHONE #

15C. INDIVIDUAL(S) AUTHORIZED TO PICK UP MEDICATION 15f. WORK PHONE #

III. EMERGENCY MEDICATION

Camp Staff will be responsible for carrying emergency medication during the camp day. Medication will be stored in a secured space over night. Participants requiring emergency medication must maintain a non-expired supply of the emergency medication at the camp facility while enrolled in camp. Participants may not be admitted to camp without the signed medication administration (forms) and the prescribed medication(s). *Edited for Greenbelt Recreation Department Camps 2021

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24 GREENBELT RECREATION CAMP PROGRAMS 2021