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2014

k o o r b r e v l i S p m a Day C

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rbrook Day Camp! Welcome to Silve r the summer I am so excited fo amazing ahead and all the ve planned. With adventures we ha r remarkable staff, the guidance of ou er more about campers will discov e world around themselves and th d th new friends an tthem, connect wi a t las ll wi that c create memories e! lifetim play swim, go boating, he opportunity to th es try , lud re inc tu n na io th ss wi nnect Every se s, create crafts, co ng s. so on p iti m gn ca g co re sin , y games e or Journe dg ba rd wa to rk wo n. io outdoor skills and for more informat mpsilverbrook.com ca w. ww t ou k ec Ch iles on al camp staff prof Watch for season – ! ar ye is th w . Ne uary ginning in late Febr www.gswise.org be ntact me estions, please co qu y an ve ha u yo If 75. .org or 414-443-39 at kireland@gswise

O Overnight opportunities (optional) Overnight fee: $25 per girl paid at registration Girls entering grades 2-3 can choose to stay overnight the Tuesday of Session 4 (SB4, July 8) and Session 8 (SB8, August 5). Girls enjoy evening activities, help prepare their own meals and sleep in a troop house.

Clover

See you at camp! d, Camp Director Kelly “Clover” Irelan

Transportation (optional) Busing is offered throughout Milwaukee County for an additional cost per session. Indicate your desired bus stop on the Silverbrook Day Camp Registration form. Pick up/drop off times are listed below.

Bus fee: $50 for 5-day sessions, $40 for 4-day sessions, $30 for 3-day sessions Bus route #1 Stop 1: College Ave. Park and Ride, College Ave. and I-94 (northeast corner), Milwaukee, 7:30 a.m./5:20 p.m. Stop 2: Franklin High School, 8222 S. 51st St., Franklin, 7:50 a.m./5:00 p.m. Stop 3: St. Alphonsus, 6000 W. Loomis Rd., Greendale, 8:10 a.m./4:40 p.m. Stop 4: St. Matthias, 9300 W. Beloit Rd., Milwaukee, 8:30 a.m./4:30 p.m. Bus route #2 Stop 5: Walker’s Point Park and Ride (South Lot), 7th St. and National Ave., Milwaukee, 7:10 a.m./5:20 p.m. Stop 6: Marion Chester Read Center, 131 S. 69th St., Milwaukee, 7:30 a.m./5:05 p.m. Stop 7: Mayfair Mall, 2500 W. Mayfair Rd. (Macy’s parking lot), Milwaukee, 7:50 a.m./4:45 p.m. Stop 8: Roosevelt School, 2535 N. 73rd St., Wauwatosa, 8:10 a.m./4:25 p.m. Stop 9: Craig Montessori, 7667 Congress St., Milwaukee, 8:30 a.m./4:15 p.m. Bus route #3 Stop 10: Martin Luther King Library, 310 W. Locust, Milwaukee, 7:10 a.m./5:20 p.m. Stop 11: Shorewood Library, 3920 N. Murray Ave., Shorewood, 7:30 a.m./5:10 p.m. Stop 12: Richards School, 5812 N. Santa Monica Blvd., Whitefish Bay, 7:50 a.m./4:50 p.m. Stop 13: Indian Hill School, 1101 W. Brown Deer Rd., River ve er Hills, 8:10 a.m./4:30 p.m. Stop 14: Grace Lutheran Church, 303 Green Bay Rd., 2 Thiensville, 8:30 a.m./4:15 p.m.

“I learne d tha like diffe t it’s ok to rent thin gs than my friends li k e.” - Silverb rook Cam per

Adult volunteer opportunities Silverbrook Day Camp encourages parents, family and friends to volunteer at camp. Adult volunteers assist camp staff with activities and in units to enrich experiences and ensure the safety and well being of each camper. Benefits of volunteering include:  Reduced fees for your camper ($120 for 5-day sessions, $105 for 4-day sessions, $85 for 3-day sessions). A three-day minimum is required to receive a session discount. 

Free bus transportation for you and your camper.



Free camp patch.

Training is required for new volunteers on Wednesday, May 28, 6:30-8:30 p.m. at the Marion Chester Read Center in Milwaukee or Monday, June 2, 6:30-8:30 p.m. at Camp Silverbrook. Adult volunteers are required to complete a background check within the last three years prior to camp. Go to rss www.gswise.org, click on Volunteers and then select Volunteer Application. Adults volunteering at e day camp are also asked to become registered members of the organization.

Girls entering grades 4-12 can choose to stay overnight every Tuesday night. Girls enjoy evening activities, help prepare their own meals and sleep in platform tents or troop houses.

Camp Silverbrook Open House Sunday, May 18, 1:00-4:00 p.m. at Camp Silverbrook, West Bend Join us for Camp Silverbrook’s Open House. Bring your family and friends to this free event to sample camp activities, take a camp tour and meet the camp director. No registration necessary. Call us at 800-565-4475 or see your camp confirmation for driving directions.

Silverbrook Day Camp serves individual girls and is designe d to help them incr ease their independence and develop leadership skill s.

Want to attend with your BFF? see the Camp Buddies section on page 4! For troop opp ortunities at C amp Silverbrook se e the Overnigh t Event and Ca mping Opportunities Guide.

Day Camp sessions All camp sessions include swimming, boating, outdoor skills, environmental education, STEM and crafts. Camp begins at 9:00 a.m. and ends at 3:30 p.m. daily. Most sessions are Monday-Friday.

A typical day at camp 9:00 a.m.

Campers arrive

9:15 a.m.

Opening flag ceremony

9:30 a.m.

Swimming, boating, arts and crafts, outdoor skills, theme activities and fun

Noon

Lunch

12:45 p.m.

Activities continued

3:00 p.m.

Games, songs

3:15 p.m.

Closing flag ceremony

3:30 p.m.

Campers depart

Brave Entering grades 1-10 Unleash your inner princess this week as your confidence climbs to new heights. Take aim with slingshots and archery, create your own crown and show off your skills at our own Highland Games. SB4: Monday, July 7-Friday, July 11 (5 days) Fee: $155 on or before 4/6 *$180 after 4/6

Wet, Wild and Wacky Entering grades 1-7 Slip and slide your way into an exciting week at camp with tons of fun water games. Get soaking wet with water relay races, wet and wild kickball and water balloon battleship. SB5: Monday, July 14-Friday, July 18 (5 days) Fee: $155 on or before 4/6 *$180 after 4/6

Experiment Explosion Glam Camp Entering grades 1-7 It is all about you this week at camp. Make your own lip gloss, try Zumba and design an outrageous outfit for our fashion show. SB1: Monday, June 16-Friday, June 20 (5 days) Fee: $155 on or before 4/6 *$180 after 4/6

Entering grades 1-7 Unleash your inner scientist with microscopes, underwater cameras, crystals, slimy goo, and explosions as camp goes crazy with experiments. SB6: Monday, July 21-Friday, July 25 (5 days) Fee: $155 on or before 4/6 *$180 after 4/6

Where the Wild Things Are

Art Burst

Entering grades 1-7 Explore the land and all of the creatures that inhabit it. Build a shelter, cook over a fire, learn how to track animals and create your own wild “counselor” for a fun counselor hunt. SB2: Monday, June 23-Friday, June 27 (5 days) Fee: $155 on or before 4/6 *$180 after 4/6

Entering grades 1-7 Explode onto the art scene this week. Make your own jewelry, build a sculpture and paint a masterpiece as you express yourself in full color! SB7: Monday, July 28-Friday, August 1 (5 days) Fee: $155 on or before 4/6 *$180 after 4/6

Camp Silverbrook’s Got Talent

Lake Escape

Entering grades 1-10 Do you dance, sing, or act? Find your inspiration at camp, practice your skills and show off your talents at our very own Silverbrook Showcase! SB3: Monday, June 30-Thursday, July 3 (4 days) Fee: $130 on or before 4/6 *$155 after 4/6

Entering grades 1-10 Discover all of the excitement Lucas Lake has to offer. Go swimming, boating, fishing, snorkeling and build a raft for the lake escape challenge. SB8: Monday, August 4-Friday, August 8 (5 days) Fee: $155 on or before 4/6 *$180 after 4/6

“She certainly has become more independent. By the end of the week she was packing her own backpack, making her own lunch and choosing what things she thought were necessary to take to camp.” - Silverbrook Camper Parent

Leadership Opportunities Program Aide-in-Training (PAIT) Entering grades 7 As a Program Aide-in-Training, you will build your leadership skills by earning your Leader in Action (LIA) Award and learning how to be an effective Program Aide. In addition to participating in camp activities, you will get a chance to use those skills as you work with younger campers in a unit or at an activity area. PAITs pay the camper fee for each session.

Program Aide (PA) Entering grades 8-9 or grade 7 after completing a PAIT session As a Program Aide, you will continue on your leadership journey by mentoring younger girls as you assist the adults in a unit or activity area. There is no fee to be a PA. PAs pay the overnight fee if you choose to stay overnight. Required training: Friday, May 30, 6:30 p.m.–Saturday, May 31, noon, Silverbrook

Counselor-in-Training (CIT) Entering grade 9-graduated seniors As a CIT, you will lead activities for a unit with an adult mentor. There is no fee to be a CIT. CITs pay the overnight fee if you choose to stay overnight. Required training: Friday, May 30, 6:30 p.m.–Saturday, May 31, noon, Silverbrook eb er

World Traveler Entering grades 1-7 Don’t forget to get your passport stamped as you hop from country to country. Experience the culture of each location as you travel with food, music and art. SB9: Monday, August 11-Wednesday, August Aug Au gu 13 (3 days) gu Fee: Fe e: $100 on or before 4/6 *$125 e: 25 5 af afte after te er 4/ 4/6 /6

“I found o ut I could do thought I could do— thiings I never like star - Silverb rook Cam t a fire.” per

3

Silverbrook Day Camp Information How to register •

Registration will automatically open Monday, February 3, at 11:00 p.m. Online registrations are processed first and then paper registrations.

Program Activity Credits (PAC) earned through the Girl Scout Cookie Program Activity or Fall Nut Sale can reduce the cost for the girl who earned the PAC to attend camp or an event. Write the camp/event name on the PAC and mail in if registering online or attach to paper registration form.

Financial Assistance is available for registered members of Girl Scouts of Wisconsin Southeast to help families meet the cost of sending their girl to camp and events. See p. 8 for the Financial Assistance form. Financial Assistance is funded by gifts to Girl Scouting and proceeds from the Girl Scout Cookie Program Activity. One resident camp, one day camp, and one event will be considered for Financial Assistance per girl.

Girls may purchase souvenirs at camp. See the Silverbrook Day Camp Registration form on p. 5 for Advance Trading Post items.

Camp Care Package

Confirmations Confirmations will be sent to your email address (if provided) or by mail. Confirmation will include: • Family guide with a packing list •

Additional forms and information

Directions to camp which is located in West Bend, WI

Refunds/cancelations •

Go to www.gswise.org and click on Camps. Click on Silverbrook Day Camp and then How to Register.

Create one account per family so that camper’s parent/guardian receives confirmation information.

Full refunds are issued if your girl cannot be placed in the session of her choice.

Sessions that are full will be marked accordingly.

Pay full payment with a credit/debit card (Visa or MasterCard) or checking account.

Adults volunteering complete the Adult Volunteer Day Camp Registration and online application and background check.

Complete the Silverbrook Day Camp Registration form and Health History forms, pp. 5-6 or download forms.

Pay full payment with a credit/debit card (Visa or MasterCard) or checking account.

Mail in or bring registration form to any council resource center.

Adults volunteering complete the Silverbrook Day Camp Adult Registration form, pg. 7, and online application and background check.

Surprise your camper with a Camp Care Package. Order a Camp Care Package for any Camp Silverbrook session. We will ensure a surprise delivery to your camper! Each kit comes with: • Camp Backpack • Plush Animal • Girl Scout Water Bottle • Activity Journal

Refunds, minus $25 nonrefundable processing fee, are available for cancelations received six weeks prior to the session start date. Within six weeks, refunds, minus $25, will only be issued for medical reasons, summer school, a death or critical illness in the immediate family, or if the family moves out of the area. Cancelations must be made in writing.

Paper

4

Trading Post

A discount is given to registrations for Silverbrook Day Camp when full payment is made at the time of registration prior to Sunday, April 6 at 11:59 p.m.

Online •

Discount

If a girl needs to change camp sessions there is a $25 fee after the first session change.

Camp Buddies Register your Girl Scout for camp with her BFF! If girls want to be placed with a specific buddy, note that on the Buddy Request line during registration. Requests made after registration cannot be guaranteed. Girls need to register for the same session, be in the same grade, and list each other as their Buddy. If registering by paper, submit the girls’ forms together. In order to honor your request both buddies must put the other’s name on the Buddy Request line.

k

erbroo Camp Silv

Camp Silverbrook il b k iis llocated d 32 miles il northwest of Milwaukee in West Bend. The 265-acre property surrounds Lucas Lake, a crystal clear 80-acre body of water fed by Silver Creek.

• Camp Dog Tag Necklace • Camp Postcards • $25 (price includes tax)

Not a Girl Scout? Not a problem All girls are welcome to attend day camp. If your girl is not a registered Girl Scout, include an additional $15 for membership dues with payment.

Girls with additional needs Let us know of any concerns you may have. Our goal is to provide a positive camp experience for all girls. Providing us with information about medications, special diets and nighttime routines along with physical and mental limitations, will help us provide a positive camp experience for your girl. For specific questions or situations, please email kireland@gswise.org or call 414-443-3975.

Silverbrook Day Camp Registration For Day Camp Adult Registration Form, see page 7. Please print clearly and use blue or black ink • Registration accepted up to two weeks before session or until session meets capacity.

Camper’s name: Address:

City:

County:

State:

Phone ❒Home ❒Cell ❒Work: (

)

Birthdate:

Zip: Troop # (if applicable):

Grade in Fall 2014:

Note: Confirmation information will be sent to your e-mail address listed below. Please print clearly. Email address for confirmation: Buddy Request (Name): SB1 Glam Camp

SB2 Where the Wild Things Are

SB3 Camp Silverbrook’s Got Talent

June 16-20 ❒ Day Camp (Grades 1-7) ❒ Overnight (Grades 4-12) ❒ PAIT ❒ PA ❒ CIT I

June 23-27 ❒ Day Camp (Grades 1-7) ❒ Overnight (Grades 4-12) ❒ PAIT ❒ PA ❒ CIT I

June 30-July 3 ❒ Day Camp (Grades 1-10) ❒ Overnight (Grades 4-12) ❒ PAIT ❒ PA ❒ CIT I

SB4 Brave

SB5 Wet, Wild and Wacky

SB6 Experiment Explosion

July 7-11 ❒ Day Camp (Grades 1-10) ❒ Overnight (Grades 2-12) ❒ PAIT ❒ PA ❒ CIT I

July 14-18 ❒ Day Camp (Grades 1-7) ❒ Overnight (Grades 4-12) ❒ PAIT ❒ PA ❒ CIT I

July 21-25 ❒ Day Camp (Grades 1-7) ❒ Overnight (Grades 4-12) ❒ PAIT ❒ PA ❒ CIT I

SB7 Art Burst

SB8 Lake Escape

SB9 World Traveler

July 28-August 1 ❒ Day Camp (Grades 1-7) ❒ Overnight (Grades 4-12) ❒ PAIT ❒ PA ❒ CIT I

August 4-8 ❒ Day Camp (Grades 1-10) ❒ Overnight (Grades 2-12) ❒ PAIT ❒ PA ❒ CIT I

August 11-13 ❒ Day Camp (Grades 1-7) ❒ Overnight (Grades 4-12) ❒ PAIT ❒ PA ❒ CIT I

# of Sessions

x session fee $

+$

# of Sessions

x bus fee $

+$

Overnight session(s)

GSUSA Membership Dues for non-Girl Scout ($15)

+$

Advance Trading Post order

+$

Accept my tax-deductible gift to support camp

+$ Total fees

Program Activity Credit (attach) PAC #

–$

Gift Certificate (attach) #

–$

Financial Assistance (attach p. 8)

–$

❒ None needed ❒ Bus Stop # Bus Stop Location Race/Ethnicity (optional, check all that apply)

Race

❒ American Indian or Alaskan Native ❒ Hawaiian or Pacific Islander ❒ White (Caucasian) ❒ African American or Black ❒ Asian

Ethnicity

❒ Hispanic or Latino ❒ Not Hispanic or Latino Advance Trading Post (optional) Size T-Shirt • $14 Sweatshirt • $30 Girl Girl YS (6-8) NA YM (10-12) YL (14-16) AS AM AL AXL AXXL $25 ❒ Camp Care Package

Enclose full amount which already includes the $25 nonrefundable deposit or enclose a minimum of $25 if applying for financial assistance. Outstanding balances, including gift certificates and Program Activity Credits are due May 12. If you register online or pay by credit/debit card, outstanding balances will be automatically charged no later than May 15. Pay in full if registration is received after May 12. Any additional fees or outstanding balances will be automatically charged 7-10 days prior to camp. For all credit/debit card or check/e-check transactions, bank/credit card statements will show payments processed by Active Network.

+$

x $25

Transportation, see page 2.

+$

Check enclosed payable to GSWISE Charge ❒ Visa ❒ MasterCard Account # Card holder’s name (print)

Subtract discounts

–$

TOTAL

$

$

Exp. date

Signature

I have read the camp information and agree that my camper and I will abide by the regulations and procedures stated therein, including those on refund, non-refundable deposit and health of camper. I understand that I am responsible for getting my camper to and from this camp or bus stop. I give my camper permission to ride the bus, if applicable. I give my camper permission to attend and participate in all phases of this session (except those noted on the Health History form), including off-site trips, if applicable. I give permission for photographs/video of my camper to be taken for GSUSA, GSWISE and American Camp Association publicity and marketing purposes. If my camper is not already a registered Girl Scout, I give my permission for her to register as a member of the Girl Scouts of the USA.

Parent/guardian signature: Date: Complete and mail to: Girl Scouts of Wisconsin Southeast, P.O. Box 14999, Milwaukee, WI 53214-0999

Over for Mandatory Health History Form

5

Health History Please print clearly and use blue or black ink.

Campers’s name: Session #1:

Date of session:

Session #2:

Date of session:

Session #3:

Date of session:

Mother/guardian name:

Phone during camp hours: (

)

Phone #2: (

)

Father/guardian name:

Phone during camp hours: (

)

Phone #2: (

)

Camper in custodial care of (check one): ❒ Both ❒ Mother ❒ Father ❒ Other Person(s) authorized to pick up child at camp/bus stop: Emergency Contacts (besides parent/guardian) 1. Name: Phone during camp hours: (

Relationship: )

Phone #2: (

2. Name: Phone during camp hours: (

)

Relationship: )

Phone #2: (

)

Medical History Family physician name:

Phone #: (

Are any medications taken on a regular basis? ❒ Yes ❒ No

)

If yes, does this need to be administered at camp? ❒ Yes ❒ No

If yes, explain: Do you have any restrictions or special needs related to physical activity? ❒ Yes ❒ No If yes, explain: The following nonprescription medications are commonly stocked in the camp health center and used on an as needed basis to manage illness and injury. Cross out any of the following items the camper should NOT be given. • Acetaminophen (Tylenol) • Athletes foot ointment or • Ibuprofen (Advil, Motrin) • Hydrogen Peroxide • Antibiotic ointment powder • Benadryl • Laxative (Neosporin) • Aloe or burn gel • Eye Drops • Anti-diarrheal • Anti-itch cream or lotion • Tums • Rubbing alcohol • EpiPen Immunization Dates (M/D/Y) (Series completed, Year of booster) “Current” is not acceptable. Tetanus or DPT

Check All That Apply Illnesses ❒ Heart defect/disease

Allergies - include specifics

Others/Special Needs

❒ Animals:

❒ Wears contacts/glasses

❒ Insect stings:

❒ Fainting

❒ Pollen:

❒ Ear problem/tubes

❒ Latex:

❒ Hearing impairment

❒ Medicine/Drugs:

❒ Emotional behaviors

Polio

❒ Musculoskeletal disorders

MMR

❒ Asthma

Hepatitis B

❒ Bleeding/Clotting disorder

Varicella/HIB

❒ Seizures

❒ Nuts:

Since last health exam: ❒ Exposed to a contagious disease ❒ Had a surgical operation ❒ Had a serious illness Describe:

❒ Diabetes

❒ Milk:

❒ ADD/ADHD (circle one) medicated not medicated

❒ Other:

❒ Food(specify):

❒ Sleep disturbances

❒ Other (specify):

❒ Menstrual cramps

Type & Severity of Reaction:

❒ Nosebleeds ❒ Other:

Please explain any items that you check. Include any useful information relative to any of these health conditions.

I give my permission for my camper to receive necessary health care, prescribed medications and emergency medical treatment. This health history is complete and accurate. I will not allow my camper to attend if they become exposed to any contagious disease, or if for any reason, I do not consider my camper to be in good physical condition. Upon arrival the camp health personnel have the right to refuse to admit anyone to the camp who does not meet the acceptable health conditions, e.g. temperature, contagious disease, etc.

Parent/guardian signature: Date: Complete and mail to: Girl Scouts of Wisconsin Southeast, P.O. Box 14999, Milwaukee, WI 53214-0999 6

Silverbrook Day Camp Adult Registration Only completed forms will be accepted.

Adult volunteer’s name: Address:

City/State/Zip:

Email Address:

Home Phone: (

)

Cell: (

)

Birthdate: Occupation: Are you a registered Adult Girl Scout for 2013-2014? ❒ Yes ❒ No If no, you can enclose the $15 GSUSA membership dues and support Girl Scouting by becoming a member. BACKGROUND CHECK AND REFERENCES (REQUIRED) ❒ Prior to submitting this form I have completed an online application and background check and submitted references at www.gswise.org. ❒ I have already completed an online application and background check with the Girl Scouts Wisconsin Southeast within the last 3 years. MEDICAL HISTORY Name of family physician: ALLERGIES

Phone number: (

)

❒ Animals ❒ Hay Fever ❒ Insect Stings ❒ Plant ❒ Pollen ❒ Medicine/Drugs ❒ Food ❒ Nuts ❒ Milk ❒ Latex ❒ Other Type and severity of reaction: ILLNESSES ❒ Bleeding/Clotting Disorders ❒ Seizures ❒ Asthma ❒ Diabetes ❒ Heart Defect/Disease ❒ Musculoskeletal Disorder ❒ Other If other, list special needs: SPECIAL NEEDS ❒ Wears Contacts/Glasses ❒ ADHD or ADD ❒ Hearing Defect/Disease ❒ Hypertension ❒ Other: IMMUNIZATIONS ❒ Tetnus DPT:

❒ HepB:

(optional)

MEDICATIONS ❒ Yes ❒ No If yes, does this need to be administered at camp? ❒ Yes ❒ No If yes, please explain: Do you have any restrictions or special needs to physical activity? ❒ Yes ❒ No If yes, please explain: Do you require a special diet or have any dietary restrictions? ❒ Yes ❒ No If yes, please explain: EMERGENCY CONTACTS Name:

Relationship:

Phone during camp hours: (

)

Name:

Phone #2: (

)

Relationship:

Phone during camp hours: (

)

Phone #2: (

)

AREAS OF INTEREST - please check all that apply (director will assign on the basis of need, not just interest) ❒ With my daughter ❒ Not with my daughter Name of Camper(s):

Grade:

Troop #:

CAMP SPECIFICS I wish to volunteer for the following: ❒ Session 1- Glam Camp ❒ Session 2- Where the Wild Things Are ❒ Session 3- Camp Silverbrooks Got Talent ❒ Session 4- Brave ❒ Session 5- Wet, Wild and Wacky ❒ Session 6- Experiment Explosion ❒ Session 7- Camp: Art Burst ❒ Session 8- Lake Escape ❒ Session 9- World Traveler I will volunteer for the following days: ❒ M ❒ T ❒ W ❒ TH ❒ F Transportation: Ride Bus both ways: ❒ M ❒ T ❒ W ❒ TH ❒ F Bus Stop: Private Transportation: ❒ M ❒ T ❒ W ❒ TH ❒ F ❒ $15 Girl Scout Membership for 2013-2014 (recommended) ❒ $14 Camp T-shirt Size: ❒ AS ❒ AM ❒ AL ❒ AXL ❒ AXXL ❒ AXXXL ❒$

Donation (accept my tax deductible gift to support camp) ❒ Total enclosed: $

I have read the camp information and agree that I will abide by the regulations and procedures stated therein, including those on refund, non refundable deposit and health. I understand that I am responsible for getting to and from this camp or bus stop. I give permission for photography/video of me to be taken for GSUSA, GSWISE and the American Camp Association publicity and marketing purposes. If I am not already a registered Girl Scout, I give permission to register as a member of the Girl Scouts of the USA. I give permission to receive necessary health care and emergency medical treatment. The health history on this form is complete and accurate. I will not attend if I become exposed to any contagious disease, or if for any reason, I do not consider myself to be in good physical condition. Upon arrival the camp health personnel have the right to refuse to admit anyone to the camp who does not meet the acceptable health conditions e.g. temperature, contagious disease, etc.

Adult volunteer signature:

Date: 7

Summer Camp Financial Assistance Form Please print clearly and use blue or black ink.

Financial Assistance is available towards the camp fee, transportation and overnight during camp • If you registered online, mail this form to the address listed within one week or mail with paper (if applicable). Advance Trading Post orders are not covered by Financial Assistance. Each form registration and $50 nonrefundable deposit for is considered on an individual basis and information provided will be kept confidential. One resident camp or $25 nonrefundable deposit for resident camp, one day camp and one event will be considered for Financial Assistance per girl a day camp. depending on need. • You will receive a letter/email indicating the I am applying for Financial Assistance for: amount granted and amount due, if any. Girl’s name: Grade in fall 2014: • Participant needs to be a registered member of Girl Scouts of Wisconsin Southeast. Address: • Use one form per applicant. City: County: Complete and mail to: Girl Scouts of Wisconsin Southeast State: Zip:

ATTN: Financial Assistance P.O. Box 14999 Milwaukee, WI 53214-0999

Parent/guardian name: Phone #1: (

)

Phone #2: (

)

For Day Camp only: check one Registered Girl Scout for 2013-2014? ❒ Yes ❒ No Troop #: Individual: ❒ Yes ❒ No ❒ Girl Day Camper ❒ PAIT ❒ PA ❒ CIT I Has this camper participated in: ❒ Fall Product Sale ❒ Cookie Program Activity Please check the camp of choice: Check Household Income Range: ❒ $0-$10,000 ❒ $10,001-$20,000 ❒ $20,001-$25,000 Volunteer Led Day Camps ❒ Lakeland-  June 9-13 ❒ $25,001-$30,000 ❒ $30,001-$35,000 ❒ $35,001-$40,000 ❒ $40,001-$50,000 ❒ Deer Trails- June 16-20 ❒ $50,001-$60,000 ❒ $60,001-$70,000 ❒ $70,001-$80,000 ❒ $80,001-$90,000 ❒ $90,001+ ❒ Rising Stars and Meadow Springs- June 16-20 ❒ Prairie Hill- June 23-27 Number of people living on this income: Children Adults ❒ Sunny Trails- July 7-11 Statement of Need: Please state specific reasons why this assistance is needed. ❒ Enchanted Waters- July 14-18 Use a separate sheet of paper if necessary. ❒ Trefoil- July 14-18 ❒ Whispering Willows- July 14-18 ❒ River Valley- July 21-25 ❒ Sun Lakes- July 21-25 ❒ Alpha Moraine- July 28-Aug 1 ❒ Glacier Hills- July 28-Aug 1 ❒ Windy Waters- July 28-Aug 1 The early registration discount will be granted only if the registration form and Financial Assistance ❒ Woodland Trails- July 28-Aug 1 form are received before the early registration date. ❒ Arrowhead- August 4-8 Fees: ❒ Country Cousins- August 4-8 ❒ Kenosha- August 4-8 Total camp fee: $ ❒ Indian Springs- August 11-15 Bus fee (if applicable): +$ ❒ Northern Lights- August 11-15 Day camp overnight fee (optional): +$ Silverbrook Day Camp: Email:

TOTAL FEES: Subtract Nonrefundable Deposit ($50 resident camp) ($25 day camp) (if applicable): Subtract Program Activity Credit (if applicable): TOTAL CREDITS: Total fees (Line A): Minus Total Credits (Line B): AMOUNT REQUESTED:

I verify that the information given is correct and true. Parent/guardian signature: 8

=$

Line A

–$ –$ =$ $ –$ =$

Line B

❒ SB1- June 16-20 ❒ SB2- June 23-27 ❒ SB3- June 30-July 3 ❒ SB4- July 7-11 ❒ SB5- July 14-18

❒ SB6- July 21-25 ❒ SB7- July 28-August 1 ❒ SB8- August 4-8 ❒ SB9- August 11-13

For Resident Camp only: check one ❒ Alice Chester ❒ Camp iGirl Session Title: Session Dates:

Date:

Parents will be notified of any balance due. Balances need to be paid before the start of the camp or event.


2014 Silverbrook Day Camp Booklet