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A SUMMER TO DISCOVER Cross Island YMCA Summer Day Camp 2012


Is your child ready for a summer of adventure? The Cross Island YMCA embarks on another year of fun and excitement in our summer day camp. Welcome to our new and returning campers to Summer Camp 2012 at the Cross Island YMCA. As one of the largest youth service organizations in the country, the YMCA has all of the resources necessary to deliver quality childcare at an affordable cost. This is our mission, and we look forward to serving you at the Cross Island YMCA. Our day camp offers hands on learning through indoor and outdoor educational activities. Our goal for this Summer Camp is to deliver a program curriculum that allows each camper to discover new skills and talents while enhancing their current abilities. Enclosed you will find registration and medical forms with all of the necessary enrollment information. We look forward to having our best summer yet; if you have any further questions please feel free to call us 718-479-0505/ 718-551-9336/718-551-9309. Thank you for choosing our day camp for your child. Sincerely, Tyronza Murray Senior Program Director

YMCA Day Camp Through programs like Day Camp, we nurture your child’s sense of selfconfidence and introduce them to positive, fun experiences that build leadership and social skills. Well-trained, qualified staff serve as positive role models for campers. Y Day Camp enhances camper’s self-confidence, self-esteem and leadership skills through structured (and fun!) activities. Campers develop a true understanding of diversity in an atmosphere of acceptance and approval of the uniqueness of others. Campers are encouraged to be creative, expressive and learn new skills. Summer learning activities offer fun way for campers to read and learn over the summer months. All YMCA Day Camps are licensed by the NYC Department of Health and Accredited by the American Camping Association (ACA).


WELCOME TO CAMP Parents Trust Us

YMCA Day Camps provide high quality camp experiences for your child, which help build a healthy spirit, mind and body. SAFETY The American Camp Association (ACA) accredits each of our day camp programs. This independent body establishes standards for key aspects of camp operation, program quality, health and safety of campers. All YMCA Day Camps are licensed by the NYC Department of Health. Additionally, many YMCA day camp staff are trained in CPR and First Aid.

OUR YMCA MISSION The YMCA of Greater New York is a community-based service organization which promotes positive values through programs that build spirit, mind, and body, welcoming all people with a focus on youth.

OUR VALUES Caring, honesty, respect and responsibility.

CONTACT US For more information or have questions, please contact: Tynisa Martin, Camp Director: 718-551-9336; tmartin@ymcanyc.org Grantley Trotman, Camp Coordinator 718-551-9336, gtrotman@ymcanyc.org Shonnell Batson, Program Associate 718-551-9309, sabatson@ymcanyc.org

CAMP LOCATION The YMCA Summer Day Camp operates out of Cross Island YMCA. We also use offsite facilities such as local parks and schools to conduct Day Camp.

Kids Love Us

YMCA Day Camps offer you a chance to have fun while building a healthy spirit, mind, and body. Plus you get to... > Make new friends > Play sports and games > Get messy > Learn funny songs and skits > Have fun > BE A KID!

DATES & HOURS OF OPERATION Cross Island YMCA Summer Day Camp is an eight-week program that runs Monday to Friday, 9am - 4pm with optional morning and evening extended hours. Session Dates Session I July 2 - July 13 (No Camp July 4th) Session II July 16 - July 27 Session III July 30 - Aug 10 Session IV August 13 - Aug 24 Mini Camp Aug 27 - Aug 31

OPEN HOUSES Saturday, March 3, 2012 Saturday, April 28, 2012 Saturday, May 19, 2012 Wed., June 13, 2012

10 – 4 pm 10 – 4 pm 10 – 4 pm 4 – 7 pm

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REGISTRATION MADE EASY

PARENT ORIENTATION

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Parent Orientation is mandatory. You may choose from one of the following meetings: June 13 7pm—8pm June 16 5pm—6pm June 25 7pm—8pm June 27 7pm—8pm

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Registration begins on February 1, 2012. Follow instructions and fill out all enclosed registration packet forms making sure they are completed and signed. Register in person. Submit your child’s medical form completed with parent information and signature as well as the doctor’s information, signature and stamp as soon as possible. It’s a good idea to keep extra copies of the medical form for your records. To reserve a space, a non-refundable deposit of $100 per session is required. This payment will be applied to your child’s first week of camp. $50 non-refundable registration fee is required for campers who are not YMCA members at the time of registration. There will be a $25 (per change) transaction fee for any changes made with regard to camp or transportation after registration is completed. The YMCA accepts all major credit cards or you may sign up for automatic billing to ensure payments are made on time with no late fees incurred.

PROMOTIONAL OFFERS

Early Bird Discounts Take advantage of the10% Early Bird discount when registration is completed before Saturday, May 19. Siblings Discounts 10% off each additional sibling. Discounts cannot be combined.

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FINANCIAL ASSISTANCE The YMCA of Greater New York awards scholarships to campers based on a parent or a family’s annual income. The scholarship applications must be submitted by Saturday, May 19, 2012.

GOVERNMENT & UNION VOUCHERS We accept ACD, HRA, TWU Local 100, and 1199 SEIU vouchers. You must have your confirmation letter with you at the time of registration.

REFUNDS AND CREDITS If your child cannot attend camp for a period of time paid, you may submit a request for credit along with documentation to the Camp Director. In the event of illness or injury, a doctor's note would be necessary for withdrawal. Credits can be used for camp or other programs throughout the year. Any refund requests will be submitted to the Camp Director and will be granted under the discretion of the Senior Program Director. All requests should be made prior to the start of the session.


ABOUT YOUR Y DAY CAMP

A DAY 8:00-9

STAFF Staff are hired based on experience and commitment to working with children from varied backgrounds. Lead counselors are at least 18 and have certification in CPR, First Aid and Water Safety. All camp staff receives a minimum of 40 hours of pre-camp training. Cover letters and resumes should be emailed to jobscrossisland@ymcanyc.org beginning Feb. 1, 2012.

AT CAM P

:00 Arrival 9:00-1 & Cam 0:00 p Chee Science rs 10:00Experim 11:00 ent S w imming 11:0012:00 Art Acti 12:00vity 1:00 Lunch 1:00-2 :00 Sports 2:00-3 :00 Vocabu 3:00-4 lary Re :00 lay (gy Snack m) and Jo urnal

CAMP GEAR Each child will receive 2 shirts and a camp bag. Swim caps will be given during the camper’s first day of swimming. Camp t-shirts must be worn every day. Additional shirts may be purchased at $9 each or 3 for $25. Swim gear consist of a towel, swimsuit, swim cap, a change of clothing, water shoes and a plastic bag (or other receptacle for wet swim gear). Camp gear is distributed during the camper’s first day of camp. It is suggested to wear shorts, sneakers and T-shirts. For safety, do not wear skirts or sandals.

YMCA DAY CAMP OBJECTIVES YMCA Summer Day Camp helps campers ages 2 –12 years old and teens ages 13-16 years old grow mentally and physically by participating in challenging activities in both small and large group settings under the supervision of a caring and well trained staff.

SUMMER LEARNING

SOMETHING TO EAT On trip days campers receive a cold lunch consisting of a sandwich, fruit and a drink. Hot lunch is served on all other days. Lunches & menus are provided by the Department of Education. Early Childhood Summer Program will not provide lunch. Lunch must be provided by the parent or guardian. Snack must be provided by the parent or guardian of each camper. The Cross Island YMCA will not be distributing snacks.

TRANSPORTATION Transportation to and from the Cross Island YMCA is available only to campers in Youth & Teen or Specialty Camps (not Early Childhood Summer Program, contact directly) who attend regular hours (9:00am – 4:00pm). We do not offer transportation for our extended hours campers. The registration deadline for transportation service is Tuesday, May 31.

To succeed in school and life, children and young adults need ongoing opportunities to learn and practice essential skills. This is especially true during the summer months when children lose much of what they learn during the school year. YMCA of Greater New York Day Camps provide high-quality summer learning initiatives that give children a variety of ways to improve reading and math skills and explore music, drama, art and sports. Through fun, themed curriculum that incorporates key academic components, children will practice and further their academic skills, learn to plan and create projects, learn teamwork and develop new skills. To inspire reading, our program will provide books recommended by the Department of Education for summer reading.

The Cross Island YMCA offers transportation within the following communities: Arverne Bayside Bellerose Cambria Heights Douglaston Elmont Far Rockaway Floral Park Flushing Forest Hills Franklin Square

Fresh Meadows Glen Oaks Hempstead Hollis Jamaica Jamaica Estates Kew Gardens Laurelton Little Neck New Hyde Park Ozone Park

Queens Village Rego Park Rochdale Rosedale St. Albans Springfield Gardens Valley Stream West Hempstead

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EXPLORE PLAY AND GROW

Each week of camp provides your child hands-on activities including educational field trips and theme days.

EARLY CHILDHOOD SUMMER PROGRAMS Ages 2 - 5.8 • Sessions I - IV (Mini-session available for 4.5 – 5.8) Rates: See session and fee on page 6 for all options Questions? Please contact Sunita Batra, Early Childhood Director 718-551-9313; sbatra@ymcanyc.org Day Camp Session Options Monday - Friday, Monday, Wednesday & Friday Tuesday & Thursday Day Camp Hours 9:00am - 4:00pm Extended hours morning and evening available. Please ask about our half day options. Early Childhood Medical Form Please use the child & adolescent medical health examination form included in this booklet. Our Promise Our primary goal is for each child to develop a positive self-image. The staff is made up of carefully selected teachers and assistant teachers. They provide guidance and supervision so that each child can achieve self-confidence and awareness.

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Our camp offers air-conditioned classrooms, outdoor playground, picnic area, indoor pool and gym. Children participate in a wide variety of activities, including arts & crafts, swim, gym, music, and organized games. Each week will feature a special theme, and each session will have a trip to the zoo, children's museum or park. All activities are geared to meet individual needs, abilities, and interests.


EARLY CHILDHOOD 2012 SUMMER PROGRAM

SESSIONS AND FEES

PARTICIPANT INFO Child’s Name ___________________________________________________ Age ______________ D.O.B ___________________ M □ F □ Address _____________________________________________________________________________________ Apt # _____________________ City _______________________________________________________________ State ___________________________ Zip _______________ Home Phone ____________________________________________ Cell Phone ____________________________________________ CHECK ALL SESSIONS AND CIRCLE ALL PRICES THAT APPLY TO YOU PreSchool Summer Program 3 to 4.5 years 5 Days (Monday—Friday)

Toddler Summer Program 2 to 3.4 years 5 Days (Monday—Friday) □ Session I □ Session II

7/02 - 7/13 7/16 - 7/27

$450 $500

□ Session III □ Session IV

7/30 - 8/10 8/13 - 8/24

$500 $500

3 Days (Monday, Wednesday, Friday)

□ □ □ □

7/02 - 7/13 7/16 - 7/27

$333 $370

□ Session III □ Session IV

7/30 - 8/10 8/13 - 8/24

$370 $370

□ □ □ □

$290 $290 $290 $290

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2 Days (Tuesday, Thursday) Session I Session II Session III Session IV

7/02 - 7/13 7/16 - 7/27 7/30 - 8/10 8/13 - 8/24

$436 $485 $485 $485

3 Days (Monday, Wednesday, Friday)

□ Session I □ Session II

□ □ □ □

Session I Session II Session III Session IV Session I Session II Session III Session IV

7/02 - 7/13 7/16 - 7/27 7/30 - 8/10 8/13 - 8/24

$315 $350 $350 $350

2 Days (Tuesday, Thursday)

7/02 - 7/13 7/16 - 7/27 7/30 - 8/10 8/13 - 8/24

Session I Session II Session III Session IV

7/02 - 7/13 7/16 - 7/27 7/30 - 8/10 8/13 - 8/24

$270 $270 $270 $270

Early Childhood Summer Program 4.5 to 5.8 years 5 Days (Monday—Friday)

Additional Services Extended Hours

AM only

PM only

Both

Session I

$81

$81

$162

Sessions II, III, IV

$90

$90 Fees

$180

Session I $___________________________ Session II $___________________________ Session III $___________________________ Session IV $___________________________ — Discounts $___________________________ Extended Hours (Rate multiplied by # of sessions) $___________________________ Total Session Fee $___________________________ $50 Registration Fee (applies to non-members only) $___________________________

Grand Total $___________________________

□ □ □ □ □

Session I Session II Session III Session IV Mini Session

7/02 - 7/13 7/16 - 7/27 7/30 - 8/10 8/13 - 8/24 8/27 - 8/31

$436 $485 $485 $485 $200

 No camp will be held on July 4th. Session I rates have been prorated.  Sessions may be split.  A non-refundable deposit of $100 per session is required at the time of registration.  A $50 non-refundable registration fee is required for campers who are not YMCA members.  Accepted forms of payment are cash or credit card.  Financial Aid is available to those that qualify. Forms are available at the Members Services Desk.

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EARLY CHILDHOOD 2012 SUMMER PROGRAM

REGISTRATION FORM

PARTICIPANT INFO Child’s Name ___________________________________________________ Age ______________ D.O.B ___________________ M □ F □ Address _____________________________________________________________________________________ Apt # _____________________ City _______________________________________________________________ State ___________________________ Zip _______________ School Name _______________________________________________________ Grade starting in Sept 2012 ___________________ Y Member? Y □ N □

T-Shirt Size

Child: XS □ S □ M □ L □ XL □

PARENT/GUARDIAN INFO Guardian 1 Name ________________________________________ Guardian 2 Name ________________________________________ Relation __________________________________________________ Relation __________________________________________________ Work Tel # ________________________________________________ Work Tel # ________________________________________________ Mobile Tel # _______________________________________________ Mobile Tel # _______________________________________________ Home Tel # ________________________________________________ Home Tel # ________________________________________________ Email _______________________________________________________ Email _______________________________________________________ AUTHORIZED PICK UP AND EMERGENCY CONTACT INFO At dismissal and/or in case of an emergency, the following people are authorized to pick up my child: 1. Parent/Guardian 1: Yes □ No □ 2. Parent/Guardian 2: Yes □ No □ 3. Name ____________________________________________ Relation __________________________ Tel ____________________________ 4. Name ____________________________________________ Relation __________________________ Tel ____________________________ 5. Name ____________________________________________ Relation __________________________ Tel ____________________________ PARENT/GUARDIAN AGREEMENT I, the undersigned, give permission for my child to participate in all summer camp activities for the days he/she attends. I understand that no refunds or credits will be given for missed days under any circumstances. I understand that a completed medical form signed by the physician is required before my child may begin camp. In addition I am fully aware that all balances are due by the due date listed before my child may begin camp. I also hereby give authority to YMCA staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. In addition, in consideration of the good will, public service, and community aid provided by the YMCA of Greater New York, I hereby grant permission to the YMCA to use my child’s name, to take and publish photographs, video of him/her which include his/her voice and image, in any media for YMCA purposes. I release all rights to such photographs and video. I acknowledge that the YMCA will be the sole owner of all rights arising out of their use for all purposes. I understand that I shall receive no compensation from their use from any source whatsoever.

Parent/Guardian Signature _____________________________________________________ Date ____________________________


SUMMER DAY CAMP This program encourages campers to have fun while participating in group activities that develop creativity. Recreational activities, swimming lessons, theme days, arts-n-crafts, various sports, special events, challenge course activities and so much more are provided.

YOUTH CAMP Ages 6 - 12 • Sessions I - IV, Mini-Camp Rates: $385 per session Youth Camp balances scheduled and optional activities for boys and girls. Campers participate in a wide range of sports, instructional swimming, mini trips, arts and crafts, weekly themed days, environmental science and more. To facilitate academic success our recreational reading component is designed to help kids sharpen their reading skills throughout the summer months. Campers are paired with others within 2 years of their age range. For instance Unit I: Campers born in 2006 who are 6 years old or have completed Kindergarten. Unit II: Campers born in 2004 & 2005 who are 7 or 8 years old.

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YOUTH MINI-CAMP Ages 4.5 - 14 • Session Dates: August 27—31 Rate: $200 Calling boys and girls to the adventure of Mini Camp! As a group, mini campers will have fun while participating in group activities that develop creativity. Mini campers will be involve in recreational activities, arts-n-crafts, team sports, special events, treasure hunt and many traditional camp activities.


SPECIALTY SPORTS CAMPS Sports Camp is designed to provide children with a wonderful learning experience (socially, emotionally, and physically) using sports as its medium. The focus is to keep campers active, learning and playing a wide variety of sports and games. The YMCA Sports Camp will be organized and coordinated by a staff of YMCA professionals, counselors and experienced sports instructors. Sports Campers will also receive swimming lessons twice a week.

BOYS TEAM SPORT CAMP Ages 6 - 12 • Session I - IV Rates: $435 per session Baseball, Basketball, Soccer and Flag Football. Campers will learn basic fundamentals and rules for each of the sports. Each day of the week our staff will focus on one of the four sports. Our goal is to expose the children to a variety of sports. Camper should bring proper equipment for each sport.

GIRLS TEAM SPORT CAMP Ages 6 - 12 • Session I - IV Rates: $435 per session This summer Team Sports Camp will incorporate four popular sports for girls: Softball, Basketball, Soccer and Volleyball. Campers will learn basic fundamentals, rules and skills for each of the sports. Each day of the week our staff will focus on one of the four sports. Our goal is to expose the children to a variety of sports. Campers should bring proper equipment for each sport.

BASKETBALL CAMP Ages 6 - 12 • Sessions I - IV Rates: $435 per session Classes are based on appropriate age and level of play. All ability levels are welcomed. Offensive and defensive skills and team concepts develop the most complete basketball player possible.

MARTIAL ARTS CAMP Ages 6 - 12 • Session III & IV Rates: $435 per session In this camp, participants will learn techniques and positive characteristics such as self-respect, self-discipline, honor, and righteousness, Martial arts has been proven to be effective in defense situations. There will be an exhibition on the last day.

GYMNASTICS CAMP Ages 6 - 12 • Session I & II Rates: $435 per session Drills and skills in all Olympic events, following a progressive program. Dance, conditioning, stretching and performance tips will focus on fun for gymnasts of every level. The last day exhibition will give gymnasts an opportunity to show their new skills.

TENNIS CAMP Ages 6 - 12 • Session I - III Rates: $435 per session The Tennis Camp offers drills and activities carefully designed for different developmental levels so each camper will have a successful learning experience. The camp will focus on positioning, court layout and rules and regulations. The campers will also learn about the basic fore-hand and back hand strokes and compete in both singles and doubles activities. Campers must bring a racket and a sun visor or hat.


A SUMMER OF FUN

Each week of camp provides your child hands-on activities including educational field trips and theme days.

ART SPECIALTY CAMPS Cross Island YMCA Summer Arts Camp allows all young people, regardless of previous ability, to learn to design, paint, write, dance, and act. Using the amazing artistic resources along with YMCA partners with local artists, museums and theaters to offer a one of a kind summer arts experience!

PERFORMANCE ARTS CAMP Ages 6 - 12 • Sessions I - IV Rates: $435 per session Performance Arts Camp participants experience a wonderful summer of dance, drama, music & art. The summer activities include: swimming lessons, field trips to various museums and events, and projects that explore our weekly themes. Our outstanding staff will be teaching this multi-arts workshop in a fun and nurturing environment. Campers will learn all forms of dance from lyrical to hip-hop and try your hand at creating your own dances by learning the basics of choreography. In addition, campers will learn the fundamentals of acting, character study, and more, as they prepare to perform in a culminating production. Children will learn the ins and outs of theatre, do improvisation exercises, and even try script writing. The Arts improves self-esteem and total health. Join us for a fun and exciting camp experience which will culminate in a performance at each session's end.

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VISUAL ARTS/CRAFTS CAMP Ages 6 - 12 • Sessions I - IV Rates: $435 per session Visual Arts/Crafts summer camp program is designed for campers who wish to explore a variety of arts areas. Campers experience a vast array of creative arts, including sculpture, painting, collaging, scrapbooking, drawing, and more. This project based camp will give young artists hands on experience trying new mediums. Campers will make different art projects weekly, learn new skills, and develop lasting friendships in Visual Arts/Crafts Camp!


SUMMER CAMP FOR TEENS

TEEN SPORTS

TEEN CAMP

The Teen Sports camp gives active teens, both girls and boys the opportunity to practice teamwork and play competitive sports. The camp will also focus on teaching fitness and healthy lifestyles.

Ages 13 - 15 • Sessions I - IV Rates: $385 per session At the Cross Island YMCA, we recognize that teenagers have a variety of changing interests. This awareness provides the foundation for our approach to the 2012 camping experience for young adults. Teen Camp will have three major components: sports and recreation, visual and performing arts, and leadership training. All activities, trips, and additional programming will be an outgrowth of these three components.

TEEN TRIP Ages 11 - 15 • Sessions II - III Rates: $625 per session Join us as we go on a fun trip every single day of the session. Trips will not repeat, and campers will get to experience places they have never gone before! Come travel Long Island, Connecticut, and NYC each and every day! Please note: Campers in Trip Camp will not participate in swimming, as they will not be on site to do so. Lunch is not provided for this camp. Trip camp children need to provide their own lunch or bring money to purchase lunch on the trips.

Ages 13 - 15 • Sessions I - III Rates: $435 per session

COUNSELOR–IN-TRAINING Ages 16 - 17 • Sessions I - III Rate: $250 per session Cross Island YMCA’s CIT program is designed for tomorrow’s leaders that are interested in being a camp counselor someday. This is an opportunity you don’t want to miss! The CIT program has many advanced components. CIT’s learn much of the same material covered during our summer camp staff training. The CIT program is a great opportunity for exceptional campers to develop their leadership skills. The program will provide hands-on learning allowing teens to slowly work into responsible roles leading children. Staff will assist teens in developing their communication and organization skills. CIT candidates will be interviewed by our Camp Director.

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SUMMER CAMP FOR CHILDREN WITH SPECIAL NEEDS INCLUSION CAMP Ages 6 – 14 • Sessions I - IV Rate: $700 per session The Cross Island YMCA is extremely proud to offer our Inclusion Camp. This camp brings an inclusive recreational experience to children with disabilities. This unique camp gives children with special needs the same experience as other campers. Children with disabilities and their peers who are typically developing come together to participate in recreational activities such as swimming, arts and crafts, educational activities, reading, physical fitness and more. Camp counselors will serve as shadows—one counselor to every 2 campers.

LISA BETH GERSTMAN CAMP FOR CHILDREN WITH PHYSICAL CHALLENGES Ages 6 – 14 • Session A & B Rate: $650 per session The Cross Island YMCA is extremely proud to offer The Lisa Beth Gerstman YMCA Summer Day Camp program serving children with physical and developmental challenges in an integrated setting. Every child deserves the opportunity to participate in a safe, caring, and fun learning environment. Our goal is to develop each child’s spirit, mind, and body through quality driven programs. This special camp is made possible through the generous support of the Lisa Beth Gerstman Foundation. Its donation has offset the expenses of equipment, transportation and staffing required to serve youngsters with special needs. All children will receive wheelchair accessible transportation, one-on-one swimming instruction, adaptive physical activities and equipment. A nurse is also present both onsite and on field trips outside of the Y for children who require special care like catheterization and/or medication administration.

LBG DAY CAMP SESSION DATES

LBG DAY CAMP HOURS

Monday - Friday Session A July 9 - July 27 Session B July 30 - Aug. 17

9:00am - 4:00pm

LBG CONTACT INFORMATION 13

Jean Dattner at 718-551-9325, jdattner@ymcanyc.org Dianne DiPeri at 718-551-9319, ddiperi@ymcanyc.org


YOUTH & TEEN 2012 SUMMER DAY CAMP

REGISTRATION FORM

PARTICIPANT INFO Child’s Name ___________________________________________________ Age ______________ D.O.B ___________________ M □ F □ Address _____________________________________________________________________________________ Apt # _____________________ City _______________________________________________________________ State ___________________________ Zip _______________ School Name _______________________________________________________ Grade starting in Sept 2012 ___________________ Y Member? Y □ N □

T-Shirt Size

Child: XS □ S □ M □ L □ XL □ Adult: S □ M □ L □ XL □ 2XL □

PARENT/GUARDIAN INFO Guardian 1 Name ________________________________________ Guardian 2 Name ________________________________________ Relation __________________________________________________ Relation __________________________________________________ Work Tel # ________________________________________________ Work Tel # ________________________________________________ Mobile Tel # _______________________________________________ Mobile Tel # _______________________________________________ Home Tel # ________________________________________________ Home Tel # ________________________________________________ Email _______________________________________________________ Email _______________________________________________________ AUTHORIZED PICK UP AND EMERGENCY CONTACT INFO At dismissal and/or in case of an emergency, the following people are authorized to pick up my child: 1. Parent/Guardian 1: Yes □ No □ 2. Parent/Guardian 2: Yes □ No □ 3. Name ____________________________________________ Relation __________________________ Tel ____________________________ 4. Name ____________________________________________ Relation __________________________ Tel ____________________________ 5. Name ____________________________________________ Relation __________________________ Tel ____________________________ PARENT/GUARDIAN AGREEMENT I, the undersigned, give permission for my child to participate in all summer camp activities for the days he/she attends. I understand that no refunds or credits will be given for missed days under any circumstances. I understand that a completed medical form signed by the physician is required before my child may begin camp. In addition I am fully aware that all balances are due by the due date listed before my child may begin camp. I also hereby give authority to YMCA staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. In addition, in consideration of the good will, public service, and community aid provided by the YMCA of Greater New York, I hereby grant permission to the YMCA to use my child’s name, to take and publish photographs, video of him/her which include his/her voice and image, in any media for YMCA purposes. I release all rights to such photographs and video. I acknowledge that the YMCA will be the sole owner of all rights arising out of their use for all purposes. I understand that I shall receive no compensation from their use from any source whatsoever.

Parent/Guardian Signature _____________________________________________________ Date ____________________________


YOUTH & TEEN 2012 SUMMER DAY CAMP

SESSIONS AND FEES

PARTICIPANT INFO Child’s Name ___________________________________________________ Age ______________ D.O.B ___________________ M □ F □ Address _____________________________________________________________________________________ Apt # _____________________ City _______________________________________________________________ State ___________________________ Zip _______________ Home Phone ____________________________________________ Cell Phone ____________________________________________ CHECK ALL SESSIONS AND CIRCLE ALL PRICES THAT APPLY TO YOU Youth Camps

Specialty Camps

Youth (Units 1-4) & Teen Camp □ Session I 7/02 - 7/13 □ Session II 7/16 - 7/27 □ Session III 7/30 - 8/10 □ Session IV 8/13 - 8/24 □ Mini Camp 8/27 - 8/31

Additional Services Extended Hours Session I Sessions II, III, IV

Basketball Camp □ Session I 7/02 - 7/13 □ Session II 7/16 - 7/27 □ Session III 7/30 - 8/10 □ Session IV 8/13 - 8/24

$391 $435 $435 $435

Crafts Camp □ Session I □ Session II □ Session III □ Session IV

7/02 - 7/13 7/16 - 7/27 7/30 - 8/10 8/13 - 8/24

$391 $435 $435 $435

Boys Team Sports Camp □ Session I 7/02 - 7/13 AM only PM only Both □ Session II 7/16 - 7/27 $81 $81 $162 □ Session III 7/30 - 8/10 $90 $90 $180 □ Session IV 8/13 - 8/24

$391 $435 $435 $435

Performance Arts Camp □ Session I 7/02 - 7/13 □ Session II 7/16 - 7/27 □ Session III 7/30 - 8/10 □ Session IV 8/13 - 8/24

$391 $435 $435 $435

$346 $385 $385 $385 $200

Girls Team Sports Camp 7/02 - 7/13 AM only PM only Both □ Session I □ Session II 7/16 - 7/27 Session I $112 $112 $224 □ Session III 7/30 - 8/10 Sessions II, III, IV $125 $125 $250 □ Session IV 8/13 - 8/24 Fees Martial Arts Camp (9 Days) Session I $______________________ □ Session III 7/30 - 8/10 Session II $______________________ □ Session IV 8/13 - 8/24 Transportation (ages 6+ only)

Session III $______________________ Session IV $______________________ Mini Camp $______________________ — Discounts $______________________ Extended Hours (Rate multiplied by # of sessions)

Transportation (Rate multiplied by # of sessions)

$50 Registration Fee (applies to non-members only)

$______________________ $______________________ $______________________

Grand Total $______________________

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$391 $435 $435 $435

$435 $435

Gymnastics Camp □ Session I 7/02 - 7/13 $391 □ Session II 7/16 - 7/27 $435 Tennis Camp □ Session I □ Session II □ Session III

7/02 - 7/13 $391 7/16 - 7/27 $435 7/30 - 8/10 $435

Teen Trip Camp □ Session II 7/16 - 7/27 $625 □ Session III 7/30 - 8/10 $625 Teen Sports □ Session I 7/02 - 7/13 $391 □ Session II 7/16 - 7/27 $435 □ Session III 7/30 - 8/10 $435 Counselors In Training □ Session I 7/02 - 7/13 $225 □ Session II 7/16 - 7/27 $250 □ Session III 7/30 - 8/10 $250 Lisa Beth Gerstman Camp □ Session A 7/09 - 7/27 $650 □ Session B 7/30 - 8/17 $650 Inclusion Camp □ Session I □ Session II □ Session III □ Session IV

7/02 - 7/13 7/16 - 7/27 7/30 - 8/10 8/13 - 8/24

No camp will be held on July 4th. Session I rates have been prorated. Sessions may be split. A non-refundable deposit of $100 per session is required at the time of registration. A $50 non-refundable registration fee is required for campers who are not YMCA members. Accepted forms of payment are cash or credit card. Financial Aid is available to those that qualify. Forms are available at the Members Services Desk.

$630 $700 $700 $700


YOUTH & TEEN 2012 SUMMER CAMP

MEDICAL FORM

PARTICIPANT INFO Child’s Name ____________________________________________________________ Age _________________ D.O.B _____________________________ Address _________________________________________________________________________________________________ Phone _______________________ Guardian Name _____________________________________________

Phone: _______________________________________________

Place of Employment (Mother) ______________________________________________________ Phone _____________________________________ (Father) _______________________________________________________ Phone _____________________________________ In Case of Emergency, notify: _________________________________________________________ Phone _____________________________________ If Parent or Guardian is not available in an emergency, notify: 1. Name _______________________________________________ Relation _______________________________ Tel __________________________________ 2. Name _______________________________________________ Relation _______________________________ Tel __________________________________ * Has this camper ever been exposed to any communicable disease during the three weeks prior to camp attendance? Yes □ No □

(If yes, state type of exposure: ______________________________________________________________)

HEALTH HISTORY (Check, giving approximate dates) ILLNESSES

□ Rheumatic Fever □ Seizures □ Diabetes □ Asthma □ Chicken Pox □ Ear Infections

ALLERGIES __________________________ __________________________ __________________________ __________________________ __________________________ __________________________

□ Hay Fever □ Poison Ivy □ Insect Stings □ Penicillin □ Other Drugs ____________________________________________________ □ Food _______________________________________________________________

Other Past Illnesses

_________________________________________________________________________________________

Operations or Serious Injuries (& dates)

_________________________________________________________________________________________

Hospitalizations (& dates)

_________________________________________________________________________________________

Chronic and Recurring Illnesses

_________________________________________________________________________________________

Any specific activities to be encouraged?

_________________________________________________________________________________________

Conditions that require activity to be restricted? _______________________________________________________________________________ Permission for all program activities unless otherwise noted by Dr. _________________________________________________________ Appliance worn (glasses, contacts, etc.) Medication taken

_________________________________________________________________________________________

_________________________________________________________________________________________

Additional Suggestion from Parent/Guardian _____________________________________________________________________________________

CONSENT FOR EMERGENCY MEDICAL TREATMENT I do hereby give authority to the Cross Island YMCA Summer Day Camp to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. Signature ________________________________________________________

Relationship ______________________________________________________

Phone # _________________________________________________________

Date ________________________________________________________________

Department of Health and Mental Hygiene— The City of New York — Bureau of Food Safety and Community Sanitation

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PHYSICAL EXAMINATION To be filled out by your child’s physician

The purpose of this health record is to provide the staff with pertinent information which will help to serve the needs of this child in Summer Day Camp and other Cross Island Y programs.

IMMUNIZATION HISTORY Record of dates of basic immunization and most recent booster doses

□ DTap, DTP, TD Date __________ Date __________ □ Polio Date __________ □ MMR □ Hem. Influenza type B □ Hepatitis B Date __________ Date __________ □ Varicella □ Pneumococcal Conjugate (PCV) □ Other ________________________________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________ Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

Date __________

MEDICAL EXAMINATION to be filled out by licensed physician. Examination is acceptable when performed no more than 9 months prior to arrival at camp. Code: S = Satisfactory X = Non Satisfactory (explanation required) O = Not Examined General Appearance ___________________________________________________________________________________________________________________ Height __________

Weight __________

Blood Pressure __________

Hgb Test (Date) __________

Urinalysis (Date) _________

Eyes

__________

Vision __________

w/Glasses

__________

Posture/Spine

__________

Throat/Tonsils

_________

Heart

__________

Ears

__________

Hearing

__________

Extremities

__________

Feet

_________

Lungs

__________

Skin

__________

Nose

__________

Teeth

__________

Hernia

_________

Abdomen __________ Genitalia __________ Neurological Findings _____________________________________________________________________________________________________________________________ Describe Abnominal Findings and/or Handicapping Conditions __________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________ Allergy (please specify) __________________________________________________________________________________________________________________________ Recommendations and restrictions while in camp: Special Diet _________________________________________________________________________________________________________________________________________ Special Medicine (name, dose, administration) _____________________________________________________________________________________________ Swimming _______________________________________________________ Activity Restriction _________________________________________________________ General Appraisal __________________________________________________________________________________________________________________________________

I have examined the person herein described, reviewed his/her health history and it is my opinion that he/she is physically able to engage in Summer Day Camp. ____________________________________________________________M.D. Physician’s Name (Please Print)

____________________________________________________________M.D. Examining Physician (Signature)

Address ___________________________________________________________________________________________________________________________________ Date of Examination ______________________________________________________

Phone # __________________________________________

Department of Health and Mental Hygiene— The City of New York — Bureau of Food Safety and Community Sanitation

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THE NEXT ADVENTURE New York YMCA Sleepaway Camp Boys and Girls (Ages 6 – 16) Located 86 miles northwest of Manhattan, the New York YMCA Camp is a globally diverse community built upon the YMCA core values of caring, honesty, respect and responsibility. Here each child enjoys adventures, new friendships and joyful experiences. Campers are secure in our bully-free camp from day one. Children are always supervised by highly trained counselors. Friendships are immediately fostered through teambuilding and cabin activities. By supporting each camper and cabin group, our counselors help campers form the life-long relationships for which our camp is known.

• Sports

• Horseback Riding

• Performing Arts

• Outdoor Life Skills

• Swimming

• Boating

• Waterskiing

• Tubing

• Arts

Call us toll free at 877-30-YCAMP or visit us online ww.newyorkymcacamp.org to learn more.

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238-10 Hillside Ave. Bellerose, NY 11426 (718)479 - 0505 Www.facebook.com/CrossIslandYMCA www.ymcanyc.org/crossisland

Cross Island YMCA

Cross Island YMCA 2012 Summer Camp Guide  

Cross Island YMCA 2012 Summer Camp Guide

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