where summer comes to life - … summer comes to life. 2 ymca staff all about mr. jim! with 18 years...

SUMMER DAY CAMPS 2018 tricommunityYMCA.org / 508.765.5466

TRI-COMMUNITY YMCA

WHERE SUMMERCOMES TO LIFE

2

YMCA STAFFAll About Mr. Jim! With 18 years of experience working at Camp Foskett, Jim has worked as a Camp Counselor, Project Adventure Director, CIT Program Director, and Assistant Camp Director. His side job for 11 years is a music teacher and band director at Shepherd Hill High School, in the Dudley-Charlton School District. Jim has a bachelor’s degree in Music Education from the University of Massachusetts and a master’s degree in Conducting from Sam Houston State University in Texas.

Hiring Requirements We have a comprehensive pre-employment screening procedure that includes: ✓YMCA job application

✓Minimum of 3 checked references ✓Personal interview with YMCA supervisors

✓CORI/SORI checks

✓Minimum age is 16

Staff Certifications ✓Current CPR, First Aid and AED certification

✓Specialty staff (i.e. Lifeguards) must maintain certifications specific to their program area.

Staff Training All staff are required to successfully complete a program-specific orientation focusing on discipline, supervision, staff/camper participation, policies, procedures, Y Staff Code of Conduct and child abuse prevention.

Staff: Camper Ratios School Age - 1:10 • Preschool - 1:5

YMCA Staff Policies: ✓To protect Y staff, volunteers & program participants, the Y recommends that at no time during a Y program may a staff person be alone with a single child where they cannot be observed by others.

✓Staff shall never leave a child unsupervised.

✓Staff must use positive techniques of guidance, including re- direction, positive reinforcement and encouragement rather than

competition, comparison and criticism.

✓Staff will have age-appropriate expectations and set up guide- lines and environments that minimize the need for discipline.

✓Staff respond to children w/ respect, consideration and treat all children equally, regardless of sex, race, religion or culture.

✓Staff will serve as positive role models for youth by performing duties with respect, loyalty, patience, courtesy, tact and maturity.

✓Staff may not be alone with children they meet in YMCA programs outside of the YMCA. This includes babysitting, sleepover and inviting children to your home. Any exceptions require a written explanation before the fact and are subject to administrator approval.

✓Staff are not to transport children in their own vehicles. Any exceptions require supervisor approval.

✓Staff communicates with parents regarding day-to-day activities and encourage parents to report or question any behavior or event their child may share that appears out of the ordinary.

✓Parents can visit, unannounced, any program their child participates in.

TABLE OF CONTENTS YMCA Staffing ..……………………..….…… 2

Calendar ……………………..……...… 3

Camp Foskett ……………………..……...… 4 - 5

Transportation ……………………….…..….. 6

Scamper Camp ………………………………..…. 7

Summer Fun Club …………………..……….... 8 - 9

Town Pool ……………….…………………..... 10

Registration ………………………..…………..... 11

Camper Information ………….... 12

Session Dates & Rates …….….... 13

Transportation ……………………. 14

Health Form ..…………………....…. 15

Open House …………………………………….…. 16

Tri-Community YMCA

P: 508-765-5466 / F: 508-765-5894

W: www.tricommunityYMCA.org

Camp Foskett

P: 508-248-7541 (July 9- August 24)

C: James Flynn, Camp Foskett Director

[email protected] (Monday - Friday, 8:30 a.m. - 3:30 p.m.)

Dear YMCA Friend,

We’re ready for the warm weather! Join the Tri-Community YMCA for your summer day camps. Inside you will find everything you want to know.

Summer is a time to meet new friends and reconnect with old friends. The Y summer camps foster building relationships and having fun in a safe and supportive environment. Join us and experience all the excitement of our summer programs. Whether its canoeing on a lake, learning to swim, mountain bike riding, field trips, songs, skits, a friendly game of basketball, or just hanging out with your friends. The Y has something for everyone!

Our programs are available for all children ages 3-15 and we encourage you to get out and get active!

Yours in Health,

Glenn R. Juchno, Executive Director Tri-Community YMCA

Welcome to the Tri-Community YMCA Summer Day Camps 2018

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“My child’s

confidence level

went through

the roof!”

- Justin

TRI-COMMUNITY YMCA 2018 DAY CAMP CALENDAR

JUNE

S M T W T F S

1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

JULY

S M T W T F S

1 2 3 *4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

AUGUST

S M T W T F S

1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

Sunday June 3 Camp Foskett

OPEN HOUSE

Week A June 25 - 29 (SFC Only)

Week B* July 2 - 6 (SFC Only)

Week 1 July 9 - 13

Week 2 July 16 - 20

Week 3 July 23 - 27

Week 4 July 30 - August 3

Week 5 August 6 - 10

Week 6 August 13 - 17

Week 7 August 20 - 24 * No Camp on July 4th

“Our children absolutely loved the program, and I appreciated the fact that they woke up every morning excited about going.”

- Meredith

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DAY CAMP HOURS Monday - Friday: 9:00 a.m. until 3:30 p.m.

PHONE NUMBER Camp Foskett: 508-248-7541 Phone in operation only during summer camp from

July 10 to August 25; from 8:30 a.m. until 3:30 p.m.

EXTENDED CARE Monday - Friday: 6:45-8:00 a.m. and 5:00-6 p.m.

To help busy parents out, we included an Extended

Care Program. This program provides supervision for

your child and breakfast for those early morning drop

offs (until 8:00 a.m.). There is no need to sign up for

Extended Care, but you must purchase a punch card at

the Front Desk:

*Extended Care is available ONLY atthe YMCA in Southbridge

1 visits for $5

5 visits for $25

10 visits for $40

MEDICAL REQUIREMENTS A health form MUST be completed and returned to the

YMCA the Friday before attending Camp. The Health

Form REQUIRES a Doctor’s signature on immunization

history only. The rest of the form may be completed and

signed by a parent.

*Campers cannot attend without completed health andregistration forms on file at the YMCA

CAMP FOSKETT

CAMP FOSKETT is located on 189 Daniels Road

in Charlton, MA on the beautiful South Charlton

Reservoir, with 114 acres of forested land and

wide open fields, and sanded beach area for daily

aquatic activities.

DAY CAMPERS Ages (5-12)

We provide a safe, affordable and fun day camp for elementary school children, age 5-12. Our summer program provides a range of activities to attract every-one’s interest. Kids enjoy a summer full of nature, water fun, games, sports, arts & crafts and new friendships.

When: Monday – Friday, 9:00 a.m. – 3:30 p.m.

Where: YMCA Camp Foskett, Charlton, MA

Fees: Members $150/wk; Non-members $200/wk

SENIOR CAMPERS Ages (13-14)

Our senior camping program offers older campers a chance to continue & expand on their camping experience. Program includes field trips around south-ern New England and participation in mountain biking. All trips are included in fee. Senior campers must demonstrate good behavior to qualify for trips.




C.I.T. PROGRAMAges (15)

Our C.I.T. program offers our oldest campers a chance to learn from Camp Foskett staff & take on more responsibilities. C.I.T.’s will learn life skills like leadership & communication. This program includes field trips to points of interest around southern New England, which are included in the fee. CIT’s must demonstrate good behavior to qualify for field trips.



Fees: $110/week

Camp Foskett

Open House Sunday, June 3rd 12 p.m. - 4 p.m.

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• Sunscreen• Bug Spray• Closed toed shoes

only - NO Sandals• Money for Camp Store

WHAT TO BRING • Swimsuit• Towel• Water Bottle• Play Clothes• Lunch & Snacks

Please LABEL everything you send to

camp with your child’s name. Things that

are brought to camp are the sole responsibility

of the camper. Camp staff cannot be held

responsible for lost or stolen items.

All campers should wear regular play clothes

and sneakers. PLEASE do not send camp-

ers in sandals, open-toed shoes, or crocs

at camp! Parents should send children with

appropriate cold & wet weather clothing.

CAMP FOSKETT

PROGRAMS & ACTIVITIES

At Camp Foskett every camper is encouraged

to participate in the following activities:

A TYPICAL DAY INCLUDES:

• Swim lessons & recreational swim

• Boating, canoeing & kayaking

• Outdoor cooking

• Sports

• Themed activities

• Arts & crafts

• Nature / hiking

• Brain Games

• Creative Building

• *NEW ZIPLINE ELEMENT

OLDER CAMPERS (9+ years)

• Fishing

• Archery

EXPLORE, DISCOVER AND GROW!

CAMPERS CHOICE

Campers will now have the ability to choose (either as a

group for younger campers, or an individual for older

ones) an activity of their choice to participate in.

Activities may include: Project Adventure, Boating,

Newspaper, Archery, Biking, Outdoor Cooking, Dance,

Arts and Crafts, etc.

LUNCH Pack a lunch daily from home, preferably packed in a

disposable bag with the child’s name on it (lunch boxes

tend to be forgotten). Lunches are refrigerated until

lunch time. Send your child with a drink, or a water

bottle to refill. PLEASE LABEL EVERYTHING.

CAMP STORE At both Camp Foskett & Summer Fun Club the camp

store will run daily featuring camp t-shirts, drawstring

bags, and other camp apparel. Additional pre-packaged

snacks and drinks are also available for purchase.

FAMILY NIGHTS Families of Camp Foskett Campers are invited to join us from 6:00-8:00 p.m. on the following dates: July 19, August 2 and 16

At Camp Foskett 189 Daniels Road, Charlton

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Transportation is provided from pre-determined stops

selected for their convenience and safety. Children

should be supervised at the bus stops at all times by a

responsible person. The camp provides a ‘bus monitor’

who is responsible for the personal safety, attendance

and behavior of the campers. Times given are

approximate and a 5-10 minute variance either way is

reasonable. It is the responsibility of the parent or

guardian to meet your child at the bus stop, per the listed

bus schedule.

Camp Foskett will only release campers to adults listed

on the registration under “Authorized Pick Up”. All adults

must provide a photo State I.D. at the time of pick up. If

you do not meet your child per the schedule, your child

will be transported to the Y and be supervised by camp

staff. Children will not be left unsupervised at bus stops.

BUS #1 HOLLAND - STURBRIDGE A.M. / P.M.

A. 7:50 / 4B. St. Anne’s Church Driveway, Rte 148 8:05 / C. 8:20 / D. YMCA 8:40 /

BUS #2 SOUTHBRIDGE - WEBSTER - DUDLEY

A.M. / P.M.

A. 7:35 / B. Bud’s Country Store 7:55 / C. 8:15 / D. Park Avenue School 8:25 / E. North Village Entrance 8:35 / 4:55 F. Shotokan Karate Academy Parking Lot 8:50 / 5:15

BUS #3 BROOKFIELD - SPENCER - CHARLTON

A.M. / P.M.

A. Old Lashaway School (Brookfield) 7:55 / B. Spencer Big Y 8:05 / C. 8:15 / D. Charlton Library 8:40 /

CAMP FOSKETT

To and From Camp Foskett ONLY (All other programs require parent drop off & Pick up) **Bus Transportation NOT provided for Scamper Camp

DIRECTIONS:

From Southbridge:

Go past Big Y on East Main St. Turn left and go over bridge onto Dresser Hill Road. Turn left at the stop sign. Go to the next stop sign. Turn right and go up Saundersdale. At the next stop sign, continue straight across inter-section onto Schoolhouse Road. Take the sescond right onto Daniels Rd. Camp Foskett is 1.7 miles down Daniels Road on the left.

From Sturbridge:

From Route 20, once into Charlton, turn right onto Masonic Home Road. Continue up the road until you get to a stop sign, turn right onto Route 31, Main St in Charlton. Go through the center of Charlton. Take a left onto Muggett Hill Road. Go past Bay Path High School. Take the first right after Bay Path onto Bond Road. Go to the end of Bond Rd. Bear left before the stop sign as the road quickly forks. Continue straight across onto Daniels Road. Camp Foskett is 1.7 miles down Daniels Road on the left.

From Webster/Dudley:

From Main Street, Route 197 in Dudley. Turn at Dudley Fire Station on to the end of Mason Road. Turn left at the stop sign and go past Shepherd Hill High School. Turn right at the next stop sign onto Ramshorn Road. Follow Ramshorn Road approx. 2.2 miles. Turn right onto Barrett Road. Camp Foskett is .7 miles down Barrette Road on the right-hand side.

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At Camp Foskett 189 Daniels Road, Charlton Busing is NOT provided for our Scamper Campers.

SCAMPER CAMP 3-Day Program Monday, Wednesday, Friday

from 9:00 a.m. - 1:00 p.m. $71/wk - Members

$96/wk - Non-members

Boys and Girls Ages 3-5

SWIMMING

Two 40-minute swim sessions are provided weekly,

and one boating session. Swim sessions include basic

instruction in swimming with a focus on water safety,

presented in a fun, recreational way. Swim teachers are

YMCA and Red Cross Certified Lifeguard and Water

Safety Instructors and are certified in CPR and First

Aid. Bring a labeled bathing suit and towel in a plastic

bag. Campers will use the waterfront and swim in

South Charlton Reservoir.

ARTS AND CRAFTS

Painting, collage and other “open-ended” activities are

offered to promote creativity& fun!

WHAT TO BRING

Sunscreen, Bug Spray, change of clothes in case of an

accident. Bring a labeled bathing suit and towel in a

plastic bag. PLEASE no sandals, open-toed shoes, or

crocs at camp! Pack a lunch each day.

SNACKS

A snack will be offered during each camp session.

Snacks consist of a variety of crackers, freeze-pops,

juice and more. Cold drinking water is provided, but a

water bottle to refill is recommended.

REGISTRATION

Children must be 3 years old, able to dress themselves,

and completely toilet trained. Diapers, pull-ups and

training pants are not acceptable at Scamper Camp.

All fees must be paid in full at the time of registration.

Fees are non-refundable. Scamper Camp meets at

Camp Foskett in Charlton on the 2nd floor of the office

beginning at 9:00a.m. and ending at 1:00p.m.

Session #1: July 9 – 13

Treasure Hunters

Session #2: July 16 - 20

Animal Planet

Session #3: July 23 - 27

Camp Spirit Week

Session #4: July 30 – August 3

Animation Domination

Session #5: August 6 - 10

Carnival


Holiday Hullabaloo


Bon Voyage Summer

*Min. of 6 campers required torun each session week.

Note: Week #7 will ONLY run if Camp Foskett is also running.

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DAY CAMP HOURS Monday - Friday: 8:00 a.m. until 5:00 p.m.

PHONE NUMBER Tri-Community YMCA: 508-765-5466

EXTENDED CARE Monday - Friday: 6:45-8:00 a.m. and 5:00-6 p.m.

To help busy parents out, we included an Extended

Care Program. This program provides supervision for

your child and breakfast for those early morning drop

offs (until 8:00 a.m.). There is no need to sign up for

Extended Care, but you must purchase a punch card at

the Front Desk:

*Extended Care is available ONLY atthe YMCA in Southbridge

1 visits for $5

5 visits for $25

10 visits for $40

MEDICAL REQUIREMENTS A health form MUST be completed and returned to the

YMCA the Friday before attending Camp. The Health

Form REQUIRES a Doctor’s signature on immunization

history only. The rest of the form may be completed and

signed by a parent.

*Campers cannot attend without completed health andregistration forms on file at the YMCA

SUMMER FUN CLUB

DAY CAMPERS Ages (5-13) *must have completed kindergarten

We provide a safe, affordable and fun day camp for

elementary school children, age 5-12. Our summer

program provides a range of activities to attract every-

one’s interest. Kids enjoy a summer full of nature, water

fun, games, sports, arts & crafts and new friendships.


Where: Tri-Community YMCA, Southbridge, MA


C.I.T. PROGRAMAges (14-15)

Our C.I.T. program offers our oldest campers a chance

to learn from Camp Foskett staff & take on more

responsibilities. C.I.T.’s will learn life skills like leadership

& communication. This program includes field trips to

points of interest around southern New England, which

are included in the fee. CIT’s must demonstrate good

behavior to qualify for field trips.


Where: Tri-Community YMCA, Southbridge, MA

Fees: $110/week

At the Tri-Community YMCA 43 Everett Street, Southbridge Busing is not available for Summer Fun Club

* Note: The Tri-Community YMCA isclosed on Wednesday, July 4th

5-Day Program Monday through Friday

from 8:00 a.m. - 5:00 p.m. $150/wk - Members

$200/wk - Non-members

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SUMMER FUN CLUB

Each day offers fun And new challenges!

Campers Ages 5-12 (Must have completed kindergarten)

“Fun” Activities”

Swim Lessons

Recreational Swims

Rock Wall Climbing

Arts & Crafts

Drama/Skits

Sports

Games

Field Trips every week

Swim Instruction

Scheduled each day. Campers are tested

and placed into classes based on ability. Our

swim time provides instruction for beginners,

intermediate and advanced swimmers as

outlined by the National YMCA program.

All Tri-Community YMCA camps comply with regulations of the MA DPH and are licensed by the local Board of Health.

*Campers will NOT be excused from swimunless parents speak with office staff.

SUMMER ADVENTURE

LUNCH *Free Lunch will NOT be provided this year.Pack a lunch daily from home, preferably packed in a disposable bag with the child’s name on it (lunch boxes tend to be forgotten). Send your child with a drink, or a water bottle to refill.

WHAT TO BRING • Swimsuit• Towel• Water Bottle• Play Clothes

• Lunch & Snacks• Sunscreen• Closed toe shoes

only - NO sandals

Please LABEL everything you send to camp with your child’s name. Things that are brought to camp are the sole responsibility of the camper. Camp staff cannot be held responsible for lost or stolen items.

All campers should wear regular play clothes and sneakers. PLEASE do not send campers in sandals, open-toed shoes, or crocs at camp! Parents should send children with appropriate cold & wet weather clothing.

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A.J. PETRO POOL

SPLISH, SPLASH FAMILY FUN

LOCATION A.J. Petro Town Swimming Pool

15 Randolph Street

Southbridge, MA 01550

PHONE NUMBER A.J. Petro Pool: 508-764-2709

Phone in operation only during Town Pool summer

days from June 23 to August 19, 2018.

DAILY ADMISSION $5 Adults (18+)

$3 Ages 3-17 & Seniors (65+)

FREE Children ages 2 and under

SUMMER SEASON PASSES:

$40 Family (2 Adults + 4 kids)

$10 Each added person- Family

$20 Single Adult Pass (18-64)

$10 Children (3-17) & Seniors

*Children under 12 MUST bewith an adult (age 18+)

DIRECTIONS:

From the WEST: Follow Route 131 east towards

Main Street in Southbridge. At the rotary, take the

2nd exit onto Mechanic Street for 0.6 miles. Turn

right onto Randolph Street and Pool is on the left.

From the EAST: Follow Route 20 west to Route

169 South in Charlton for 4.8 miles. Turn left onto

Randolph Street and Pool is on the left.

From the SOUTH: Follow Connecticut Route 169

north into Massachusetts. Turn left onto Route 131

west. At the rotary, take the first exit onto Mechanic

Street for 0.6 miles. Turn right onto Randolph

Street and Pool is on the left.

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REGISTRATION

How to Register: Fill out all 4 sides of the Registration Packet completely, using

one form per child (additional copies are available at the YMCA).

Place an “X” in the box that indicates which camp(s) and week(s)

your child is applying for. Please note that not all camps run for a full

day. Check descriptions for details. Drop off the complete package, including application and payment for each session you registered

for at the YMCA. Registration for additional camp weeks should be

made by the previous Wednesday with accompanying payment.

Weeks must be paid in full at registration to reserve space. Parents

are strongly encouraged to take advantage of this opportunity.

Refunds and Transfers: If you need to change your summer camp plans, you can transfer

your child to another session at no charge, provided that space is

available. Full refund will only be considered with a doctor’s note. All

other refunds will be issued in form of a credit to be used for other Y

programs. 50% of the camp fees are nonrefundable. Refunds and transfers must be approved by the Camp Director. Refunds will not

be given in the event of early dismissal for misconduct.

YMCA Membership: As a member of the Tri-Community YMCA, your child will receive

the lowest camp rates available. Please note: Only memberships

which are paid through September 2018 qualify for the YMCA

Member Camp rate. Summer memberships do not qualify for the

discounted rate. If your Family or Youth Membership expires prior to September, only those weeks preceding the expiration date qualify

for the discount. This may mean renewing in advance to qualify for

additional weeks. A twelve-month youth membership is only $103.00

if paid in full. Family and adult memberships are also available.

Cancellation: If Camp Foskett is closed early due to severe weather, every attempt will be made to contact parents by phone, as well as

announce the early closing on the Tri-Community Y’s website

(tricommunityymca.org) & Facebook pages. If we are unable to

contact a parent, your child will be transported to the YMCA at 43

Everett Street in Southbridge and supervised by camp staff.

Payment Information: Camp Foskett requires a minimum 50% non-refundable deposit per

child per week. Camp Foskett July sessions must be paid in full by

June 1. Camp Foskett August sessions must be paid in full by

July 1. Scamper Camp and Summer Fun Club, must be paid in

full at the time of registration.

FINANCIAL ASSISTANCE:

Assistance is based on a sliding fee

scale and available for all Summer

Camp programs. Contact the

YMCA Front Desk or visit our

website tricommunityymca.org for

more information and to receive an

application. The Tri-Community

YMCA strives to make summer

camp available to people of all

socio-economic levels. We believe

that individuals who participate in Y

programs strengthen their spirit,

mind, and body. While participants

are expected to pay their fair share,

financial support for summer camp

is available. The amount of financial

assistance is based on family size,

gross income, and the YMCA’s

available funding. Financial support

is made possible by the YMCA

friends and families throughout

annual support campaign, United

Way, and private donations.

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CAMPER INFO

Child’s Information:

Last Name: ____________________________________________ First Name: _____________________________________________ MI: __________________

Gender: Female Male N/A Date of Birth: ________________________ Age by 6/20/18: _____________

Nickname: ____________________________________________________________ Grade Entering Fall 2018: ______________________________________

Address: _______________________________________________ City: ____________________________________ State: __________ Zip: _________________

Primary Phone: ____________________________________ YMCA Member Non-Member Exp. Date: _______________________

Emergency Name & Phone (if different from Home No.) ____________________________________________________________________________

T-Shirt Size: YS _____ YM _____ YL _____ Adult SM _____ Adult MD _____ Adult LG _____ Adult XL _____ Adult XXL _____

**Additional shirts available for purchase at $10 each

Parent(s) /Guardian(s) Information:

Parent/Guardian: _________________________________________________________ Relationship: ________________________________________________


Primary Phone #: _______________________________________ Email:

Place of Employment: _______________________________________________ Work Phone: __________________________________________________

Parent/Guardian: _________________________________________________________ Relationship: ________________________________________________


Primary Phone #: _______________________________________ Email:

Place of Employment: _______________________________________________ Work Phone: _________________________________________________

Person or agency having legal custody: ______________________________________________________________________________________________

Address if different from above: _______________________________________________________________________________________________________

I receive financial assistance from the Tri-Community YMCA (Award Letter is required). I receive financial assistance from another agency/org (proof of assistance must be presented with application)

Name of Organization ___________________________________ Contact __________________________________Phone ____________________________

Camp Waiver: In consideration for services rendered by the Tri-Community YMCA and acceptance of the undersigned in programs provided by the Tri- Community YMCA, I hereby release for myself, my child, my heir, executors and administrators, any and all right and claim for damage I may have against the Tri-Community YMCA, their agents, representatives or assignees, for any and all injuries suffered by me, my child or family. I also understand that Health and Accident Coverage are not provided by the Tri-Community YMCA and that it is my responsibility to obtain the same. The Tri-Community YMCA is founded on Christian principles and prohibits inappropriate behavior and conduct. This includes, but is not limited to profanity or abusive language or attire, smoking, use of alcohol or drugs, the removal of the YMCA property and criminal conduct of any type. Such inappropriate behavior or conduct is unacceptable and the YMCA consequently retains the right to deny membership to its applicants and to revoke a membership of any current member or participant at its sole discretion. I understand that my membership is non-refundable, nor trans-ferable to other people.

The following is mandatory, please initial: _______ I understand that no part of the camp fee is refunded in the event of early dismissal for misconduct.

The following is optional, please check if apply:

I give my permission to the YMCA to use my child’s picture in the YMCA publicity and media promotions.

Parent/Guardian Signature _____________________________________________________________ Date __________________________________________

FOR OFFICE USE ONLY

Date Received:

Front Desk Initials

All Documents Attached Yes or No

Date Info Entered:

Date Confirmation Sent:

Applications will not be accepted without payment.

All individuals receiving assistance must provide proof of

assistance.

*PLEASE PRINT

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SESSION DATES & RATES

PAYMENT INFORMATION

Payment Type (check):

Cash / Check

Scholarship

Credit Card

VISA

AMEX

MC

DISCOVER

Check Total $ _______________________ Cash Total $ __________________________

Credit Card Total $ ____________________ Scholarship Total $ _____________________

Credit Card # _________________________________________________ Exp. Date ___________

Name as it appears on Credit Card ____________________________________________________

Signature ______________________________________________________ Date ______________

TOTAL FEES DUE: $ _________________________________

Place an “X” in the box that indicates which session (s) you are enrolling your child.

Summer Fun Club

❑ Session A: June 25-June 29 $150/$200 wk

❑ Session B: July 2-3, 5-6 $120/$160 wk

❑ Session 1: July 9-13 $150/$200 wk

❑ Session 2: July 16-20 $150/$200 wk

❑ Session 3: July 23-27 $150/$200 wk

❑ Session 4: July 30-Aug 3 $150/$200 wk

❑ Session 5: August 6-10 $150/$200 wk



Summer Fun Club CIT (14 & 15 )

❑ Session A: June 25-June 29 $110/ wk

❑ Session B: July 2-3, 5-6 $88/ wk

❑ Session 1: July 9-13 $110/ wk



❑ Session 4: July 30-Aug 3 $110/ wk

❑ Session 5: August 6-10 $110/ wk



Scamper Camp (3 - 5 )

❑ Session 1: July 9-13: M-W-F $71/$96/wk



❑ Session 4: July 30-Aug 3: M-W-F $71/$96/wk

❑ Session 5: Aug 6-10: M-W-F $71/$96/wk



Camp Foskett (5-12 )

❑ Session 1: July 9-13: M-F $150/$200 wk



❑ Session 4: July 30-Aug 3: M-F $150/$200 wk

❑ Session 5: Aug 6-10: M-F $150/$200 wk

❑ Session 6: Aug 13-17: M-F $150/$200 wk

❑ Session 7: Aug 20-24: M-F $150/$200 wk

Senior Campers (13-14 )

❑ Session 1: July 9-13: M-F $165/$215/wk



❑ Session 4: July 30-Aug 3: M-F $165/$215/wk

❑ Session 5: Aug 6-10: M-F $165/$215/wk

❑ Session 6: Aug 13-17:M-F $165/$215/wk

❑ Session 7: Aug 20-24:M-F $165/$215/wk

Camp Foskett CIT (15 )

❑ Session 1: July 9-13: M-F $110/wk



❑ Session 4: July 30-Aug 3: M-F $110/wk

❑ Session 5: Aug 6-10: M-F $110/wk

❑ Session 6: Aug 13-17:M-F $110/wk

❑ Session 7: Aug 20-24:M-F $110/wk

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TRANSPORTATION & AUTHORIZED PERSONS

ARRIVAL TRANSPORTATION ( ✓ one)

Parent will drop off at Camp Foskett

Parent will drop off at all YMCA Day Camps

AM Extended Care @ YMCA

Program bus for all Camp Foskett programs,

(except Scamper Camp)

Bus # _______ Letter Stop _______

DEPARTURE TRANSPORTATION (✓ one)

Parent will pick up at Camp Foskett

Parent will pick up at all YMCA Day Camps

PM Extended Care @ YMCA

Program bus for all Camp Foskett programs,

(except Scamper Camp)

Bus # _______ Letter Stop _______

Last Name: First Name: DOB:

I give permission for my child to be released from the program at the end of the day as stated above and /or give permission to the following people to receive my child at the end of the day. Please note: Appropriate paper-work such as custody papers, must be attached if the custodial parent requests not to release the child to the other parent.

_________________________________

Address:

_________________________________

Address:

Any other transportation requests must be stated in writing and maintained in the child’s file, or the above plan must be implemented. This permission is valid for one year from the date of signature.

Signature Date

See Page 6 for more information on drop-off and pick-ups locations

*PLEASE PRINT

15

HEALTH INFORMATION FORM

Last Name: _____________________________________________ First Name: ______________________________________________ DOB: _________________

Emergency Contact ____________________________________________________ Ph# _______________________ Relationship: _____________________

Family Physician _________________________________________ Address: _______________________________________ Ph# __________________________

Medical Insurance Co ______________________________________ Policy# ___________________________ Subscriber ____________________________

MEDICAL HISTORY (CHECK ALL THAT APPLY)

Convulsions

Seizures

Ear Infections

Asthma

Heart Disease

ADD/ADHD

PDD

ODD

Other:

Birth Defects

Diabetes

Bi-polar

Autism/Asperger's

Depression

Anxiety

OCD

Bee/Hornet Allergy

Peanut/Tree Nut Allergy

MONTH YEAR

DPT / TD

Mumps, measles, rubella* (MMR)

Polio* (IPV)

Pneumococcal (PCV)

Hepatitis B

Hepatitis A

Varicella (chicken pox)

Meningococcal meningitis (MCV4)

IMMUNIZATION HISTORY

YES NO

Physician’s Signature

All immunizations up-to-date?

SPECIFIC MEDICAL, BEHAVIORAL OR DEVELOPMENTAL NEEDS

Dietary Modifications/Allergy Chronic/Recurring Illness

Current Medications (medication authorization may be required) Operations/Serious Injury

Physical Disability Developmental Delays

Behavioral Disorder

List any activities from which your child should be exempted for health reasons:

PARENT AUTHORIZATION: This Health History is correct so far as I know, and the person herein described has permission to engage in all prescribed activities, except as noted by me and the examining physician. In the event I cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the Director to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child as named above.

Signature ______________________________________________________________________________________ Date ______________________________________

*PLEASE PRINT

16

OPEN HOUSE:

CAMP FOSKETT - Sunday, June 3rd 189 Daniels Road in Charlton from 12noon - 4pm

TRI-COMMUNITY YMCA 43 Everett Street

Southbridge, MA 01550

www.tricommunityYMCA.org

Visit and Take A Tour of the Facilities!

DISCOVER • IMAGINE • GROW SUMMER DAY CAMPS TRI-COMMUNITY YMCA / CAMP FOSKETT

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